Early life experiences underlie chronic obesity and binge-eating

By Dr. Liji Thomas, MDSep 18 2019

A new study on the cognitive and emotional functioning of people with a high body mass index (BMI), which was published in the journal Heliyon shows that early life experiences can create a deep impact on future eating patterns and dietary habits leading to obesity or overweight. This means that any weight-reduction interventions must also include focused attention to such trauma. It may also explain the lack of uniform long-term weight reduction following behavioral and surgical techniques such as weight-loss surgery or cognitive-behavioral therapy.

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Weight gain is known to involve both biological and environmental causes, the psychological factors that could cause a chronic tendency to overeat have not been studied in sufficient detail. The current study was carried out by cognitive psychologists, based on a model called Schema Therapy (ST), which aimed at exploring these determinants of excessive weight gain. ST looks at the current psychology of the individual, in connection to early childhood experiences, and temperament, linking them into a harmonious whole. It is used to treat chronic emotional and relationship issues, and could be fruitful in resolving chronic behavior-related conditions like obesity as well.

Schema Therapy

ST researchers seek to understand the early maladaptive schemas, the current schema modes active in these individuals, and the dysfunctional coping strategies they used. The underlying theme in all these is the compensatory strategy developed by young people in situations where the need for caring, love, acceptance, nurturing, autonomy, and discipline, may not have been met fully by those who played an important role in their lives.

A maladaptive schema is a mode of development in which individuals come to think of themselves and about their worlds wrongly due to the way they habitually perceive, sense or emotionally respond to themselves and their surroundings, which in turn is fundamentally shaped by their early life experiences. This dysfunctional cascade is mediated by wrong thoughts and behaviors, which culminate in coping strategies such as the fight, flight or freeze responses – only, in this case they are called overcompensation, avoidance and surrender strategies.

What did the study show?

The ST schema was used to look for signs of Early Maladaptive and Coping methods adopted in 75 patients in three groups – obese, overweight and normal weight. They found that maladaptive schemas and dysfunctional coping methods were significantly more likely to be present in individuals in the first two groups. Moreover, in the presence of additional stress, the individual could shift from one mode of coping to another such as frequent binge-eating or bulimia.

The study brought to the forefront the existence of the Insufficient Self-Control schema (as the inability to cope well with distress and to control impulsive behavior), schema, and also that such individuals were also significantly more likely to feel abandoned, incompetent, subjugated. These were the major determinants of feeding attitudes and behavior in this group of people.

The schema modes in operation were as the impulsive child (selfish, uncontrolled, given to instant self-gratification, and intensely angry or frustrated) and vulnerable (lonely, unloved, incompetent, or the detached protector (causing them to avoid feeling anything and to reject all help). They had a higher rate of binge-eating and bulimia, and were more likely to be emotionally detached.

Their preferred method of coping appeared to be to avoid dealing with emotions by overeating and binge-eating, which also offered them comfort. Such individuals try to cope with their stress in ways that result in self-defeating thoughts, and behaviors or attitudes towards food which help them find comfort while also helping them avoid dealing with or facing their true feelings. Basile says, “We also documented that overeating and bingeing behaviors serve as self-soothing strategies that help individuals to cut off their feelings and quiet their internalized 'Punitive Parent.”

The greatest predictive value for obesity, frequent binge-eating and bulimia was with the insufficient self-control schema.

On the basis of this recognition, the researchers recommend that therapies to address excessive weight gain should take note of the emotional dysfunction and misguided thought patterns that drive their attitudes and behavior, linking them to their experiences in early life. This would help achieve a long-term maintenance of corrective measures such as eating appropriately.

What are the recommendations?

The following steps were recommended as part of treating such patients with ST therapy:

• Identify each patient’s maladaptive schema and coping modes
• Provide a safe setting to satisfy the emotional needs left unaddressed which are hidden deep in the patient’s Vulnerable Child mode
• De-activate the Punitive Parent mode so that the destructive inner dialogue ceases
• Reduce the patient’s resort to dysfunctional coping strategies, including that of emotional avoidance and detached protector mode
• Build up the healthy adult mode of functioning

Researcher Barbara Basile says, “The results of our study suggest that dysfunctional eating patterns and habits associated with overweight and obesity are deeply rooted within patients' personality features and current interventions are not enough to guarantee a long-lasting effect. Addressing actual schema modes and the connected early experiences within a caring and solid clinical setting, such as the one used within ST practice, might be of particular value for obese patients.”