Obesity, sex abuse linked
Expert: Weight gain is smoke, ‘adverse childhood experience’ the fire
I recently wrote a Facebook post asking about sexual abuse and the link to obesity. I thought I might get a few messages but was surprised when more than 150 people — including a few men — shared their stories.
“I was sexually abused by a baby sitter at age 5, and by my cousin from ages 8 to 13,” said Sarah Fitzsimons, 38, from Colorado. “I always felt like my parents didn’t do anything to protect me.”
Fitzsimons said the focus in her family was the way she looked. She recalls being referred to as “the thin, pretty one” out of five siblings. After the abuse started, she used food as a coping mechanism, she said. “It’s what comforts me. It was the one thing I could control.”
Now about 80 pounds overweight, she said “being fat feels safer, but it doesn’t feel great.” Fitzsimons said she’s interested in weight loss but that she feels her size prevents unwanted sexual attention. This is not to say that body fat prevents sexual assault; it doesn’t. But she said she has found there is less lewd commentary from men about the way she looks when she is carrying extra pounds.
In the early 1980s, Dr. Vincent Felitti uncovered the connection between adverse childhood experiences and a host of negative physical and mental health outcomes, obesity included.
“We stumbled into this by accident,” Felitti said. He was running a major obesity program. He told me about a woman who weighed 408 pounds. Through a fasting protocol, they helped her get down to 132 pounds. “She stayed there for several weeks, then suddenly regained 37 pounds in only three weeks,” he said.
The woman had a history of sleepwalking as a child. During the weight regain, she would go to bed with a clean kitchen and wake up to a messy one. She was sleep eating. Felitti endeavored to get to the bottom of it.
He learned her grandfather raped her repeatedly between the ages of 11 and 20, then she put on weight. After Felitti helped her lose weight, an older, married man at work began making inappropriate, highly suggestive remarks regarding her new shape. The unwanted sexual attention triggered the regain, he said.
Felitti began interviewing patients about adverse childhood experiences and found a significant connection to obesity. He presented his findings to the Centers for Disease Control and Prevention, which, after some reluctance, he said, became involved in studying the connection in depth.
Ten events were analyzed, including sexual abuse, intense emotional abuse, intense physical abuse, major emotional neglect, being raised by an alcoholic or drug abuser, and growing up in a home where a mother was physically abused. Over 17,000 people were surveyed and followed for 20 years.
“The relationship to obesity is very powerful,” Felitti said, referring to it as a public health paradox, because, “for these people, there are benefits to obesity: It is sexually protective, physically protective and socially protective.”
When people gain weight due to adverse childhood experiences, it’s even more of a struggle to lose pounds.
“I started to eat my feelings,” said Nicole Didier, 34, of Kansas, who has been struggling with her weight for 30 years. “It was my aunt’s husband. It started when I was 4. I felt like it was wrong, but he said they’d be mad at me if I told.”
Add to this an abusive, alcoholic stepfather who used domineering methods to control her food intake, and by third grade, Nicole was gaining weight.
Didier said food was a source of comfort during a difficult time. “Feeling unattractive because of my weight was protective. I was 470 (pounds) and suffering health consequences,” she said. “I’ve lost 70 pounds since March, but it’s such a tough road.”
Obesity isn’t the only connection to adverse childhood experiences. Addiction, suicide, heart disease and a host of autoimmune disorders also can be related.
Phoebe Adams, 44, of Arizona, said she wanted to kill her abuser, if only to protect her little sister. She said most of the sexual abuse was committed by her stepfather. It started when she was 5 and continued until she was 16.
She started puberty at 10. A recent longitudinal study of 173 girls published in the Journal of Adolescent Research shows childhood sexual abuse can trigger early puberty. That’s when she began to gain weight.
“My stepfather would call me fat and ugly and (say) no one would ever want me,” she said. “He said I was lucky for the attention he gave me.”
Once a week, he would come to her room, even picking the lock on her door to gain entrance. Her mother walked in on the abuse when Adams was 16. “She flew into a rage and kicked him out that night,” Adams said.
Adams sought comfort in eating. “He kept telling me how fat, ugly and worthless I was. It caused more and more comfort eating,” she said. “The fat was a protective layer.”
At 5 feet 1 inch, Adams weighs 210 pounds. “I have a hard time with portion control and stopping when I’m full,” she said. “My brain is conditioned over the years to override signals of fullness.”
Felitti summarized his findings in a 2010 article published in Permanente Journal: “What we have counterintuitively learned from that experience is that obesity, though an obvious physical sign and easily measured, is not the core problem to be treated, any more than smoke is the core problem to be treated in house fires.”
Telling people to simply “eat less, move more” to lose weight is a gross oversimplification. Obesity is a multifactor condition in which a variety of adverse childhood experiences, including sexual abuse, may not only trigger weight gain, but make it much more challenging to lose.