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DIABETES AND
OBESITY

Addressing Food & Mood

FOR IMPROVED OUTCOMES IN OBESITY

AND DIABETIC CONTROL

By Edward Dick, MD

W hile the management of type 2 diabetes and obesity diseases including obesity and metabolic disorders. The science

and treatment of ACES continues to evolve. Appropriate treat-
remain challenging, recent years have seen unprece-
dented availability of new medications and techno-
logical advances promising to enhance their control. despite the ment of ACES requires a team with training in trauma informed
care and a system of screening and referral to receive that care.
increase in availability of diabetes drugs and tech, effecting be- To learn more about ACES start with the websites acesconnec-
havioral change continues to vex clinicians seeking to encourage tion.com and the National Pediatric Practice Community websites.
healthy eating, active living, and adherence with therapeutic plans. bexar County has an emerging trauma informed community called
Motivational interviewing offers a framework for discussing goals the South Texas Trauma Informed Care Consortium (STTICC)
a patient may wish to achieve but clinicians may still be at a loss which will increasingly serve as a community wide resource in ad-
as to why patients seem so reluctant or unable to start new habits dressing the origins and treatment of ACES.
that would promote their health or stop practices that result in
health detriments. Psychosocial Factors in Diabetes Management
Successful management of obesity and diabetes requires atten-
Adverse Childhood Experiences (ACES) tion to complex psychosocial factors that may be present together

Evolving research suggests additional areas that may affect the but not fully identified by traditional screening tools such as the
development, progress, and control of diabetes and obesity, in- PHQ9. This complexity of factors is one reason the American di-
cluding behavioral factors and social stress. One emerging area of abetes Association (AdA) Standards of Care includes psychoso-
behavioral stress is the role of Adverse Childhood Experiences cial support as a standard element of care. Psychosocial support
(ACES). ACES first emerged as a major factor in obesity and must address distinct but sometimes interrelated factors such as
metabolic control in work done by Anda and Felitti. Anda and col- diabetic distress, the language that providers use with patients,
leagues have published data linking ACES to a variety of chronic toxic psychosocial trauma, and a spectrum of anxiety and depres-

22 San Antonio Medicine • December 2018