The Connection Between Trauma and Body Image

What research has uncovered about this relationship—and why its changing.
Published March 20, 2018

Experts discovered the connection between abuse and weight almost by accident. More than 30 years ago, doctors at California’s Kaiser Permanente were researching a new obesity treatment, a low-calorie diet that had study participants dropping vast amounts of weight. The study looked at 286 people with BMIs of 30 or greater who were in weight treatment programs, and the researchers thought they’d found gold—except for one thing: Patients bolted, with 50 percent dropping out of the study and regaining the weight, sometimes with unusual speed. After losing close to 300 pounds, for example, one woman regained 37 pounds in just three weeks.

Baffled, researchers tracked down the fleeing patients to ask why. With frightening regularity, the doctors were told about childhood abuse, and how losing the weight somehow reopened the wounds. “They saw their weight as somehow protecting them,” says Mason Turner, MD, director of Outpatient Mental Health and Addiction Medicine for Northern California Kaiser Permanente (who didn’t work on this research). “They didn’t want to be hurt again.” The researchers found that 50 percent of participants had been sexually abused—a rate 50 percent higher than the rate typically reported by women and three times higher than usually reported by men.

The insights from this small study inspired the development of the much larger, groundbreaking Adverse Childhood Experiences Study, also known as ACEs. A collaboration between Kaiser Permanente and the US Centers for Disease Control and Prevention based on findings from more than 17,000 patients, the short questionnaire looks at the impact of abuse (physical, emotional, and sexual), neglect, and challenges experienced during childhood. The higher a person’s score, the greater his or her risk of obesity. Subsequent studies have found that obesity is just the beginning: A high ACEs score has also been linked to elevated risks for addiction, alcoholism, depression, anxiety, and heart disease in findings that have been replicated around the world.

The Power of the Past

Brain researchers are getting closer to figuring out how past hurts like these wield such insidious power. “Traumatic experiences, particularly in childhood, really set the brain on a different course,” says Ryan Herringa, MD, PhD, a trauma researcher at the University of Wisconsin- Madison School of Medicine and Public Health. Typically, he says, as you grow up, the amygdala, the small section of the most primitive part of the brain where threat is processed, gets less reactive. The prefrontal cortex, associated with rational thinking, gets stronger and is better able to control the amygdala and threat responses. In trauma victims, and especially in children, “That gets derailed, so the amygdala gets more reactive as you age instead of less,” Dr. Herringa explains.

The brain, of course, is just doing its job. “When people are in danger, constant fear helps keep them safe. But that comes at tremendous cost,” he says. Fear creates elevated levels of stress hormones, and, according to Dr. Herringa, these are believed to permanently alter brain chemistry and can have negative effects on the immune system, body metabolism, and weight.

That means the brains of millions may have been hijacked by fear: Some 60 percent of the US population suffers some form of physical, emotional, or sexual abuse as children, according to ACEs data, and at least 21 percent of that group endures sexual abuse. Adults are vulnerable, too, with surveys showing that most American women—54 percent, according to a recent ABC News–Washington Post poll—have been sexually harassed, experiencing “unwanted and inappropriate sexual advances.” Abuse hurts at any age. But when people who were traumatized as kids become victims again in adulthood, the results can be especially devastating.

A Survivor's Movement

That’s why mental health experts are so thrilled at how #MeToo has ricocheted around the globe, finally tilting the scales in favor of survivors, not bullies and perpetrators. Every day, as more people expose abuse and harassment, others are emboldened to finally speak their truth, often after years of silence.

What gained traction as a Hollywood and media problem is shining a bright light in many areas, elevating awareness and stepped-up action. It’s already rocking the military, for instance, where as many as one in three service members are sexually assaulted. Nurses, with about 19 percent saying they’ve been the victim of harassment, are speaking out, too. Hotel housekeepers, continually targeted by offenders and often fearful of reporting because of their immigration status, are increasingly carrying panic buttons to help them stay safer.

It’s crossing global boundaries, too: In China, people are evading censorship by using the #RiceBunny hashtag. (There, those two words are pronounced “me too.”) And it’s sparking conversations in countries with higher assault rates, including India and some Muslim-majority countries.

Nor does it show any sign of slowing. Early fears that overzealous #MeToo-ing might devolve into a witch hunt, or that false accusations (and there have been some) might undermine the movement’s overall validity, don’t seem to be panning out. In fact, as demonstrated by the widespread use of hashtags like #IBelieveYou and #TimesUpNow, people are expecting human resource departments and law enforcement to help victims with the burden of proof, not automatically defend abusers.

The Road to Recovery

Does that mean it’s all good? No. Experts fear a different backlash, one in which people who have been abused will feel themselves pushed toward some kind of heroism. “People shouldn’t feel pressured to publicly tell their stories of trauma on social media or that they must confront the offenders,” says Claire Burke Draucker, PhD, an Indiana University mental health researcher who has been working with sexual-assault victims for decades. “Any of those things can be very healing. But they are also risky. Many people think, for example, that the offender will offer an apology, and when that doesn’t happen, it can retraumatize people.”

She says research has shown that three things can be important for healing: Telling your story to someone, learning not to blame yourself, and realizing the importance of self-care.

So if you’re a victim, no, you don’t have to go public. You don’t have to try to lose weight. But we hope you make a beginning, and start to heal.