Transforming how we view obesity– understanding how trauma is often the underlying cause.

​

“You’re too fat.” “You need to lose weight.” “You’re going to get high blood pressure and diabetes.” Anyone with a weight problem has had these statements drilled in them to the point of frustration. Overweight people know the risk factors and in most instances, want to lose weight. Sometimes the desire to lose weight is to assuage the need of others and find a place of acceptance in a world that is overly conscious of physical looks. In the American society, it’s hard to conceive that there are overweight people who are entirely comfortable with their bodies. They often struggle with the negative messages that seek to shame them for not fitting a narrowly defined mold of beauty. Achieving optimal health is important for longevity, but the way we currently go about addressing it excludes important considerations.

As the obesity epidemic increases, scientists and medical professionals struggle to explain why. Increased consumption of sugary drinks, decreased physical activity, lack of availability of highly nutritious foods in poor neighborhoods, easy accessibility of fast foods.

“The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines in physical activity are the alleged perpetrators for the epidemic, despite a lack of solid evidence to demonstrate their causal role.”1​

These factors are certainly contributors, but lacking is a more thorough understanding and examination of trauma, chronic stress and how these contribute to the obesity problem.

Shame and Blame

In my opinion, we rather blame and shame the victim. Overweight children share with me that they feel isolated, ashamed, out of control and overall, terrible about themselves. They describe feeling desperate and sometimes resort to extreme means to lose weight. They avoid eating or restrict their eating. Each time they fail, their self-esteem takes a tumble. They don’t like visiting their health care professionals because the refrain will likely be the same—” you need to lose weight’. They know it, and they feel it, yet it seems like an impossible task.
They shrink in the presence of others because they feel different and unattractive. They avoid gym or playing outdoors, the very things that can help, because of shame.
They often turn to food because it soothes their pain. Herein lies the problem and probably the solution.

I work and live in urban environments. Many of the kids I work with are overweight. Healthcare professionals and others must engage in a paradigm shift. It’s not the food; it’s unresolved trauma and persistent stress that’s causing our society to have obesity problems.

“In 1985, Dr. Vicent Felliti was head of a weight loss program at Kaiser Permanente. He discovered that people who were overweight were not born overweight and did not gradually put it on. Rather, he learned that when they gained weight, it happened quickly and abruptly. He also discovered, quite accidently, that most people didn’t see their weight as a problem but rather a solution. This has been particularly true for sexual abuse survivors. Dr. Fellitie joined with an epidemiologist at the CDC, Dr. Anda. Together they conducted research on child abuse and other risk factors. Ultimately, they called their study–Adverse Childhood Experiences Study also known as ACES. They concluded that high ACES contributed to physical, social, and emotional problems. The higher your ACE score, the higher your risk for a disease or disorder. “ 2

Adverse Childhood Experiences
Adverse childhood experiences go beyond abuse and include incarceration of a parent, absence of a parent, poverty, unstable living environment, emotional detachment from caretakers, and so forth. As you can see, the definition of adverse childhood experiences is expansive to cover many traumatic events in the life of a child. Children and adults with a high ace level live in a constant state of fight, flight or freeze. Their responses to the world are one of fear or self-protection. They have difficulty regulating their emotional and behavioral responses to external and internal experiences. They are distrustful of others. They struggle with depression, anxiety, shame, guilt, self-blame, and anger.

The experience of a high ACE is overwhelming. Those who experienced a childhood rife with trauma, loss of control and stress don’t learn appropriate coping skills. They learn maladaptive ways of coping with stress and unpredictability. Some turn to drugs and alcohol to ‘cope.’ Others engage in other forms of coping that can become unhealthy and habitual.

How do eating and obesity and high ACE level intersect?
As stated above, Dr. Felliti discovered through his research that overweight people didn’t see weight as a problem but a solution. Let’s explore what this might mean.
For sexual and physical abuse survivors, the body often becomes a source of shame. It’s not possible to separate from the body and still live. It is possible to disconnect emotionally from the body such that the awareness of pain, fullness, satisfaction, discomfort becomes possible. It becomes ‘easier’ to consume large quantities of food with little insight. Trauma causes a numbing of feelings which make it harder to regulate eating. Conversely, food can serve as a numbing agent to avoid experiencing painful emotions.
Survivors of abuse often struggle with unrealistic body perceptions. Sometimes they literally can’t see or have a distorted idea of how they look. Some overweight people don’t have a realistic picture of how large they are. Others see themselves as being bigger than they are causing other eating problems.

For some survivors being overweight is protection. The subconscious thought is the weight will protect them from future abuse. The rational mind knows this is not true, but a mind on constant high reactive mode often struggles to maintain rational thoughts.

Many people from difficult childhoods become addicted to sugar. They consume high carbs and food heavy in sugar. They will experience physical cravings and report withdrawal like symptoms when abstaining from sugar. The research is not definitive as to whether sugar addiction is real. However, one must wonder what emotional needs are being met by the overconsumption of high carbs and sugar and how it activates the pleasure part of the brain.

Trauma pounds a person’s self-esteem into the ground.
Children have a hard time separating themselves from what is going on in their homes and around them. For example, if witness to domestic violence, they internalize it as they’re not worthy or somehow caused the violence. Young children whose personality and identity not yet developed, assume the self-esteem of their parents. If mom or dad is abusive or not treated well, the child’s self-esteem becomes a reflection of a parent’s poor behaviors. If there are no efforts to correct this incorrect perception, it carries into adulthood. Sadness, anxiety and poor self-esteem are often ‘medicated’ with food. Food becomes the balm to soothe the pain. Food is the friend that never rejects or abandons. Food can meet the need for love and comfort. However, the very thing that comforts you can also cause other complications.

What to do?
If you’re a parent reading this, you might start to question everything you know about parenting and perhaps feel a bit of guilt. Stop. Things happen in life and a lot outside of our control. To the extent that parents can shelter children from traumatic events, it’s important to do so. In the unfortunate instance when that isn’t possible, be mindful of how the trauma is affecting your child. It is even if your child doesn’t think so. Ask pointed questions— “how do you feel about dad and I divorcing?” Be sure to assure them that whatever has happened is not their fault. Also avoid discussing things with children that have no control over (finances, marital infidelity, etc.) Monitor their behavior and reactions. Isolating, irritability, mood fluctuations, change in school performance can all be signs that they are struggling. Try to avoid using food as a reward. Establishing this connection early on can set the stage for later emotional eating. Practice being mindful with your child. Take walks, color, listen to music and engage in meditative breathing together. These things will be healing for all.

Health Care professionals
Assessing for trauma with every patient/client is critical. Do not make assumptions based on race or socio-economic class. No one is immune to toxic stress or trauma. Do not assume that your patient’s weight problem is the result of laziness, inactivity or not caring. Most overweight people have an emotional attachment to food so talk to them about their eating behaviors. Avoid engaging in speech that is shaming. Be compassionate and helpful. One simple, but effective intervention is to ask your client to journal their food intake and feelings state. Journaling will not only help them to make a connection between their eating and emotions, but it will also help you as well. Adopt a holistic approach. Refer to a dietitian and exercise specialist. It would be very helpful to these professionals in your office to increase compliance. Encourage the practice of mindful meditation which can help to regulate and increase tolerance of painful feelings. Do not set weight loss as a goal, initially. Survivors of trauma need to feel a sense of control and agency over their bodies. Engaging them in adopting small changes and connection with their team of helpers will be the ultimate path to greater health and weight loss.

1 McAllister, E. J., Dhurandhar, N. V., Keith, S. W., Aronne, L. J., Barger, J., Baskin, M., … Allison, D. B. (2009). Ten putative contributors to the obesity epidemic. Critical Reviews in Food Science and Nutrition, 49(10), 868-913. DOI:

2. Acestoohigh.com