Manlius weight-loss doctor says up to 75 percent of her female patients have abuse in their past.
Doctors and researchers have been surprised to find a link between sexual abuse and obesity in some women.Manlius, NY -- More than half of the women Dr. Wendy Scinta takes care of at her Medical Weight Loss practice in Manlius have sexual abuse in their past.
Typically they lose weight, hit a plateau and put the pounds back on. Over and over again. Until they deal with their demons.
Scinta saw this happen so often, with up to 75 percent of her female patients, that the medical history she takes of new patients now includes questions about abuse. Her treatment involves helping patients be comfortable with the attention that comes with thinner bodies. Mandatory group therapy sessions take place weekly in her office's conference room.
"If there's obesity, there's a good chance, especially if there's morbid obesity, that something tragic happened in that person's history, at one point or another," she said. Those affected are mostly women, mostly 100 or more pounds overweight, and mostly binge eaters. All races, and all social classes are equally represented, she said.
Ask why Americans are so fat, why our nation struggles with an epidemic of obesity and fuels a $50 billion weight loss industry, and the easy answer is that we exercise too little and eat too much -- but why? For some people, part of the explanation is unrecognized or unresolved sexual abuse, which has surfaced in Central New York and elsewhere as a surprising but plausible link to obesity.
Kaiser Permanente, for example, tracked more than 30,000 mostly middle-aged obese adults since 1982 and noticed those who were most successful in losing weight were also most likely to later drop out of the weight-loss program and regain the weight. "We unexpectedly discovered that histories of childhood sexual abuse were common, as were histories of growing up in markedly dysfunctional households," they wrote in The Permanente Journal this spring. Kaiser, based in Oakland, Calif., is the nation's largest nonprofit health plan.
"We slowly discovered that major weight loss is often sexually or physically threatening and that obesity, whatever its health risks, is protective emotionally," wrote the authors, including Dr. Vincent Felitti, a retired internist in San Diego who runs the Adverse Childhood Experiences Study, a collaboration between Kaiser and the Centers for Disease Control and Prevention.
Felitti said in an e-mail interview that "the relationship between childhood sexual abuse and obesity later in life is major, but, since childhood sexual abuse is a topic protected by shame and social taboo, it is concealed by time and by secrecy."
Victims don't want to be identified. But even in Central New York they are eager to share their stories. (See accompanying article.)
There's the teacher in New Woodstock who is shedding weight she began putting on after she was raped by a date 20 years ago. There's the Syracuse social worker who started gaining weight in college when a professor assigned a project that made her recall a family member who sexually abused her. And there's the business analyst from Baldwinsville, whose husband constantly called her "fat pig," who learned in therapy about the sexual abuse she endured before the age of 5.
All three are Scinta's patients who agreed to share their stories.
Scinta is not alone in noticing the obesity-abuse correlation in the Syracuse area.
Of the patients seeking gastric banding or gastric bypass surgery at Syracuse's Upstate Medical University since it began its bariatric program in 2002, "at least 20 percent of them have been victims of abuse, often sexual," said program director, Dr. Howard Simon.
"I know I have done my job if I can get someone -- who their whole life has been told they are nothing -- to look and feel like a million bucks," said Dr. Wendy Scinta (left). Scinta and behaviorist Johanna Smith Ellis (right) help obese patients, including some with histories of abuse, lose weight and learn to be comfortable with the attention that sometimes comes with thinner bodies. Plenty of sexual abuse victims are not obese, and plenty of people who are obese were not sexually abused, "but there is some overlap," said Tom Griffiths , a Syracuse psychologist who evaluates people considering weight-loss surgery. He doesn't keep statistics but said "pretty frequently there is an element of sexual abuse there. Before I started doing these (surgical evaluations) I have to admit, I did not ask about sexual abuse. I just sort of assumed that if it was an issue, somebody would bring it up."
Suzzanne Rosselot, a clinical social worker in Fayetteville who specializes in addictions said, "Yes, that is a part of some people's experience, but not all. ... I see a lot of depression, and I see a lot of women growing up in dysfunctional families.
"If you grew up with trauma -- emotional, sexual or physical -- then you're going to respond by sort of developing some survival skills," she said.
For some women, that means eating.
They may eat to become invisible, "because society doesn't pay attention to obese people," Scinta said.
They may eat to make themselves fat and unattractive, to repel abusers. Then, as they lose weight and start hearing compliments, they may eat to add pounds because the new attention makes them remember their abuse.
"People don't usually come up with that on their own," Griffiths said. "That kind of conclusion would more likely come from somebody with a lot of insight, who has been through therapy before."
Researchers studying eating disorders are trying to understand the role of brain chemicals and hormones in compulsive eating, but they already know why food is a common coping mechanism. It provides pleasure.
"Food hits some of the same pleasure centers as antidepressants. Some of the neurotransmitters, such as serotonin and dopamine, are triggered by food. They are sources of pleasure," Griffiths said.
"Soothing from oral pleasure is a very primitive response. It's basic to us, literally from birth. That response to gain nourishment, warmth, safety, security ... We get a lot of emotional soothing by taking in nourishment. That's from day one," he said.
"Now fast forward to some period of abuse, whenever that might occur, and you have somebody who experiences psychological and emotional turmoil, the likes of which most of us will, thankfully, never know. It's extreme emotional distress. And the individual finds they can soothe themselves by eating.''
Griffiths points out that plenty of people who were never abused eat for pleasure.
Having evaluated 1,500 to 2,000 patients seeking weight-loss surgery during the last 10 years, he divides people into two broad categories. There are behavioral overeaters, who learned unhealthy eating habits from parents, extended families or cultural, regional or ethnic influences that are not emotionally driven.
Victims of abuse fall into a different category of emotional overeaters.
Part of why emotional overeaters so frequently fail in sustained weight-loss attempts, including surgery, is because they do not develop coping skills to replace food.
"There is the risk, if there is someone who has used food as a coping mechanism, you're taking away their Prozac," Scinta said. That's why bariatric surgery programs and health insurers require psychological screening before surgery. Even then, some patients struggle after their operation, regaining the weight, developing addictions or depression or committing suicide.
Simon, the Upstate surgeon, knows that for all the good of weight-loss surgery -- it can extend longevity, improve or cure diabetes, and even reduce deaths from cancer -- several studies have shown a connection to suicide.
Medical providers who care for the obese are not surprised, given that depression is so frequently tangled with obesity.
"Almost everyone who is more than 100 pounds overweight has an element of depression," said Griffiths. "Sometimes it's the driving force behind the eating. Sometimes it's because they're overweight, or because they haven't been treated well because of their obesity."
Rosselot said while all addictions are complex, food addictions are especially tricky. Abstinence is not a valid strategy, since food is crucial to survival.
But, eating sensibly is only part of the problem.
Losing significant amounts of weight "is not about willpower. It's not about pushing yourself away from the table," said Johanna Smith Ellis, a behaviorist who works with Scinta.
Ellis, who has a master's degree in counseling and worked for years as a school psychologist, focuses her practice on weight issues. "I think the emotional component to being overweight is huge, and I think it is ignored a lot of the time."
That's partly because taking a proper patient history involves asking uncomfortable questions, Felitti, the San Diego internist, acknowledges in his "Obesity: Problem, Solution or Both?" report in the spring issue of The Permanente Journal. Incest, rape, family suicide and parental brutality were "surprisingly common among our patients -- but we did not know that before we began routinely inquiring about them."
Scinta said she usually eases into the discussion by asking new patients whether any family members had problems with alcohol. "Once you find out that there was an alcoholic somewhere, you always have to look into abuse and neglect, physical abuse and sexual abuse," she said.
Her patients pay for medical care that includes group or individual therapy sessions, or both.
"One of the things I always talk to them about is the fact that you have to be able to learn to be comfortable in a thin body, to be comfortable with the attention you will get from that," she said. "Unlike other diseases, like alcoholism that you can hide better, when you're losing weight, people are going to notice.
"I know I have done my job if I can get someone -- who their whole life has been told they are nothing -- to look and feel like a million bucks," Scinta said. "They do deserve all life has to offer. And that includes being healthy and being able to look like a normal, healthy human being."
The link
Theories abound for how childhood abuse relates to adult obesity. They include:
• Abused children may eat as a form of coping, a pattern that continues into adulthood.
• Increasing size by gaining weight may offer protection from physical threats.
• Weight gain may repel sexual abusers, and help adults avoid sexual advances.
• People may believe that being fat is socially protective, that society will expect less from and think less of someone who is obese.
• The emotions associated with abuse are thought to lead to higher levels of cortisol, the stress hormone, in the bloodstream. This can increase appetite.
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