Unspoken: The Childhood Sexual Abuse – Obesity Connection

November 14th, 2011 by MorganDowney Leave a reply »

For the past week, shocking news has come out of Penn State University of alleged child sexual abuse by a former football defensive coach, Jerry Sandusky. The scandal has taken down the university’s president and its famed head coach, Joe Paterno. The school’s credit rating has been downgraded;  federal and state agencies are investigating.

Most of us react to such news with a sickening feeling of the psychological trauma the victims of such abuse, in this case including a 10 year old boy, must endure. Less well researched is the connection between child sexual abuse and adult diseases including mortality.

In 1998, Felitti et al. published a paper on the relationship of childhood abuse and household dysfunction to the leading causes of death in adults. Their study included children who were exposed to psychological, physical or sexual abuse, violence against the mother, living with household members who were substance abusers, mentally ill or suicidal or ever imprisoned. They founded a graded relationship between the number of categories of childhood exposure and adult health risk behaviors. Persons who had experienced four or more categories of exposure, compared to none, had a 4-fold to 12-fold increase in health risks for alcoholism, drug abuse, depression and suicide attempt; a 2-4 fold increase in smoking, poor self-reported health, over 50 sexual partners and sexually transmitted disease; and a 1.4 to 1.6 fold increase in physical inactivity and severe (over BMI of 35) obesity. They found, “The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.” Relationship of childhood abuse and household … [Am J Prev Med. 1998] – PubMed – NCBI

The author, Dr. Vicent J. Felitti, was with the Southern California (Kaiser) Permante Medical Group. In 2010, he and colleagues authored another paper on medical group’s Positive Choice Weight Loss Program. The program was achieving remarkable success with a combination of absolute fasting and a group program to explore the basis of each participant’s unconscious use of food and to explore the hidden benefits of obesity for the individual. Yes, the benefits of obesity.

The group found that their ability to quickly bring about significant weight loss was frustrated by the high dropout rate of persons who were successful or who sabotaged their own efforts. They took detailed life histories of 286 patients. Writes Dr. Felitti, “Here, we unexpectedly discovered that histories of childhood sexual abuse were common, as were histories of growing up in markedly dysfunctional households. It became evident that traumatic life experiences during childhood and adolescence were far more common in an obese population that was comfortably recognized. We slowly discovered that major weight loss is often sexually or physically threatening and that obesity, whatever its health risks, is protective emotionally…The antecedent life experiences of the obese are quite different from those of the always-slender. “ A bit later, he notes, “By the mid-1980s, we had learned that our initial goal of teaching people to “eat right” was totally irrelevant to obesity, although it seemed a reasonable thing to do when we did not know what to do.” The group found that for many participants, obesity is beneficially protective: sexually, physically and socially. A woman who had rapid weight gain was raped at age 23 and subsequently gained 105 lbs. She said, “Overweight is overlooked, and that’s the way I need to be.” Finally, the program found two major predictors of weight regain: a history of childhood sexual abuse and currently being married to an alcoholic (generalizable to having a significantly dysfunctional marriage).  Obesity: Problem, Solution, or Both? 

A recent review of the published literature on interpersonal violence and obesity seems to bear out Dr. Felitti’s research. Reviewing 36 separate studies, A.J. Midei and K.A. Matthews found 81% of the studies reported a significant positive association between some type of childhood interpersonal violence and obesity, although 83% of the studies were cross-sectional. Associations were consistent for caregiver physical and sexual abuse and peer bullying. Mechanisms were not clearly identified although anger, stress, depression, sadness and loneliness were cited. Interpersonal violence in childhood as a risk facto… [Obes Rev. 2011] – PubMed – NCBI 

Perhaps, then, it should not be a surprise to find a high prevalence of patients with histories of childhood sexual abuse seeking bariatric surgery. Sexual abuse survivors and psychiatric hospitaliza… [Obes Surg. 2007] – PubMed – NCBI and childhood sexual abuse +bariatric surgery – PubMed – NCBI and Childhood maltreatment in extremely obese male and … [Obes Res. 2005] – PubMed – NCBI.

The point is that we, as a society, are just beginning to understand the devastation childhood sexual abuse can cause on the human psychological and physiological systems. We also need to realize that the person with obesity, so often scorned, isolated and penalized, may well be the adult survivor of unspeakable childhood trauma.