Why “Morbid Obesity” Still Hurts — and Why the Language Matters

[NarcKiddo]

My big assumption right now is that a lot of these biochemical changes that we're discussing likely start rewiring when we are children, and there's very little that can be done about it at that time as it's up to the discretion of the very adults who are likely causing those conditions. So, it's like great, what can I do about it now?

I entirely agree with you.

I also entirely agree with your statement that doctors are trained to fight disease. They are, and obviously that is good and necessary. However, doctors are dealing with an entire human being, not an isolated part of that person. To me, trauma-informed medicine would mean medics taking an interest in the welfare of the entire human patient and asking enough about their circumstances to give an opportunity for issues like trauma to come into medical awareness. I realise that this is probably too much to expect as my (many) recent experiences with serious medical conditions have shown me that medics have to compartmentalise to get the problem out of the way and see the next on the conveyor belt.

Given your quoted words above I think it is highly unlikely anyone would bother doing a full genetic analysis of trauma in the manner you would like to see because I don't think there is any effective drug or sellable intervention at the end of it. The cost of doing such an analysis would be very heavy. I don't think the lack of a perfect analysis should stand in the way of considering the possible effects of trauma on the experience of disease and wanting medics to take this into account. While it may be an unattainable goal to find out how to stop trauma related conditions from developing at all it is surely possible to mitigate the severity of existing symptoms if trauma is considered as a possible contributor.

I don't recall ever seeing anyone here suggest someone should stop seeking medical answers for a physical condition on the basis that what they have is trauma, but clearly I have not read every post on this forum so perhaps someone has. I believe I have seen posts where people talk about their unexplained symptoms and it has been suggested that trauma is playing into their situation, or could be the originator of the symptoms. I don't think it follows that the next step is for the sufferer to stop seeking medical answers and meditate. I do think it is reasonable to take the possibility of trauma into account. Whatever can be done in mitigation should surely be considered, both medical and psychological.

[Kizzie]

Just thought of something else - it's offtrack from obesity but I think it fits with the discussion in the thread.

In most countries, if/when those in medicine pick up on abuse/neglect of a child then they are required to report and that connects the child to social services who can/do take measures to protect the child. There is research to demonstrate that if children who are abused/neglected have even one significant other who cares for them, the damage done is reduced. If SS gets involved there may be therapists for the children and family, parenting classes for their parents, ongoing monitoring, removal from the abuse/neglect, etc. All of this can reduce the amount of traumatic stress a child is exposed to and in turn that likely mitigates the development of disease/illness related to overexposure to stress hormones, not to mention emotional overwhelm. 

So this alone is a great reason that those in medicine learn more about complex relational trauma and developmental trauma disorder.

 

[Kizzie]

Just to bring this thread back to obesity, here is an article The Big Blue and I wrote for the newsletter "Complex Trauma Perspectives" for the Complex Trauma Special Interest Group at the International Society for Traumatic Stress Studies - https://istss.org/wp-content/uploads/2026/04/Complex-Trauma-Perspectives-April-2026.pdf. Scroll down to page 13 to our article "Beyond Willpower: Understanding Obesity as a Complex Trauma Response". It's about the science behind obesity that those in healthcare need to know given obesity carries a good deal of judgement and stigma, and for so many of us dealing with it, shame.

I find it interesting when I read that so many people who have been prescribed GLP-1 medications say that one thing they have found is it cancels the "food noise" for them, that is, the driven thinking about food many of us have. It's interesting and a relief that this is because of a medication for the body and not a psychiatric one to help deal with the emotions of CPTSD such as antidepressants. (And actually, weight gain has been shown to be a side effect of certain psych meds - See https://pmc.ncbi.nlm.nih.gov/articles/PMC12121960/.)

[Hope67]

Kizzie and The Big Blue - Thank you for writing such an interesting and helpful article.  I have been obese in previous years of my life, and am still overweight.  I recognise how my CPTSD has impacted my body and made my relationship with weight to be one of shame and perceived judgement over time, when others haven't thought about the potential reasons for that weight gain and relationship to food.

I am grateful to you both for focusing on this issue, and I really like the Complex Trauma Perspectives newsletter.

[Kizzie]

Thanks Hope, glad you liked the article and the newsletter!

[Kizzie]

An article on Ozempic and food noise from Scientific American: Ozempic Quiets Food Noise in the Brain—But How? - https://www.scientificamerican.com/article/ozempic-quiets-food-noise-in-the-brain-but-how/

[Marcine]

Congrats Kizzie and TBB on the publication of your compassionate, scientific, readable and important article!

"...telling someone whose interoceptive system is disrupted to listen to your body's hunger cues is akin to telling
someone who is deaf to try harder to hear. The signal may not be there or it's so distorted that it can't be trusted."

This hit hard, as did the call for language that reflects the complexity and nuances of the lived reality.

The hopeful note of it not being too late, that survivors are not broken, and that we can encourage positive change in the medical establishment's awareness of the vast ways that trauma shows up in our bodies... yes.

[dollyvee]

Throughout the rest of my life, I've had several times of going through various bloodwork and tests done for other things, and generally, everything was always good.  I've even had doctors tell me that my results seemed too perfect.  There has literally never been an answer for almost 50 years.

Yes, I've been in this situation before where I was told that my results were great and it was all in my head and that there was nothing wrong (and for a lot if people with certain autoimmune conditions as well ie the book, Why do I Still Have Thyroid Symptoms When My Results Are Normal?). However, it doesn't mean that doctors always look in the right places as I found out. A lot of them don't have training in complex system disorders like MCAS foe example and they are very quick to write things off. What helped me most was seeing a functional medicine practitioner  (some of whom are also doctors) though the costs can be extortionate and again, it can be a crap shoot as to who you get just like GPs. But it did help point me in the right direction as to what was going on physically, so that I could then clear that out of the way and begin focusing on my trauma.

Again, I get that one subset of symptoms line up with trauma, but it seems perhaps like landing on an answer that fits because of one symptom aligning rather than staying open to other options. For example, nosebleeds are also caused by dehydration.

Anyways, these are just my two cents.

dolly

[dollyvee]

Given your quoted words above I think it is highly unlikely anyone would bother doing a full genetic analysis of trauma in the manner you would like to see because I don't think there is any effective drug or sellable intervention at the end of it.

Yes, and unfortunately the same argument could be made for trauma.

There was apparently a study done by the American College of Preventative Medicine and this is a summary write up (I will find the initial study as well if possible):

https://www.madinamerica.com/2023/01/american-college-of-preventative-medicine-makes-recommendations-for-preventing-and-mitigating-adverse-childhood-experiences/

It seems like the most impactful way of dealing with ACEs was actually through resiliance programs in school:

Concerning KQ3, the present study finds that school-based mental health promotion programs positively impacted ACE. These programs showed an increase in student resilience and protective factors (such as enhanced coping skills). While there were some positive findings, overall, there is limited evidence for the efficacy of most of the interventions reviewed for children that had experienced childhood adversity. The intervention with the strongest link to positive outcomes was cognitive behavioral therapy for children that had been sexually abused.

In the recommendations listed they say:

Health systems should conduct a rigorous evaluation of the implementation of trauma-informed approaches for patients with a history of ACE.

However, it is also stated that:

Five of these seven recommendations are based on expert opinion rather than solid evidence. The remaining two are based on "limited quality evidence," according to the authors of the current work. None of these recommendations have robust and consistent evidence to support their efficacy.

The present research is partly an attempt to implement those findings into healthcare protocols. While some authors have lamented that we have not incorporated the lessons from this research into societal care, others argue that the data is essentially unusable as the survey score does not correlate with trauma effects (among other problems).

For me, it's also really interesting going back and reading the thread on Is it Autism and CPTSD that has been added to recently where there is a similar idea of which one is it? However, the tone and openness given to that exploration is much different than the correlation between health/medical issues and cptsd ie one seems to not be able to give a definitive answer and consider the nuance (ie I can't really say which one it is or what came first) and the other does not. Again, it's just interesting to consider and observe the difference.

dolly

[dollyvee]

Congrats on finding that Ozempic limits the food noise happening Kizzie

[TheBigBlue]

Just to bring this thread back to obesity, here is an article The Big Blue and I wrote for the newsletter "Complex Trauma Perspectives" for the Complex Trauma Special Interest Group at the International Society for Traumatic Stress Studies - https://istss.org/wp-content/uploads/2026/04/Complex-Trauma-Perspectives-April-2026.pdf. Scroll down to page 13 to our article "Beyond Willpower: Understanding Obesity as a Complex Trauma Response". It's about the science behind obesity that those in healthcare need to know given obesity carries a good deal of judgement and stigma, and for so many of us dealing with it, shame.

I wanted to thank Kizzie for sharing the article, and also thank everyone who took the time to read it and share their reactions. 💛

One reason co-writing this article was important to me is that for most of my life I viewed obesity almost entirely through the lens of willpower, discipline, and personal responsibility. That perspective brought with it a great deal of shame and self-blame, which many trauma survivors know all too well. Looking back, I can see how incomplete that picture was.

During the process of researching the science and writing the article, I found myself reflecting on my own experiences in ways I had not before. In some ways, it felt like parts of my story were finally being witnessed and understood.

What has struck me most over the past days isn't whether every detail applies equally to every person. It's how many survivors have expressed some version of: "I felt seen."

For me, that was always the goal.

Not to suggest that trauma explains everything. Not to argue that there is only one path. But to acknowledge that for many people, there are experiences underneath the weight that are rarely discussed with compassion.

Reading the responses has reminded me that many of us spent years believing our struggles were personal failures, when in reality there were often much bigger stories underneath.

I'm grateful to everyone who shared their experiences and perspectives. The conversations that resonate most with me are the ones that help survivors better understand themselves, treat themselves with a little more compassion, and feel a little less alone. 💛

[NarcKiddo]

Thanks, Dolly. That's interesting reading and aligns with commentary I have also read on PCEs (positive childhood experiences) mitigating the effects of ACEs. I think we have a thread on it somewhere.