Social Determinants of Health: Pediatric Obesity 2017
With Dr. Chris Bowling · StayCurrentMD
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Pediatric Obesity 9 items
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Public Policies to Address Obesity: Pediatric Obesity 2017
46 min · Published Feb 2018
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Psychology Journal Club: Pediatric Obesity 2017
27 min · Published Feb 2018
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Rapid Fire and Conclusion: Pediatric Obesity 2017
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Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder
Lurie Children's Hospital · 6 min · Published Mar 2026
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Nutrition Journal Club: Pediatric Obesity 2017
31 min · Published Feb 2018
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Welcome & Introduction: Pediatric Obesity 2017
3 min · Published Feb 2018
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What the experts said
Age-standardized mortality rates show clustering of respiratory disease deaths in eastern Kentucky and southern West Virginia coal-mining areas.
Cardiovascular disease mortality is very high in the Mississippi Delta region (Arkansas, Tennessee, Mississippi, Louisiana border) and in Appalachia.
Eastern Kentucky and southern West Virginia are the epicenter of the current heroin outbreak, with staggering rates.
The heroin epidemic in the Ohio River Valley resulted from a distribution network encountering a population primed by the prescription drug epidemic.
Cancer mortality rates are very high in the Mississippi Delta and Appalachia, possibly tied to chronic respiratory illness.
Areas with high mortality from multiple diseases (respiratory, cardiovascular, cancer, infections) have a distribution similar to areas affected by pediatric obesity.
Common infections (pneumonia, diarrhea) show geographic clustering tied to socioeconomic status, similar to obesity and oral health.
The ACEs (adverse childhood experiences) study was developed in 1997 by Felitti and Anda in San Diego, starting as a dropout study from an obesity treatment program.
Patients succeeding in the obesity program were dropping out at rates equal to those struggling, prompting investigation into other life factors.
The ten adverse childhood experiences (ACEs) are: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, mother treated violently, household substance abuse, household mental illness, parental separation/divorce, and incarcerated household member.
In families with ACEs, there are increases in smoking, substance abuse, obesity, diabetes, heart disease, stroke, and cancer.
Even when controlling for behavioral factors (obesity, smoking, substance abuse), children exposed to ACEs still had higher rates of diabetes, heart disease, stroke, and cancer.
Children exposed to ACEs had shortened life expectancy even when controlling for behavioral risk factors.
In the ACEs study population, 67% of families reported at least one ACE, 40% had two or more, and 12.5% (1 in 8) had four or more.
The effects of multiple ACEs are more than additive—they are almost multiplicative, with profound health impacts as the number of ACEs increases.
Chronic activation of the fight-or-flight response—persistent elevation of epinephrine, cortisol, norepinephrine—has real physiologic consequences over a lifetime.
Toxic stress causes neuronal desensitization and altered neuronal response.
Toxic stress affects the hypothalamic-pituitary-adrenal axis and other parts of the endocrine system.
Overstimulation by norepinephrine, epinephrine, and cortisol may affect leptin resistance and insulin resistance in children with obesity.
Toxic stress decreases the ability to fight off infection and changes immune modulation.
Living in a stressful situation changes gene expression through epigenetic mechanisms—methylation and histone modification—that can result in adverse health outcomes.
Epigenetic changes from toxic stress have profound impacts on development, aging, mental health, diabetes, and cancer.
Social determinants of health can be used as proxy questions to screen for adverse childhood experiences and categorize families by risk.
Barriers to ACEs screening in pediatric practice include provider concerns about parent pushback, time constraints, lack of resources to address identified problems, and poor reimbursement.
Bowling's practice partners with Beech Acres Parenting Center, which provides an in-office parenting specialist to counsel families, connect them with resources, and teach behavioral techniques.
The SEEK (Safe Environment for Every Kid) screening tool from the University of Maryland is used at 1-month, 9-month, 2-year, and 3-year well-child visits in Bowling's practice.
Food insecurity is directly connected to adverse childhood experiences and is one of the more commonly answered questions on the SEEK questionnaire.
Unstable or variable housing impacts the ability to maintain healthy food environments and to maintain contact with families in obesity care.
The original ACEs study population was 70% white, 70% college-educated, and 100% insured, demonstrating that ACEs are not limited to low-income populations.
In Bowling's suburban practice, 10–15% of the population screens positive for adverse childhood experiences on the SEEK tool at a single point in time.
Nadine Burke Harris is a developmental specialist at UCLA who gave a 16-minute TEDMed talk on toxic stress and ACEs.
In one clinic, 25% of families screened positive for food insecurity, making it difficult to discuss weight management when families cannot put food on the table.
Primary care providers in Maine feel supported in asking ACEs screening questions and have connected with behavioral health colleagues for referrals.
Motivational interviewing skills are useful for asking ACEs screening questions in a non-threatening way and getting to the root of family issues.
Most families accept ACEs screening questions without resistance or pushback once the rationale is explained by the nurse.