Columbia University School of Social Work, New York, USA.
Department of Medicine, Tri-Service General Hospital, School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
Obes Res Clin Pract. 2021 Mar-Apr;15(2):101-105. doi: 10.1016/j.orcp.2020.12.010. Epub 2021 Jan 29.
Obesity has been steadily rising in the last few decades and to some extent, have been linked to exposure of adverse childhood experiences (ACEs). ACEs are intense stressors or traumatic events experienced or witnessed by children, ranging from all types of abuse (physical, emotional, and sexual), neglect, substance abuse or community violence. These traumatic events deprive the sense of safety and stability of a child, leaving psychological and physiological effects that span into adulthood. The prevalence of ACEs is common across developed and developing countries alike, though the rates differ across ethnicities. Using the United States as an example, the prevalence of ACEs experienced by communities of color is higher than white children. Children around the world could all be exposed to ACEs, hence the original questionnaire capturing the score of ACE has been adapted to different cultural situations. The mechanism linking ACEs to obesity during adulthood include biological, psychological, and environmental factors. Nevertheless, a higher ACE score heightens the risk of poor mental health, attempted suicide and development of obesity and diabetes in adulthood. Prevention of ACEs starts from building positive relationships within families, developing healthy relationship skills, and screening of ACEs during early and routine pediatrician's and primary care visits. Intervention needs to include case management services and psychosocial support programs. When these risk factors are intervened early, it lessens the risk of obesity and diabetes in adulthood.
在过去几十年中，肥胖症一直在稳步上升，在某种程度上与儿童时期经历的不良经历（ACE）有关。ACE 是儿童经历或目睹的强烈压力源或创伤性事件，包括各种虐待（身体，情感和性虐待），忽视，药物滥用或社区暴力。这些创伤性事件剥夺了儿童的安全感和稳定性，对其造成心理和生理上的影响，一直持续到成年。ACE 在发达国家和发展中国家都很普遍，尽管种族之间的发病率有所不同。以美国为例，有色人种社区经历 ACE 的比例高于白人儿童。世界各地的儿童都可能接触 ACE，因此，最初用于捕捉 ACE 分数的问卷已被改编为适用于不同文化情况。将 ACE 与成年肥胖联系起来的机制包括生物学，心理和环境因素。尽管如此，较高的 ACE 评分会增加成年后患心理健康不佳，自杀企图以及肥胖和糖尿病的风险。预防 ACE 从家庭内部建立积极关系，发展健康的人际关系技能以及在早期和常规儿科医生及初级保健就诊时筛查 ACE 开始。干预措施需要包括病例管理服务和社会心理支持计划。如果及早干预这些危险因素，则可以降低成年后患肥胖症和糖尿病的风险。
