There is a secret to weight loss that should be more widely known and it has nothing to do with supplements, specialized diets, or intermittent fasting. Instead, it’s something that countless people, especially after a yearlong pandemic, have in common: trauma.
Scientists began understanding the relationship between weight gain and trauma decades ago. Since then, they’ve learned that negative, life-altering experiences can lead to weight gain and difficulty losing weight. These findings bubble up in pop culture and media coverage periodically. Surprisingly, however, that critical insight is nowhere to be found in the place you’d most expect it.
Top-performing weight loss apps, used by millions of people each year, make no mention of the relationship between trauma and weight. Apptopia, a mobile intelligence provider, created a list for Mashable of the leading weight loss apps, which includes , (formerly Weight Watchers), , , , and . Collectively, they were downloaded 31 million times in the U.S. between March 2020 and March 2021.
Scrolling through these apps you’ll find important resources like healthy recipes, tips for dealing with stress eating and meal planning, and tools to log meals, calories, and exercise, but no acknowledgement of a fundamental aspect of weight gain.
A major link emerged in 1993, when a study of 100 significantly overweight patients discovered that many of them had disproportionately experienced childhood sexual and physical abuse, in addition to other types of trauma, compared to 100 patients who’d always been “slender.” The heavier patients commonly said they overate to cope with stress and used their weight as a “protective device.” Subsequent research has further illuminated the connection between post-traumatic stress symptoms and weight gain.
Researchers believe that weight can function as a physical and psychological shield for some survivors of sexual trauma, protecting them from unwanted attention or advances. Other types of trauma like bereavement, natural disasters, and domestic violence, can play a role by unleashing higher levels of the stress hormone cortisol. That may lead both to comfort eating and to inflammation. Ultimately, the lesson of research on trauma and weight is that nothing is ever as simple as calories in and calories out.
The premise of popular weight loss programs is that limited self-discipline and poor habits stand between someone and their desired weight. Some apps, like WW and Noom, teach users important new behaviors and skills, helping them to evaluate their choices without necessarily addressing the trauma that may be driving their decisions. Other apps are workout guides and calorie trackers that splash images of svelte, toned bodies across the screen, presumably as motivation. Leap Fitness Group has created a line of such apps: Lose Belly Fat at Home, Lose Weight App for Women, Lose Weight App for Men, and so on.
While some people may only need a meal tracker and exercise regimen, many could benefit from learning how trauma changes the body and mind. This feels particularly true at a time when people are emerging from a traumatizing pandemic, perhaps heavier than they were a year ago, eager to travel, wear real pants, and slip back into a swimsuit. The process of managing their weight might be less daunting if they grasped how past trauma combined with fresh adversity may have contributed to gaining weight.
Certain techniques and strategies, including mental health treatment, can shift how people view their dietary and exercise habits in the context of their trauma. That reframing often alleviates feelings of guilt and self-sabotage that surface during attempts to lose weight, especially if those efforts are initially successful but the weight eventually returns.
When people feel there’s some “sinister” part of themselves that skips exercise or indulges in treats, thereby halting progress toward their weight loss goal, it can set up a heartbreaking cycle, says Dr. Thomas Rutledge, a staff psychologist at the VA San Diego Healthcare System where he treats veterans in a weight control clinic. Many of his patients have post-traumatic stress disorder.
“You feel like there’s a monster inside of you,” says Rutledge of the emotional pain some experience when it feels like they’ve betrayed themselves and have no power to change their behavior. “People give up [trying to lose weight] as a result.”
“You feel like there’s a monster inside of you.”
Mashable contacted several of the leading weight loss apps identified by Apptopia, but only Noom, WW, and Lifesum responded. Each company agreed to talk about trauma and weight management and offered compelling reasons for not raising it with their users.
While acknowledging its importance, they feared that discussing trauma would be irresponsible since their programs aren’t specifically in the business of providing mental healthcare. Even though trauma is common, they want to appeal to a broad audience and worry that a discussion of the subject could feel too niche. They also can’t offer a quick fix, like when advising a user who’s craving a certain food or feeling overwhelmed with meal planning.
Gary D. Foster, Ph.D., a psychologist and chief scientific officer for WW, said the company looks for “commonalities” shared by all members, like how to manage the body’s stress response. The stress itself could be triggered by anything — grief, unemployment, disruption to one’s routine — but WW content is written in the broadest strokes.
“[W]e’re not mental health professionals, so we spend a lot of time thinking about when we bring up issues like trauma, how much are those going to be activators, and are we leaving people sort of at a little bit at risk?” said Foster, explaining that talking about past trauma might trigger distress or even a mental health crisis.
Dr. Andreas Michaelides, Ph.D., chief of psychology for Noom, said the program’s coaches, who work with members, receive training about how trauma can affect weight management. While they may use that knowledge to help a “Noomer” experiencing challenges, it’s not part of the program’s extensive library of courses that cover topics like the psychology of weight loss, “keystone” eating habits, mindfulness, and factors aside from food, sleep, and stress that influence one’s ability to lose weight and keep it off. Michaelides said that if a user expressed concerns about their history of trauma, a Noom coach will consult the company’s clinical team about whether they would benefit from mental health treatment or other resources.
Both Noom and WW apply principles of behavior change to weight management. The programs don’t just focus on budgeting calories but instead educate members about how to become more self-aware and change their behaviors. Those skills arguably increase users’ sense of agency and control, which in theory should improve their mental health and well-being, even if they still wrestle with post-traumatic stress symptoms.
Lifesum, which currently offers food tracking, has plans to incorporate behavior science into its program. The goal is to help people “recognize even in uncertain times things they can control,” said Andrew Zimmermann, founder of a behavioral science consulting firm and a member of Lifesum’s health advisory board.
For Zimmermann, a product like Lifesum exists on a continuum of wellness services and shouldn’t be all things to its users. Similarly, he said, just like a person goes to the gym to work out and a physical therapist to treat an injury, someone hoping to lose weight might use an app to track their habits and see a counselor to work on deeper emotional issues.
What’s more difficult for those in the weight loss field to confront are the limits to the transformative power of behavior change when unresolved trauma pulls people back to the routines or coping skills they’re trying to replace.
“We don’t come at it from the angle of you’ve let yourself go, we’ve got to turn this around.”
Rutledge, the psychologist at the VA San Diego Healthcare System, agrees that there are good reasons for weight loss programs to carefully consider how they talk about trauma, especially if there are no mental health professionals on hand. Even with the best intentions, these conversations can be insensitive toward and counter-productive for the person trying to lose weight.
Yet he also argues that the “future of the field” lies in finding effective ways to talk about trauma and the larger role emotions play in weight management. The current business model appeals to people through simplicity, offering straightforward tasks like counting calories, adopting hacks and tips, and completing workout routines. Meanwhile, any underlying trauma goes undiscussed.
“It is hard to monetize trauma so there is little industry incentive to talk about this issue,” he said.
Rutledge, who is also a professor of psychiatry at U.C. San Diego, helps his patients make connections between their traumatic experiences and how they eat. He encourages them to see their choices as something that had positive benefits, since eating may have helped soothe their anxiety or gaining weight made them feel protected. Instead of feeling ashamed about using these tactics to cope and survive, Rutledge recommends patients try several strategies to navigate their trauma and related weight gain.
One technique is to identify and replace their mental “safe weight,” or the amount they weigh that feels like a protective shield. Choosing a number that’s associated with a different type of safety — strength and health, for example — can make it easier to lose weight without worrying about feeling vulnerable. Rutledge avoids making that new association about thinness or skinniness. He also helps his patients appreciate the idea that excess weight isn’t the best safety tool and guides them toward valuing the protection conferred by newfound physical capability or mobility.
Rutledge said that it can be useful to write down the types of comments and situations that might prompt someone to feel unsafe, and thus more likely to experience PTSD symptoms and abandon their weight loss efforts. He recommends scripting new responses instead. Someone worried about receiving a compliment about their body can decide in advance how they’d like to answer. They can also plan for feeling uncomfortable eating with a friend by deciding in that moment to take three slow breaths through their nose to relax while reminding themselves to feel proud of the changes they’re making.
“We don’t come at it from the angle of you’ve let yourself go, we’ve got to turn this around,” says Rutledge. “They were probably gaining weight because they were coping and food was one of the limited options available to them.”
Mercifully, some weight loss programs and apps are similarly nonjudgmental, but what they continue to leave out about the role of trauma has the potential to truly empower their users.