In today's society there is a tremendous amount of discussion about childhood obesity and the need to regulate the foods consumed by children. Schools are being directed to not have vending machines that dispense high calorie fatty foods. Government is considering enacting regulatory control over fast food and setting standards of calorie density. Some of this may be in fact be useful, but likely not as useful as people might hope. What if the problem of obesity in childhood and adults has at it root other things besides the intake of food. Is the remedial action occurring at the right point in society? What else might be happening that leads to childhood obesity?
A young man in early twenties was sitting quite uncomfortably in the waiting room; he was alive with fidgets and visible signs of distress, clearly anxious and feeling uncertain. For the purposes of this article we will call him Bill. Bill had made the appointment to talk about the possibility exploring what counseling might be able to do in supporting him with the depression and frustration he was experiencing.
Bill stood approximately 5"10", and weighed about 380 pounds. In later discussion he mentioned a 50 inch waist and how his weight was a barrier to his successfully finding a job. Bill had recently graduated from a state college with a 4.0 grade point average, been on thirty or so interviews without being tendered a job offer. He was feeling very depressed and quite frustrated.
This young man told of several experiences that we very unpleasant as he sought work one in particular were an interviewer that had been particularly judgmental and a little demeaning to this young man. Bill recounted that he had been interviewed for a job for which he was well qualified, and how the interviewer blatantly suggested that anyone his size wouldn't be competent to of managing a complex caseload. Apparently the interviewer alluded that Bill just wasn't ambitious, self-directed or able to exercise adequate self control to perform the require job duties. That Bill showed a glaring lack of "stick-to-it-ness" evidenced by his size and girth.
Bill left that interview angry, hurt and embarrassed! Feeling depressed he consulted his family doctor for some options, and was referred for counseling. In the first meeting a family history of chaotic and difficult family dynamics became apparent. Bill's mom was a little overweight but not morbidly obese, however his three sisters all had struggled with eating disorders. Bill's biological father was also overweight, but again not morbidly so as was Bill. "Why am I so fat?" A frequent query Bill repeatedly asked as his story unfolded. The brief summary of his story was terribly difficult for him to detail, he had been the victim of sexual abuse by one of his mother's "friends" which were occasional live in boyfriends, though non stated more than a couple of years. Mom had been married and divorced three times before Bill was out of middle school, and there were intermittent "friends" between those marriages.
Additionally, bill had been physically abused, and the family had on three different occasions before Bill graduated from high school been involved with child protective services. They made frequent moves and location changes; he could recall nine or so apartments before high school. He began to gain weight rapidly in high school and it created a great deal of ridicule from others and negative feelings about self. His only escape was academics and he was able to secure a scholarship and attend college. He discussed the how food seemed to be the only real constant in his life and that was a poison that was slowly killing him and making him unhappy.
Through the next couple of sessions, a great deal of information was shared with Bill about the nature of family dynamics and the impact of secure attachments or the lack thereof on an individual. Some of the information shared helped Bill develop a different idea about eating and obesity in general.
The basics of what was shared with Bill was research findings that show that males that are victims of sexual abuse as children, are at greater risk of developing eating patterns that create obesity. The frequency and duration of the sexual abuse may increase the risk manifold for dysregulated eating behavior and account for a good portion of morbid obesity in young males. Females apparently react differently to sexual abuse as children, moving in the direction of food restriction and it is likely a foundational element in many eating disorders.
Other studies were reviewed that indicated that parental depression and the quality of attachment between caregiver/child can be a precursor of child obesity as well. This was especially powerful for Bill, in that he strongly believed his mother had been depressed most of her life. She had tried committing suicide on three different occasions, all resulting in the children being collected by Child Protective Services and temporarily placed in foster care.
Additionally, in discussions between Bill and his sisters they collectively felt that their mother had always looked at them as burden and could not remember a time when she ever seemed pleased to have them around, unless it was to serve her in some manner. Several articles were summaries of the Aversive Childhood Experience Studies, hereafter referred to as ACE. The Ace study looked at factors that create health risks in individuals that have experienced them; one of these health risks is obesity. The following are the elements of the ACE study that increase the risk:
Physical abuse by parent or caregiverSexual abuse or exploitationPhysical neglect or abandonmentUnstable living environmentEmotional neglect (deprivation of empathy, nurturance, protection, and directionWere Substances abused in the home (with or without addiction)Was there mental illness (even mild)Separation and divorceDomestic violence (includes family screaming, yelling, the use of intimidation, threats of harm which may NOT include physical contactParent or caregiver absent, or incarceratedFrom Bill's story of his childhood it is clearly evident that he was the beneficiary of at least half of these ACE elements. Statistically what the ACE studies have discovered is that approximately 90% of the people that come into counseling have had at least four of the elements active in their early developmental life.Some of the research shared with Bill, was also about brain function and physiology, particularly around food choices and eating patterns, the information coupled with a better understanding of himself set the stage for Bill to successfully reduce his weight 100 pounds in the next 8 months.
Some of those reading this article may be thinking of this as a weight loss story, which is true, but more importantly is the idea that family dynamics and the quality of the home environment greatly impact the emergence and maintenance of obesity in the lives of people. Maybe the more impactful way to deal with the national child obesity plague is not regulating food choice and calorie density, but greater focus on mediating and addressing the effects of dysregulated families that are creating environments that promote a variety of health risks. Bill's story is not unique, there are many suffering because they are being or were raised in homes where the environment provokes a constant state of distress and frequently overwhelms the child's ability to adapt.
Dr. Robert Rhoton PsyD is a full time faculty member in Behavioral Sciences at Ottawa University whose Research Interest are Traumagenic family dynamics; Child & family Trauma; Clinical use of process language; Non-Egoic models of treatment. If you wish more information or to contact this author please feel free to do so at bob.rhoton@ottawa.edu or 602.371.1188
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