Some women aren’t overweight because they have an appetite for big portions. It’s not because they loathe the treadmill, or because they have a thyroid problem, or because they’re too lazy or too busy to plan out a sensible meal or fit in a workout.

Instead, they wear their excess weight as a shield.

How-to Tips Can Miss the Mark

Most of the tips that you’ll find in magazines, websites and books focus on the how of losing weight: How to lose 20 pounds by changing your diet; how to build muscle without bulking up; how to squeeze in a workout when you’re busy; how to learn to love lunges. It’s assumed that people don’t have the tools, the knowledge, the willpower or the motivation to lose weight.

It isn’t that this advice is useless; it’s that this kind of advice misses the point of why. Weight loss, done the healthy way, leads to physical well-being, but it may not do much if there’s trauma brewing inside.

The Why

Why a shield? For individuals who’ve experienced a traumatic event, usually some kind of abuse, their weight helps them create a barrier to the outside.

For some, weight serves to minimize their looks and sexuality. In today’s society, thin is in, and if you don’t fit the mold, in theory, people will pay less attention to you and your body. Some women use their weight as protection against future abuse. According to the Survivors of Incest Anonymous:

If for instance we perceive obesity to be unattractive, and if we believe or were told that we were abused because we were attractive, we may overeat in a misguided yet totally understandable attempt to defend ourselves from further sexual assault.

Michael D. Myers, M.D., an obesity and eating disorder specialist, estimates that 40 percent of his significantly obese patients have experienced sexual abuse. On his website, he writes: “In a sense, obesity protects a person from their sexuality since, in Western culture, obesity is frowned upon.”

On sexual abuse and eating, Mary Anne Cohen, CSW, the director of The New York Center for Eating Disorders, writes:

What is the connection between sexual abuse and developing an eating disorder? The answer is guilt, shame, anesthesia, self-punishment, soothing, comfort, protection and rage. Sexual abuse can have many different effects on the eating habits and body image of survivors. Sexual abuse violates the boundaries of the self so dramatically that inner sensations of hunger, fatigue, or sexuality become difficult to identify. People who have been sexually abused may turn to food to relieve a wide range of different states of tension that have nothing to do with hunger. It is their confusion and uncertainty about their inner perceptions that leads them to focus on the food. Many survivors of sexual abuse often work to become very fat or very thin in an attempt to render themselves unattractive. In this way, they try to de-sexualize themselves. Other survivors obsessively diet, starve, or purge to make their bodies ‘perfect.’ A perfect body is their attempt to feel more powerful, invulnerable, and in control, so as not to re-experience the powerlessness they felt as children. Indeed, some large men and women, who are survivors of sexual abuse, are afraid to lose weight because it will render them feeling smaller and childlike. This, in turn, may bring back painful memories that are difficult to cope with. A patient described how she gained 30 pounds at the age of 8. Her mother accused her of eating too many raviolis at the school cafeteria. She was scared to tell her mother that her uncle was sexually molesting her. Another patient had been abused by her alcoholic father starting at age 7. As a teenager, she binged and made herself throw up before going out with her boyfriend because she felt dirty, anxious, and guilty about her sexual feelings.

Emotional Eating

For some, weight is a consequence of emotional eating. Emotions may become too high-risk. They’ve been through so much already that they’d rather avoid any more hurt. They’d rather push down the depression, anxiety, anger, confusion or pain. They may use food to numb their feelings or soothe their discomfort. Perhaps it started out as a once-in-awhile comforting treat and mushroomed into a full-fledged habit: Heading for the fridge or pantry becomes an automatic reaction to upset and anxiety.

Some Research

Research has yet to show a causal relationship between childhood abuse and adult obesity, but studies have found a link. A 2007 prospective study published in the journal Pediatrics found that sexually abused girls were more likely to be obese than girls who weren’t abused. By 24 years old, the girls who were abused were twice as likely to be obese than girls who weren’t. The authors said, “These results provide some of the first prospective evidence that childhood sexual abuse may place female individuals at inordinately high risk for developing and maintaining obesity,” though one of the researchers noted that there’s no “one-to-one relationship” between the two.

Research has found a link between obesity and physical and sexual child abuse in middle-aged women. Even when taking other variables into account — including education, stress, age and physical inactivity — a large California study of 11,115 women ages 18 and older also found a connection between child abuse and obesity. In another study, as the number and severity of the abuse went up, so did the risk for obesity.

On his website, Arya M. Sharma, M.D., chair of the Cardiovascular Obesity Research and Management at the University of Alberta, Edmonton, Canada, writes:

To anyone running a bariatric clinic, stories of sexual abuse linked to obesity should come as no surprise. Previous reports have estimated that as many as 20-40% of patients seeking weight loss, particularly bariatric surgery, may have histories of sexual abuse.

He cites one meta-analysis to the contrary, which didn’t find a significant link between obesity and abuse. However, only two studies were used in the calculations. He writes:

So does the meta-analysis by Maras change my opinion – not in the least.

As someone regularly dealing with bariatric patients, I would need far more robust data to convince me that what I hear reported from my patients is purely anecdotal. I will continue to maintain that no obesity history is complete without explicitly exploring sexual, mental, and physical abuse and their relationship to ingestive behavior.

Childhood abuse may up the risk for eating disorders and disordered eating, too. A 2000 study showed that teens with a history of sexual or physical abuse had an increased risk of disordered eating, including vomiting and laxative use. Other research found that girls who were sexually abused were more likely to have eating disorders as teens.

Abuse may be common among individuals with binge eating disorder (BED). For instance, a 2001 study found that out of 145 individuals with BED, 83 percent reported some kind of abuse:

59 percent reported emotional abuse, 36 percent reported physical abuse, 30 percent reported sexual abuse, 69 percent reported emotional neglect, and 49 percent reported physical neglect. Emotional abuse was associated with depression, body dissatisfaction and low self-esteem.

How To Heal

Whether your weight is an intentional barrier, a consequence of emotional eating, or a bit of both, the following tips may help:

See a therapist. To find a therapist in your area, try Psych Central’s therapist finder. Tips on choosing a good therapist can be found here, here and here. Seek out resources and support. The Joshua Children’s Foundation, which helps victims of sexual child abuse, offers a list of resources. Work on curbing emotional eating. While working on the underlying cause of your weight — such as exploring why it’s protective and healing any trauma — is key to emotional health, reducing unhealthy behaviors can contribute to your overall health, too. This is something you can work on with your therapist. In the meantime, here are some sources to get you started: mindful emotional eating; 10 skills for mindful eating; avoiding emotional eating and dealing with it; and an inspiring story. Make strides to overcome the abuse or traumatic event. Life coach Evelyn Lim includes a list of tips for overcoming an abusive relationship, which can be adjusted to any trauma. Examples include distancing yourself from the past, setting boundaries and expectations, and doing what helps you feel good. Learn to express your emotions in a healthy way. About.com has good advice for individuals with PTSD on managing emotions, but it’s a useful list for anyone. It includes: identifying and monitoring your emotions, using writing as a tool, breathing and using relaxation techniques and seeking out social support. For in-the-moment relief, try simple self-soothing strategies. This blog post lists 11 suggestions that the author uses to ease her emotions. Among them you’ll find: reading poetry, talking to a friend who helps “soothe you” and bundling up in comfy layers. Consider what helps you feel better and jot it down. Keep your list handy, so when you’re in the throes of an emotional eruption, you have several ready-made solutions that specifically work for you. These can be everything from writing in your journal to walking around the block to crying to calling a good friend to attending a support group. These may not be magical remedies, but exploring healthy ways to lift your spirits or make sense of the situation can do a world of good.

Wearing Your Weight As Armor