Abused as a child, obese as an adult?

There is a connection between psychological and physical experiences of violence as a child and adiposity in adulthood.

If children experience sexual or physical violence at an early age they are more likely to develop obesity in adulthood. An explaination could be their health behavior and their mental status which ultimately affects their eating behavior. Abused children eat out of misery or frustration in order to develop a "thicker skin". What sounds plausible is in fact more complex than you would guess initially. "The connections between sexual and physical violence in childhood and adiposity in adulthood are multifactorial events that include psychosocial as well as biological influential factors," explains erklärt Prof. Anette Kersting.** She is an IFB expert for psychosomatic medicine and psychotherapy.

Prof. Kersting, what is already known about the connection between abuse in childhood and adiposity in adulthood as multifactorial events? What exactly does that mean?

The connections between violence as well as abuse experiences and other traumatic experiences in childhood and adiposity in adulthood have long been known.* But we know significanly less about the mechanisms that underlie those connections. Especially the combination of negative affects such as feelings of anger, threat or depression and an eating behavior without restraint, and few physical exercise seem to be of importance.

Terms such as misery gut and comfort eating are already indicating that negative feelings are often compensated by excessive eating.

An eating behavior without restraint often serves as coping strategies and self-calming. People generally react to stressors that are hard to control such as parental violence and abuse experiences with rather emotionally focused coping strategies. That means that the child tries to reduce wearing feelings for example by eating excessively. Often high-calorie food intake are accompanied by the activation of the reward system in the brain. Physical inactivity that might be connected with depression is another risk factor for the development of adiposity. Stress, food and the connected food intake often leads to repeated diets which in turn paradoxically contribute to the development of adiposity. This mechanism is better known as yo-yo dieting. After the diet the body needs less energy than bevor, the basic metabolic rate sinks. A study that was published in 2011 in the New England Journal of Medicine by Sumthran et al. showed that even one year after a low-calorie diet over ten weeks with an average weight loss of 13.5 kg the hormones that increase appetite and weight gain were pathologically modified.

Beyond that there is another pathopsychological connection: In how far is obesity to be interpreted as a protection measure?

Being thin is the western ideal of female and also sexual attractiveness. People who have suffered sexual abuse can thus experience their adipose bodies as a protection from sexual approaches of potential sexual partners. Adiposity can thus also have an adaptive function in the sense of a self-protection mechanism for people with abuse experiences.

American scientists also view metabolic and hormonal changes after child abuse as responsible for the development of adiposity. Do you also see this connection and how can it be explained?

When we are exposed to stress the hormon cortisol is built and released. This can lead to an increased insulin concentration in the blood which in turn leads to an increased appetite. Positive neurobiological feedback mechanisms, the above-mentioned activation of the reward system in the brain, in connection with the intake of special food that is often rich in carbs and fat lead to a reduction of the feelings of stress and can thus further promote unhealthy eating habits. This closes a circle that is hard to break.

* Vamosi et al.,The relation between an adverse psychological and social environment in childhood and the development of adult obesity: a systematic literature review, Obesity Reviews March 2009, Vol. 11, issue 3

** Prof. Dr. Anette Kersting ist Direktorin der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie am Universitätsklinikum Leipzig. Für das IFB forscht sie im Bereich Esstörungen (Essanfallsstörung oder Binge-Eating-Disorder) und zu den psychologischen Auswirkungen bei Patienten nach Adipositas-Operationen.

Interview by Carmen Brückner

Keywords: Psyche