Definition Sexual and Physical Abuse in Obese Children

Of importance for both the development of obesity in some individuals and
for treatment is the issue of sexual abuse. In the last decades it has been more
fully acknowledged that many children are abused. Research has increasingly
demonstrated that mistreatment – e.g. physical punishments, sexual abuse, verbal
insults, violent quarrels and alcohol abuse by parents – is a common experience
for many children. Abuse in childhood is a risk for adult obesity and
many other diseases and health risk behaviors [18]. There is a graded relationship
between how many different kinds of mistreatment or neglect a child has
experienced and the probability of developing diseases and risk behaviors in
adulthood. If a child has experienced many different kinds of mistreatment then
the risk increases that the child will demonstrate different health problems.
Mistreatment has psychological, behavioral and somatic consequences. Low
self-esteem, distrust, depression, body dissatisfaction and even self-hatred are
common psychological outcomes of severe abuse. Examples of behaviors include
self-destructive behaviors of varying degree such as suicide attempts, drug or
alcohol abuse, binge-eating and weight control behaviors such as dieting and
purging. Many abused children develop in adulthood somatic symptoms, e.g.
headaches, chronic pain, gastrointestinal problems and obesity.
Women are especially vulnerable to sexual abuse. It is estimated that
between 15 and 30% of all women have been sexually abused as children. Some
data suggest that abuse is a contributing factor that significantly increases the
risk of developing eating disorders and obesity. One psychological mechanism
behind this is that many people react to the psychological distress by comforting
themselves with food. Many abused girls and boys, especially if the abuse
was sexual, react to the abuse also by becoming severely dissatisfied with their
bodies. This leads in many cases to attempts to control body weight by behaviors
typical of eating disorders – bingeing, purging, etc. Bingeing and bulimic
behaviors may in turn lead to obesity. Some sexually abused individuals (mostly
women) may develop obesity as a defensive mechanism against undesired sexual
advances. By becoming obese they keep potential proponents at a distance.
It is important to take the possibility of abuse into consideration when
planning the treatment for overweight. Patients with a history of sexual abuse
lose less weight during treatment and more often than other patients discontinue
treatment [19]. It is, therefore, important to address the emotional sequels of
abuse. To help patients who have suffered abuse requires tact and sensitivity.
This group of patients needs time and confidence to disclose extremely painful
and degrading experiences.