From Childhood Obesity to 
Eating Disorder Treatment

By Dr. Amy Wasserbauer, Ph.D, Remuda Ranch, Programs for Eating and Anxiety Disorders

She walks into the initial assessment at Remuda Ranch Programs for Eating and Anxiety Disorders, with a familiar story, "I was a chubby child, teased often for being overweight. My doctor told my mom I was in the ‘obese’ category. I felt unaccepted by my peers and family. Mom put me on diet after diet, but it didn’t work. Mom always dieted too and would say bad things about her own body. Dad put us both down. In my frustration, I ate more and more. I can now admit that food was my friend. In the midst of all my problems, it helped me feel better." She goes on to admit that there were multiple issues in her family that heightened her anxiety and can’t remember a time when she didn’t use food for comfort as a child. Sadly, she reports that at one point in high school she learned how to use an eating disorder to manipulate her weight, and with that came positive reinforcement by family and friends. Now, 10 years later she’s caught in the web of an eating disorder that is relentless. It never allows her to know what normal eating is, and it keeps her afraid that if she stops she’ll go back to the obese little girl that was teased and rejected. Her life consumed with fear of weight gain, drives her to obsessions with diet, food manipulation, and excessive exercise. There is no space to live a normal life, or develop close friendships; instead, she uses destructive behaviors that take a toll on her body, mind, and soul.

I could tell many other stories with similar themes and patterns of women teased due to their weight issues as children, who turned to anorexia or bulimia for their answer. The themes of rejection, low self-worth, insecurity, control, and "never feeling good enough" stem from their obesity issues. In further exploration, I learn there are even deeper roots that need to be uncovered.

Asking more thorough questions is necessary

"What was your relationship with food like as a child? When do you remember first going to food for comfort? What was going on in your life when you did this?" The patterns of behavior with food are then discovered in the context of family dynamics and personality characteristics. "My parents were constantly arguing and I felt scared, so I ate," or "My best friend rejected me in elementary school, so I ate." Sometimes I hear, "I was being abused by a neighbor (or family member) so I ate." Some report, "My mom was never happy with her size, so she put the entire family on a diet. I was hungry, so I hid food in my room and ate."

There are many more stories like this and the pattern is evident. Food becomes the source of comfort, security, protection, and control, leading the child to weight gain and possible obesity. The pattern of "using food" is established. The emotional issues driving the person to food are denied and ignored. The child develops an unhealthy relationship with food due to unhealthy relationships. Unique personality characteristics such as intense emotional sensitivity, perfectionism, driven-ness, and anxiety may heighten her use and abuse of food. Thus from childhood on, she has no idea how her body will handle normal eating because she does not know what it is to eat normally. In addition to this, we live in a culture that defines beauty from magazine covers—a fantasy image that no woman can live up to. The child using food to deal with her life, often teased and rejected, turns to something that feels hopeful and energizing at first: an eating disorder. Initially, she receives positive affirmations and attention that she craves, so believes she has found the answer to her problems. Unfortunately, she has never dealt with the themes of her life that occurred at the genesis of her food and weight issues. The emotions and negative thoughts that stem from the stressors in her life that were never faced, are magnified with obesity issues. She believes all is well using the eating disorder to cope, until it consumes her life.

Once in treatment, a woman in this situation must face the truth that she has never known a life without food manipulation. On the road to recovery she will build a new relationship with food, her body, herself, and her family. She will unveil the themes and behavior patterns originating from her life circumstances that led her to use food as her coping mechanism. This will take time, but with the support of her treatment team and family, she will begin to build new life skills to trust and love herself and her body. She’ll learn to challenge her negative messages, changing them into positive ones. Experiencing her emotions with new skills will free her from food manipulation and allow her to truly embrace life. She will continue to grow and heal long after she leaves treatment with the help of her outpatient treatment team, family, and friends.