Kathleen Kendall-Tackett examines what else makes us gain weight and why trauma needs to be a part of the discussion.
The weight-loss industry capitalizes on our obsession with losing weight or “getting in shape,” raking in an estimated $64 billion in 2014, according to research firm Marketdata Enterprises. Unfortunately, Americans continue to get heavier, even as we spend increasingly more money on diet and weight-loss products.
Even the American Psychological Association has gotten in on the act. At an annual meeting a few years back, obesity was a presidential theme. I attended most of the sessions on this topic and heard a lot about diet, behavior change, exercise, portion control, and eating more fruit and vegetables. The conclusions in the majority of sessions were pretty clear: Americans are fat because they are eating too much and exercising too little.
The problem is that obesity is much more complex than the speakers at these sessions made it sound. They had left out something important: trauma. I did not hear it mentioned even once, a significant omission.
Evidence now suggests that trauma does indeed make people fat.
For example, in a study of 4,641 middle-aged women, with a mean age of 52 years, a history of childhood physical or sexual abuse doubled the risk of both depression and obesity (Rohde et al., 2008). Similarly, a meta-analysis of 24 studies (N = 48,801) found that physical or sexual abuse in childhood increased the risk of metabolic disorders including diabetes and obesity (Wegman & Stetler, 2009). Although this association existed for both men and women in the study, it appeared to be stronger for women.
Perhaps one of the more convincing studies regarding the link between trauma and obesity was conducted using data from the Nurses’ Health Study II (N = 73,418). In this study, the authors found that childhood sexual or physical abuse increased the risk of Type 2 diabetes, a disease often cited as being related to a higher BMI (Rich-Edwards et al., 2010). This association existed even after controlling for age, race, and body type at age 5, parental education, and parental history of diabetes. The more severe the abuse, the more severe the symptoms of diabetes. For women who experienced severe physical abuse, the risk of diabetes increased by 50%. For women who experienced repeated forced rape, diabetes risk increased by 69%. The body mass index (BMI) was also influenced by past abuse. Physically and sexually abused girls had higher BMIs than their non-abused counterparts, and they gained weight more rapidly. This was especially true for those who experienced repeated forced sex.
Another study used a sub-sample of this same data set (N = 54,224) and examined the impact of posttraumatic stress disorder (PTSD) on weight (Kubzansky et al., 2014). The researchers found that PTSD symptoms increased the risk of being overweight or obese. In addition, PTSD altered BMI trajectories over time. The more PTSD symptoms the women had, the greater the increases in BMI.
A review by Masodkar, Johnson & Peterson (2016) concluded that research is needed to reveal the multidimensional and intricate relationship between PTSD and obesity. The implications of this research would be essential for treatment, prevention, and potential public health reforms.
There are a number of plausible mechanisms that explain the link between trauma and weight. One of the key factors is the impact of trauma on sleep. Trauma survivors often have impaired sleep, including longer sleep latency (minutes to get to sleep), shorter sleep duration, more night wakenings, and greater daytime fatigue (Kendall-Tackett, Cong, & Hale, 2013). A growing body of research shows that sleep problems in turn have been found to increase the risk of obesity. In a meta-analysis of 36 studies (N=634,511), short sleep duration was related to obesity worldwide. This was true for both children and adults (Cappuccio et al., 2008). Even short periods of sleep deprivation can elevate cortisol and glucose levels, and increase insulin resistance (McEwen, 2003). In another study, short sleep duration was related to metabolic syndrome in middle-aged adults. Specifically, short sleep duration was related to:
- abdominal obesity
- elevated fasting glucose
- hypertriglyceridemia (Hall et al., 2008).
What these findings suggest is that people who experience chronic sleep problems are physiologically prone to gain weight and to gain weight in ways that impair their health (e.g., abdominal obesity). Insulin resistance is also particularly concerning as it is a hallmark syndrome of metabolic syndrome, a risk factor for cardiovascular disease and diabetes (Haffner & Taegtmeyer, 2003).
For many Americans, their BMI is likely to remain high until their trauma symptoms are addressed. This is not simply a matter of trauma survivors eating more (although that could be true in some cases). The more plausible argument is that trauma has changed their physiology, especially their sleep, and has made it more likely that they will gain weight. All the diet and exercise advice in the world will not alter this underlying problem. In short, if we want to do something about the “obesity epidemic,” trauma needs to be part of the discussion. Until it is, our efforts are likely to fall far short of the mark.
Cappuccio, F. P., Taggart, F. M., Kandala, N. B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31(5), 19–26. doi:10.1093/sleep/31.5.619
Haffner, S. (2003). Epidemic obesity and the metabolic syndrome. Circulation, 108(13), 1541–1545. doi:10.1161/01.cir.0000088845.17586.ec
Hall, M. H., Muldoon, M. F., Jennings, J. R., Buysse, D. J., Flory, J. D., & Manuck, S. B. (2008). Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep, 31(5), 635–643. doi:10.1093/sleep/31.5.635
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: a comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine, 8(1), 16–22. doi:10.1089/bfm.2012.0024
Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress. JAMA Psychiatry, 71(1), 44. doi:10.1001/jamapsychiatry.2013.2798
Masodkar, K., Johnson, J., & Peterson, M. J. (2016). A review of posttraumatic stress disorder and obesity. The Primary Care Companion For CNS Disorders. doi:10.4088/pcc.15r01848
McEwen, B. S. (2003). Mood disorders and allostatic load. Biological Psychiatry, 54(3), 200–207. doi:10.1016/s0006-3223(03)00177-x
Rich-Edwards, J. W., Spiegelman, D., Lividoti Hibert, E. N., Jun, H.-J., Todd, T. J., Kawachi, I., & Wright, R. J. (2010). Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. American Journal of Preventive Medicine, 39(6), 529–536. doi:10.1016/j.amepre.2010.09.007
Rohde, P., Ichikawa, L., Simon, G. E., Ludman, E. J., Linde, J. A., Jeffery, R. W., & Operskalski, B. H. (2008). Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse & Neglect, 32(9), 878–887. doi:10.1016/j.chiabu.2007.11.004
Wegman, H. L., & Stetler, C. (2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosomatic Medicine, 71, 805–812. doi:10.1097/psy.0b013e3181bb2b46
Dr. Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. She is Editor-in-Chief of two peer-reviewed journals: Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the Board for the Advancement of Psychology in the Public Interest. Dr. Kendall-Tackett specializes in women’s-health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2016 Outstanding Service to the Field of Trauma Psychology from the American Psychological Association’s Division 56.
Dr. Kendall-Tackett has authored more than 400 articles or chapters, and is currently completing her 35th book, The Phantom of the Opera: A Social History of the World’s Most Popular Musical. Her most recent books include: Depression in New Mothers, 3rd Edition (2016, Routledge UK, in press), Women’s Mental Health Across the Lifespan (2016, Routledge US, in press, with Lesia Ruglass), Psychology of Trauma 101 (2015, Springer, with Lesia Ruglass) and The Science of Mother-Infant Sleep (2014, Praeclarus, with Wendy Middlemiss). Her websites are: