Food addiction: the psychological truth behind extreme obesity, trauma and the price of social isolation

The movie "The Whale," with Brendan Fraser in the leading role, ignited a conversation surrounding severe obesity. Some commend the film for its realism, while others condemn it for promoting fatophobia. How did you view this film?

Psychological dietitian Marzena Sekuła from LuxMed group's Harmonia clinic*: I appreciate that "The Whale" was made, as it helps de-stigmatize the image of a patient suffering from severe obesity. The film portrays a tormented, lonely man who needs assistance with basic life activities. It demonstrates that obesity is not merely a cosmetic issue, but a debilitating disease, often seeping from the patients' traumatic experiences.

So, how does society perceive individuals with severe obesity?

Oftentimes, the issue gets simplified down to improper diet and insufficient physical activity. However, the reality is much more severe. Extreme obesity typically translates to an excess body weight of not just five or ten kilograms, but often fifty or even a staggering one hundred and fifty. Such a simplistic view of obesity is hugely disheartening for those living with it, adding to feelings of guilt, negatively affecting self-esteem, and even precipitating suicidal thoughts.

Where does the real issue typically lie?

The real problem should be sought not merely in the plate, but also beneath it. In "The Whale," we encounter a man named Charlie who suffers from food addiction due to unresolved trauma following his partner's death. Many of my patients have experienced similarly taxing circumstances—they've mourned the loss of loved ones, fallen prey to sexual exploitation, or come from homes marked by physical and psychological violence.

Why do traumatic experiences influence our relationship with food so much?

Eating, especially highly processed food, can temporarily improve mood and alleviate psychological pain. Consumption causes a spike in the release of serotonin and dopamine—the "happiness hormones"—bringing temporary relief and pleasure. This tends to foster a vicious cycle. When neurotransmitter levels dip, mood drops, and we seek ways to revive the feeling of contentment.

We often underestimate the "power" of highly processed food. We don't consider it something that can lead to addiction. Whereas frequent purchases of small alcohol bottles lead to labelling someone an alcoholic, overeating processed food doesn't cause similar alarms. One might say it's socially acceptable. Consuming such food brings pleasure and might cause a loss of self-control. It's also effortless to find comfort in processed food, given its easy availability.

Approximately 9 million Poles suffer from obesity, with around 800 thousand cases being extreme. How do these individuals live?

You might say individuals afflicted with extreme obesity experience what could be termed social death. Establishing relationships, starting families, or securing jobs are challenging feats for them. Society pushes them to the margins as they become socially isolated, confined to their homes and hidden from judgemental eyes. They try to become invisible, living alone and often, dying alone as well.

They grapple with not just physical, but also unimaginable emotional pain. Simple tasks like rising from a bed or a couch require monumental effort and border on the miraculous. A patient weighing 661 pounds (300 kg) won’t have the capacity to rise off the floor unaided—they're dependent on others. Obesity is a complex illness. It manifests subtly at first, intensifying over time, inducing over 200 complications, wreaking havoc on body and mind. Patients often describe their problems as cloaked beneath numerous kilograms.

Are they fearful of judgement?

I recently had a conversation with a young woman suffering from obesity. She was 20 years old and wore layers of black clothing as a way to camouflage her body. She kept her arms crossed over her torso, her body taut with tension as feelings of shame and danger overwhelmed her.

It took a considerable time for her to calm those reactions. This only happened when she recognized that I was not there to judge her but to help. Those who have endured great harm in their lives often tell me directly that their excess weight acts as a protective shield. When they themselves find their bodies unattractive, they believe they are less likely to draw attention from potential wrongdoers. However, they pay a tremendous psychological and somatic price for this.

Can you provide some examples?

Many of my patients prioritize the needs of others over their own, concentrating their energy on caring for their loved ones, leaving them with little time or energy for self-care. I advise them to practice some healthy selfishness in their lives—much like the airplane safety instruction where you must secure your own oxygen mask before helping others.

Why do they think in this way?

Childhood experiences influence this thinking. From an early age, they accept the belief that they are less important. One patient recently confessed that as an eight-year-old he wasn't free to play with his peers. Instead, he stayed home to care for his younger siblings. In this way, he subconsciously programmed himself to believe that his needs don't matter. He was forced to play the role of a caregiver at an age when he should have been attending to his basic needs as a child.

Can you recall any especially challenging patient history?

I listen to numerous shocking stories daily. However, the account of a particular 45-year-old patient has stayed with me. During our first appointment, we conducted a preliminary standard interview. It emerged that she had made several failed attempts to reduce her body weight and she blamed herself for these failures. The woman scheduled her next visit rather promptly, just a week later, expressing her desire to address a problem she had been suppressing for years.

What did she confess to you?

She disclosed that she was molested by her father as a teenager and, for nearly three decades, she had not told anyone about it. She blamed herself for the incidents. Overeating and excess weight were her means of escaping from the traumatic memories. She felt like a snail, using her body fat as a shell to hide in. Only then did she feel safe.

Once we reached the root of the problem, psychotherapy began to show results. Over time, the patient started dealing with her deeply buried suffering, which also initiated her physical healing.

And they exacerbate the issues faced by the affected individuals.

Every person, regardless of their weight or their appearance, deserves respect. Labeling or detrimental remarks reduce a patient's will to fight for their health, even when the critics might have intended to motivate. This problem is widespread, not just in society, but also amongst medical staff. I recently received a report about discrimination against obese individuals in healthcare—we have much to change in this regard. Therefore, not only is education crucial, but we also need to change the approach towards treating patients with obesity.

How does such discrimination influence decisions about treatment?

As a result of judgment and a lack of understanding, obese individuals often prefer to take matters into their own hands. They try out the next "miraculous" weight loss cures which, instead of producing spectacular results, destabilize the hunger and satiety mechanism, creating a yo-yo effect and intensifying the feelings of helplessness.

Keep in mind, obesity needs treatment. More and more centers in Poland offer comprehensive obesity treatment—not only surgical treatment, but also dietary, physiotherapeutic, and psychological treatment. Patients can expect full support and don't have to fear rejection.