Thomas Rutledge Ph.D.

The Healthy Journey


How Sexual Trauma Prevents Weight Loss

Understanding the connection between weight gain and sexual trauma.

Posted Jan 08, 2020

For thousands of people this year, their primary barrier to weight loss isn’t finding the time to start a new diet or the money to afford a new gym membership—it is overcoming their sexual trauma history. Unfortunately, even as research on the relationship is growing, sexual trauma is rarely evaluated by physicians, dietitians, or bariatric surgeons during weight loss treatments and people are rarely aware of the potential connection between their sexual trauma history and their poor weight loss results, making sexual trauma an unseen barrier to most healthcare providers and patients. This type of invisible elephant in the room is capable of trampling even the most determined weight loss intentions unless it is addressed.

Image by Gerd Altmann from Pixabay
Source: Image by Gerd Altmann from Pixabay

For patients with a sexual trauma history, the standard "eat less, move more" approach is often insufficient for them to achieve long-term weight loss. This is because their excess weight—no matter how consciously disliked or unwanted—provides a vital sense of safety. To some, excess weight functions like a suit of armor where their increased weight and size reduces feelings of vulnerability; for others, weight gain helps them feel invisible in social settings, warding off unwanted comments and attention. Most insidious, however, is the third group: those who blame themselves on some level for their sexual trauma experience. For members of this group, they may use weight gain as a form of punishment to themselves or as a reminder of what they have convinced themselves they deserve. In all the above cases, weight loss rarely lasts. Whether through lifestyle changes or even bariatric surgery, weight loss beyond a certain point causes the person to feel vulnerable, visible, or valuable again, often resulting in behaviors that return them to their old weight. Because this pattern is largely unconscious, it commonly escapes awareness. It is not unusual to see smart, hard-working people, frustrated by years of failed diet and exercise programs, while still lacking insight about their trauma-turned-weight loss saboteur.

Thankfully, it is possible for a person to overcome the barrier of sexual trauma in their weight loss efforts. For a weight-loss breakthrough to be achieved in these cases, however, it is necessary that the person first, increase their awareness of how sexual trauma can undermine weight loss efforts and secondly, develop new skills and strategies to remove and replace old patterns. It is important to recognize that although multiple psychotherapies are effective for trauma symptoms—including sexual trauma—the specific effects of sexual trauma on weight gain and weight loss are rarely discussed in the standard forms of these treatments. 

Understanding Sexual Trauma and Weight Regain Behaviors

Recognizing some of the characteristic ways in which sexual trauma symptoms interfere with weight loss is a vital first step to lasting improvement. This recognition, particularly as the person learns to notice their signs and symptoms quickly, gives them the power to begin overwriting sabotaging thoughts and behaviors with new and more effective responses. These symptoms and weight regain behaviors typically follow a predictable sequence: triggered by the physical and social effects of initial weight loss, the person experiences an increase in anxiety and depressed mood. These emotions compound with additional weight loss, eventually reaching a breaking point where the person may:

  • Engage in emotional eating or binge eating.
  • Drop out of weight loss groups or exercise programs prematurely.
  • Isolate themselves and begin avoiding normal social activities.
  • Begin wearing larger clothing to conceal weight loss.

Although people lose weight for different reasons, most everyone wants to feel better, look better, and feel more comfortable around others. In the case of sexual trauma, however, weight loss commonly produces the direct opposite of these desired feelings, leading to feelings of discomfort and vulnerability. Appreciating this counterintuitive effect is sometimes highly therapeutic to the person, who may otherwise feel like they are “crazy” or doing something that doesn’t make any sense. It does make sense. In fact, it is entirely sensible that a person engaging in a behavior that caused them to feel vulnerable, uncomfortable, and afraid would rapidly cease this behavior and engage in actions to eliminate these feelings.

Weight-Loss Strategies for Overcoming Sexual Trauma

Although behaviors such as binge and emotional eating tend to get all the attention, it is the ways sexual trauma changes thinking and emotions that are the true weight regain culprits. Recognizing that weight regain behaviors are symptoms rather than causes, here is an overview of four strategies that can help a person make a weight loss breakthrough:

  1. Identify, challenge, and replace your mental “safe weight." Many people with a sexual trauma history have a mental “safe weight," beyond which they start to feel vulnerable. This might be a boundary weight, such as breaking 250 or 200 pounds, or perhaps a weight associated with their trauma experience. Whatever the value, specifying this weight helps the person anticipate and prepare for increases in certain emotions as they approach this weight. Further, it is important to acknowledge that there is no weight that is 100 percent safe from sexual trauma. Sexual trauma affects up to one in four women and one in six men. It impacts children, adults, and the elderly. And it occurs in every country in the world, past and present. Yet even if there is no real “safe weight," the “safest weight” in our risky world is indisputably the weight at which we are strongest, fittest, and most physically capable. While an ideal weight might look different for each person, we can begin to adopt the belief that weight loss can actually increase safety and excess weight may make us weak, slow, and vulnerable. Our emotions can become an ally in our weight loss efforts rather than an adversary.
  2. Appreciate that excess weight as a safety tool doesn’t really work and replace it with a better approach. When weight gain is used to create a sense of safety, it generally provides partial relief at best, while backfiring in other ways. When weight gain is used as a shield to lessen anxiety, for example, it also becomes an unhealthy reminder that we require ongoing protection. Worse still, it simply exchanges feeling vulnerable for feeling shame and the burden of a poor body image. Although some might claim that the problems of excess weight are the lesser evil compared to feeling vulnerable, it is still far from a good solution. A better solution is to adopt behaviors that create feelings of safety and confidence while promoting good health, without the downside of also creating new problems. For example, activities such as weight training and martial arts can assist with weight loss and overall health while promoting a sense of safety through improved strength, self-defense skills, healthy social relationships, and self-discipline.  
  3. Replace former threatening cognitions associated with compliments and attention with empowering alternatives. One of the most universally valuable strategies is to develop and practice new ways of thinking about and responding to increasing social attention that often follows from weight loss. The goal of this strategy is to replace self-limiting patterns of automatic thoughts and emotional reactions to weight-loss attention—usually negative and anxiety-promoting—with responses that help a person feel calm, confident, and in control. A practical approach to this works best. Write out the specific types of comments, situations, and behaviors that trigger safety concerns and script new responses, tactics, and responses to each. Rehearse them with a friend, support group, or therapist and then practice and refine them in actual social situations. The ultimate goal isn’t simply to help a person “survive” social situations; rather, the aim is to develop ways of thinking and behaving in these formerly triggering situations that allow the person to engage and enjoy them.
  4. Use role models such as athletes and celebrities who have overcome sexual trauma histories. More than ever before, a person with a history of sexual trauma can appreciate that they are not alone in their experience. In the past few years alone, multiple Olympic and professional athletes and actors and actresses have publicly shared their sexual trauma backgrounds. As difficult as it was for them to reveal these intensely personal experiences on a large scale, most were motivated by the belief that their actions could inspire and strengthen others. If so many respected and successful people in our society can overcome their sexual trauma experience in making their valuable contributions to our country and culture, then consciously using one or more of these individuals as role models can possibly help a person achieve far more than they could without this inspiration.