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A comprehensive view of the problem and the potential solutions. As a developmental psychologist I would add to this comprehensive approach a life stage perspective. It needs to be tailored at each age from childhood to geriatric. We do know food preferences, eating styles, activity levels and exercise habits are established early in childhood, and we should start in infancy if we are serious about prevention. Comprensive intervention needs to match each stage of life.

Beyond the health care systems, we need to look at food supply, transportation and access to recreation. Health in all policies is needed. Every time a road is built, specific crops are subsidized, or school lunches approved we have to think about long term health. Last, let us look at the national with lowest rates of obesity - in western europe its usuallly France, and see what we can learn.

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One other variable, often not considered is adverse child experiences (ACES), traumatic events in childhood. Most people do not realize that Dr. Felitti, who developed these questionnaires is an internal medicine physician with Kaiser who had a specialized practice for morbidly obese patients. In doing a comprehensive history, he would ask about first sexual experience and noted that a large number of morbidly obese patients reported sexual abuse in early childhood. That is where the ACES work started - with obese patients. Early trauma impacts both behavior and physiology.

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Fantastic piece and a point well made - thank you for sharing!

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