An obesity patient's mysterious weight regain exposed a hidden epidemic

In the mid-1980s, internist Vincent Felitti ran an obesity clinic in San Diego using a technique that produced dramatic, medically supervised weight loss. One patient, a twenty-eight-year-old nurse's aide, lost an astonishing amount of weight over fifty-one weeks, dropping from 408 pounds to 132. Felitti expected a success story. Instead, when he saw her again months later, she had regained more weight than seemed biologically possible in that time.

It turned out that her slimmer body had attracted a coworker's romantic attention, and the moment he suggested sex, she went home and began eating uncontrollably, day and night. Pressed to explain, she revealed a childhood history of incest with her grandfather. It was only the second such case Felitti had encountered in over twenty years of practice. Ten days later, he heard a strikingly similar story. He and his team began asking more patients directly, and found that most of their morbidly obese patients had been sexually abused as children.

When Felitti presented these findings at an obesity conference in 1990, some experts openly doubted his patients were telling the truth. But a researcher from the Centers for Disease Control encouraged him to test the pattern on a much larger scale. The result, developed with co-investigator Robert Anda, became the Adverse Childhood Experiences study: more than seventeen thousand Kaiser Permanente patients, mostly white, middle class, and insured, answered ten questions about abuse, neglect, and family dysfunction in childhood.

Only a third of respondents reported no adverse experiences at all. And as the number of adverse experiences rose, so did nearly everything else: depression, alcoholism, attempted suicide, obesity, heart disease, cancer, workplace absenteeism. People with the highest scores were roughly seven times more likely to consider themselves alcoholic, and their likelihood of attempting suicide rose by roughly fifty times compared with those who reported no adverse experiences at all.

Robert Anda reportedly could not hold back tears the first time he saw the completed data. What had begun as one confusing case of weight regain in an obesity clinic had revealed that certain health-damaging behaviors, like extra weight, weren't necessarily the problem to be solved. Often, they were themselves a solution the body had found long ago, to a problem no one had ever asked about.

Before you try to eliminate a habit you don't like in yourself, whether it's overeating, drinking, or something else, try asking what it might currently be doing for you, since the Adverse Childhood Experiences research found that behaviors we label as problems are often solutions someone found long ago to a danger or pain nobody ever addressed. Ask specifically what the habit protects you from feeling, prevents from happening, or numbs when it gets too loud. Resist stripping the habit away before you've found something else that can do that same protective job, or you risk trading one crisis for another. And when you're tempted to ask what's wrong with you, try asking instead what happened to you, since that question, more than any other, opens the door to actually understanding the pattern.