Helping Child Victims of Sexual Abuse

When a young girl with morbid obesity shows up at a doctor’s or psychologist’s office, it must be understood that sexual abuse may be the cause of, or contributing to her health issues. We must gently share with her the fact that girls are five times more likely to be abused than boys. Then compassionately ask her if she has been abused. We should also remember that age is a significant factor in sexual abuse. The median age for reported sexual abuse is nine years old. So we must inquire in a gentle, loving, risk-free way so that the girl with obesity feels safe and cared for. She may have never known this feeling and it may seem odd to her that a complete stranger cares for her, since she most likely has shared her story with people who ignored her.

The secrecy of sexual abuse keeps victims alone, quiet, and self-soothing, In the case of a girl with obesity, most likely food has become her comfort. How we care for this child should reflect our deepest commitment to acting with compassion and love. If a girl with obesity does share her story, help her feel safe. Let her know you are honored to be part of her journey towards healing and happiness. As you know, this is only the beginning of a very long road for this girl. She will need to tell her story to the authorities; she will need support and love from family and friends during the investigation. She will most likely need medical treatment, and psychological or possibly spiritual counseling. She will need compassion every step of the way. Most importantly, the girl with obesity will need to know that there is an end to the long journey towards health, safety, and happiness and that she is strong enough to take that first step. We can share with her that there is a strong connection between obesity and eating disorders in girls who have been sexually abused. And that this is not a life sentence of eating to sooth all the hurt she has ever felt.

In 2010, Kaiser Permanente,studied more than 30,000 mostly middle-aged obese adults and noticed those who were most successful in losing weight were also most likely to drop out of the weight-loss program and regain weight. The researchers unexpectedly discovered that histories of childhood sexual abuse were common, as were histories of growing up in markedly dysfunctional households.

Clinicians must ask the uncomfortable questions when taking the history of a girl with obesity. Incest, rape, family suicide and parental brutality are unfortunately common in girls with obesity. More importantly clinicians must share with caregivers and children how sexual abuse and eating disorders are connected. There are many theories to explain the link. These are the main ones:

• Sexually abused children may eat as a coping mechanism that can continue into adulthood.

• Children who are sexually abused may feel that gaining weight offers protection and helps them avoid adult sexual advances.

• Some research shows that emotions associated with abuse are thought to lead to higher levels of cortisol, the stress hormone, in the bloodstream. This can increase appetite.

What you can do to help children with obesity who have been sexually abused?

Stay engaged with them during their treatment plan. Give generous amounts of compassion, love and respect for surviving and speaking up. Support the Child Victims Act which will eliminate both criminal and civil statutes of limitation for child sexual abuse. This will prevent predators and their protectors from escaping responsibility for their crimes by waiting out the statue of limitations on reporting child sexual abuse.

On a personal note on June 14, 2016, on the New York State Legislative Office Building steps I will stand beside advocates who are demanding that the Governor sign the Child Victims Act. I am doing this because I am a researcher who has studied the link between obesity and sexual abuse. Federal Bureau Investigation data says that 1 in 5 of ALL children are sexually abused before age 18. We know that pedophiles and sexual abusers are - with rare exception - lifelong abusers, with as many as 100 victims each. Yet, only 10% of this abuse is reported to authorities. There are many reasons for this but a major deterrent is that children are only given one year to report abuse.

Chubby, Chunky, Heavy Big: How Do We Talk Compassionately to Our Children About Weight?

Many parents are watching their children getting bigger and bigger and wonder, when do I say something? How do I help them when I can’t even help myself? I have had the honor of hearing many people’s stories about their feelings about their own weight and their children’s weight. I have learned that feelings about weight gain and loss are deeply embedded in our personal histories, our exposure to distorted media images of what people look like, and our ability to protect our sense of self from feeling "less than" because of our weight.

When I have listened to parents share their stories, I often feel sad when I witness a painful memory resurface that causes a quiver in their voice. Or when I see a parent attempt to squint away tears when they remember a name they were called or a sharp word from a classmate. Their pain is real. Their confusion as to why and how their children are gaining too much weight is equally real. I am encouraged when a parent instinctively shies away from using fat-shaming language and tries to approach the subject gently. Many of the parents I have spoken to avoid using words like ‘fat’, ‘obese’ or ‘overweight’ when they discuss their child's weight. They often used words like ‘big’, or ‘heavy’, and refer to the whole family as such. ‘We are big people,’ or ‘Our family has always been on the heavy side.’ Or sometimes they affectionately speak of their child's size as in, “She’s always been my chunky monkey ” or “He’s my little chubster.”

Their affectionate terms for obese or overweight is how I chose the title of this post. I want everyone reading to feel as if I am speaking to them, not over them. Some articles on children’s weight gain, or on how to be a healthy family, use words that come directly from research papers, or clinical guides, or make a huge assumption that the reader [parent] has time, energy, and money to do all the things they suggest in the book.

The fact that many parents are working several jobs, and still need to get help from food pantries or food stamps is never addressed. How much money you make and how many jobs you work has a huge impact on how healthy you can be and how healthy your family can be. These are difficult times, with many issues competing for parents' time and money. Parents need everyday language with realistic solutions that help them and their children stay emotionally healthy during this obesity epidemic.

I remember one single mom called me at the Center for Best Practices for Early Childhood Obesity Prevention to ask about the guidelines that recommended that children only get two hours of screen time per day. “That’s almost two episodes of Dora the Explorer!” she shouted into the phone. “It’s sooo not in reality. I have to get ready for work in the morning, and with Dora on, the kids stay busy so I can get everything ready to get us out the door.”

Now some people would urge her to get better organized, or give some helpful hints on how she could prepare things the night before, making the morning rush less hectic. Or advise that she insist that they all eat breakfast together, like that really happens, or could even possibly happen, in most families today. My approach was to tell the mom that Dora is her helper. If the screen time in the morning helps her then use it. But see it for what it is—just one strategy for this period of time in their lives until her children are old enough to be left alone. It doesn’t mean that her situation won’t change and that she won’t always be able to choose the healthier thing to do for her children. But for now it is okay to do what is easiest, less stressful, and keeps everyone safe. She is keeping her children safe while she gets ready for work, which is her number one priority. She is acting in their interest as best she can for where she is in her life.

And children are resilient. Yes, perhaps watching two hours of Dora everyday may have some impact on her child’s development, but so would leaving her children unattended while she is rushing around getting ready for work.

This obesity epidemic has taken an emotional toll on parents that has largely been ignored in parenting books and magazines. Telling parents to tell their child to eat less and move more has not stopped nearly 60% of US children from gaining too much weight. Nor has it helped 57% of adults who are overweight or obese. Telling a parent who is overweight or obese themselves to set an example of good health for their children and model healthy behaviors is like telling a drowning person to swim.

Obesity is widespread for many reasons. Parents need to understand all of the reasons a child may be overweight and have the tools to address the epidemic with compassion and empathy. Everyday we hear chatter on television, or read in magazines and newspapers about how big Americans have become. While fat-shaming and bullying have sadly become part of our culture, it has been especially alarming that people in leadership roles are trying to 'normalize' fat-shaming and bullying. Demeaning statements about people's weight and women’s bodies in this recent election brought fat-shaming language and bullying behaviors to a new level. Terrible words were uttered into microphones and tweets were sent about the size of women's bodies without any remorse or apology. And the children heard. Sadly, schools across the country are reporting a surge in bullying and name-calling during and since the recent presidential election.

Our children struggling with rapid weight gain need us more than ever to be compassionate and kind to them. They need adults to keep them safe and give them a compassionate space to grow and thrive. Children need to know that we will protect them from fat-shamers and bullies and not turn a deaf ear to demeaning remarks about different body types and sizes.

How do we create a safe, engaging space with our children to talk about the obesity epidemic? How do we help children understand that no matter what their size there are ways to prevent diseases like Type 2 diabetes and hypertension? How do we help children feel supported and thrive in a fat-shaming culture? My upcoming posts will address these questions and more, because a likely reality for many children as they become teens, and then young adults, is that they will struggle with weight gain and weight loss perhaps for the rest of their lives. Weight gain and loss takes its toll on children in a physical way and it also can lead to deeply felt residual emotions that may become part of their psychological make-up. Being tender and caring during this obesity epidemic is essential to helping children become a healthier weight and happier people.

Another question I am often asked is “So what do you think is going on? Why are the children so big, or heavy, or chubby, or chunky nowadays?” Unfortunately, the answer is not as simple as too much time spent playing video games, or fast food, or no recess at school. Instead, we should think about the childhood obesity epidemic as the result of a perfect storm that has been brewing for nearly forty years. There is not one single thing we can point to that explains why some children are affected and others are not. Many parents will be nostalgic for times past. They will reminisce about when they played outdoors freely, watched television only after their homework was done, and drank soda only on special occasions. That world feels like it slipped away and isn’t something their children will experience. There is kind of resignation about the modern world, and obesity is just one more problem that comes with it. Other parents feel alarmed, confused and helpless about how to stop their child from becoming ill with hypertension, diabetes, sleep apnea, and other lifelong illnesses. Children are getting bigger and bigger, and many parents are feeling a sense of urgency to act, say something, and do something to help their child.

Because obesity is a complex problem, we must be careful when we accept easy answers for why children are gaining weight rapidly. If we believe that obesity is simply the result of eating too much and not exercising enough we are putting the blame on the children and more often, the parents. We need to take into consideration all the reasons that caused children to become chunky, chubby, heavy or big. There are many reasons children are getting heavier, some reasons are well known and accepted, however, may reasons are still being researched. This post is the first of a six part series on how best to talk about rapid weight gain with children and how to protect children from fat-shaming and weight bias at home, at school, and at the doctor's office.

The Link Between Obesity and Sexual Abuse

The effects of child sexual abuse (poor self esteem, poor body image, impulsive behavior and drug abuse) are common predictors of the binge eating and obesity. That is, compulsive eating may be one way to manage the depression related to child sexual abuse. Other factors in the connection between child sexual abuse and obesity, along with eating disorders, might include a desire to “de-sexualize” to protect against further abuse, as well as a range of psychiatric conditions (depression, anxiety, sleep disturbances, physical complaints, phobic reactions, low self esteem, suicidal feelings and substance abuse).

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Maintaining Healthy Weight

Here is an easy thing to do to help your child stay a healthy weight. Encourage your child to run, skip or hop for just five minutes several times a day. Remember when you were a kid and you ran because you felt like running. Or maybe you were a hopper, or a skipper. Skipping home from school or to a friend’s house to play. These fast, spontaneous bouts of physical activity, researchers learned, can help fight childhood obesity, high cholesterol and high blood pressure.

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What If My Child Needs Bariatric Surgery?

If you are a parent of an extremely obese child you may need to consider bariatric surgery to help your child achieve a healthy weight. Children as young as 8 years have become candidates for bariatric surgery to reduce life threatening conditions. There are several serious issues raised when performing bariatric surgery on children. Here is a list of 10 things every parent needs to know and should expect from their doctors if their child is having bariatric surgery.

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Childhood Obesity and Heart Disease

Childhood obesity is one of the main risk factors for cardiovascular disease (CVD). 1 in 3 children in the United States is overweight or obese. Nearly 60 percent of overweight children have at least one cardiovascular risk factor because they are overweight. Childhood is a critical time for preventing obesity and the development of CVD risk factors and ultimately CVD in adults.

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What Kind of Calories Are Best For My Child?

Researchers are beginning to understand that our bodies process foods, or calories, in different ways. Therefore what our children eat is just as important as how much they eat. It turns out that the recent advice given by organizations such as the USDA and the American Heart Association to eat a low-fat, carbohydrate rich diet that included some sugars, and refined grains like bread and pasta, and even starchy vegetables like potatoes, could be the reason for the obesity epidemic.

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 Antibiotics and Childhood Obesity: Are Children Being Under-Treated?

For over 50 years doctors have prescribed antibiotics to children using this rule of thumb: a big child is equal to half an adult, and a small child is equal to half a big child, and a baby is equal to half a small child. But now that 1 in 3 children are overweight or obese and are as big as adults, can this rule of thumb still apply? Are children being under-treated?

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What Do I Say To My Child if They Are Overweight?

Research shows that children, especially girls, as young as five years of age are aware of their size and whether they are overweight. It is very important to talk to your child compassionately about their weight. What you say is important to discovering the best way to help them achieve a healthy weight.  

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Autism and Obesity: Findings from a New Study

A study published today in Pediatrics says the mothers who are obese are much more likely to have a child with autism and other developmental disabilities. This study takes us along a new path of research that will finally put the link between autism and vaccinations to rest. However, it is important to note that the study author from UC Davis, Irva Hertz-Picciottosay has been quoted as saying that "It's hard to say if they are lined, it might be there's some environmental factor that contributes to both the obesity epidemic and the rise in autism cases. Or it cold be the increase in obesity is, in fact, contributing to the increase in autism. But it's certainly not going to account for all of it."

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Is Childhood Obesity Neglect?

Todd Varness et al, provide an excellent overview and reasonable criteria for the removal of an extremely obese and sick child from the home. I think it is important to remember too, as we hear about these cases, that physicians rarely advocate for the removal (and usually only temporarily) of a child due to obesity and that these are extreme and very rare situations.

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The Link Between Depression and Obesity

Depression and obesity are often thought to be dependent on one another. If someone is overweight we often think they may be sad or depressed. A recent article in the International Journal of Obesity entitled, ”Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis,” studied whether obesity causes depression.

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