Williams Dominique R, Chaves Eileen, Karp Sharon M, Browne Nancy T
The Ohio State University College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA.
Neuropsychology & Pediatric Psychology, The Ohio State University, College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA.
Obes Pillars. 2022 Dec 18;5:100052. doi: 10.1016/j.obpill.2022.100052. eCollection 2023 Mar.
Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual.
This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology.
TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience.
Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
发生在婴儿期、儿童期和青少年期的创伤性事件可能会对一生都产生影响。童年不良经历（ACEs）与慢性健康问题和精神疾病相关，并且会对教育和就业机会产生负面影响。关于ACEs与儿童肥胖风险之间的关系，有越来越多的证据。创伤知情护理（TIC）是一种在临床和组织层面上对患者进行护理的方法，它能应对过去的创伤对个体可能产生的影响。
本临床综述将聚焦创伤产生的毒性应激对儿童的影响，这种影响是通过对正常生理机能的威胁来实现的，包括通过能量调节病理生理学表现出肥胖，随后讨论TIC原则。使用案例研究方法讨论了可用资源以及如何在实践中运用创伤知情原则。
TIC项目认识到创伤对患者和临床医生的影响。TIC的实施包括应用美国药物滥用和心理健康服务管理局指南中概述的TIC的四个假设和六个关键原则。在精心设计的系统支持下的临床医生认识到，披露并非TIC的目标；相反，广泛的创伤询问（如果有必要则进行风险和安全评估）以及与干预措施的联系才是重点。最佳实践沟通使临床医生能够获取信息，而不会因不断重复患者的创伤经历而再次伤害患者。
将肥胖治疗的支柱（即营养、体育活动、行为疗法、药物管理）与TIC的原则（认识、识别、应对、抵抗再次创伤）相结合，可为患者提供全面、有针对性的护理和家庭支持。TIC的预期结果与儿童肥胖治疗的目标一致，即改善健康和生活质量、自我意识（如身体形象和自尊）以及预防负面健康结果。
