America is getting fatter. Half our population is now considered overweight and another 18% obese. (New York Times, November, 2000.) Yet, extremely overweight women, carrying a burden of 100 to 200 extra pounds and subject to severe physical limitations plus a slew of health problems, also have to contend with society’s stigma regarding overweight. This causes them profound emotional anguish.

Society’s synonyms for “fat” include “self-indulgent,” “gross,” “dirty,” “lazy,” “stupid,” “undisciplined,” “out of control,” “disgusting,” "revolting,” “unattractive,” “ugly,” “a slob,” “sloppy.” These words are internalized by the overweight woman. “I feel so different, and an outcast. Diversity should be all-inclusive,” says Lisa* 39, a corporate employee who started her battle with weight as a chubby 8-year-old when her mother took her to one weight-loss program after another. Says Mark Roehling of the Western Michigan University’s Haworth College of Business: “The overweight person is out of the running.” His research shows that weight discrimination is much more prevalent in the hiring process than any other prejudice.

Our society has an ambivalent and convoluted attitude towards food and weight. The average women’s magazine has a recipe for “Doubly Decadent Chewy Chocolate Cake” close on the heels of “Seven Magic Methods for Vanishing Those Unwanted Pounds!” Andy Steiner, in the Utne Reader of March/April 2002 asks: “How can the skyrocketing obesity rates have happened when slimness, exercise and healthy food are obsessions in American media and advertising?” Marilyn Warm, author of Fat? So? claims that “American culture has this binge-purge mentality when it comes to food. We binge on high-calorie, high-fat items and purge on diets and food restrictions.”

Excess weight rapidly becomes a self-perpetuating problem. Sniggers from other health club members discourage women who used to enjoy swimming and aerobics. They are forced to buy clothes neither stylish nor suited to them, children point at them in supermarkets, and they are ashamed to go out of the house. And they are subjected to extreme verbal abuse.

Debra, applying her brakes rather suddenly on the freeway, was confronted by a driver who thrust his head out his car window, puffed up his cheeks and yelled, “ Fat pig – go on a diet!” “How much do you weigh?” inquired a stranger of Celia at a gas station. “You’re the fattest human being I’ve ever seen!”

“I can never get comfortable,” says Pricilla. “Fat people have to sit with their legs apart to accommodate their bellies. Struggling to squeeze into an airline seat or restaurant booth is humiliating. I can’t hide my problem like a binge drinker or a drug addict.” She dreams of a career change, but is scared she will not fit behind a school desk.

There are profound reasons why these women have “chosen” to protect themselves so well. An eating disorder is a survival mechanism. The root cause of extreme overweight - and other significant eating disorders - is what Lewis Engel and Tom Ferguson in Hidden Guilt term “basic badness” – the introjected belief that the person is worthless and undeserving, that “there is something deeply and fundamentally wrong with them.” This results from a dysfunctional family system, harmful parenting on all levels and a significant amount of childhood abuse and deprivation. These “tapes” must be erased at a cellular level; thus treatment is long-term and arduous. The therapist who works with such a client may face the challenge of dealing with dissociative and personality disorders, and many defenses, often with accompanying financial issues.

Harriet and Pauline, in psychoanalytic depth therapy, hypnotherapy and EMDR for 10 years, have come to the end of exploring and processing their abusive pasts. Both these women are losing weight as never before. They will keep it off, since emotional issues are no longer present and they now see weight loss as a choice. It is a means to give themselves the full and rich lives they now believe they deserve.

Taking part in the emergence of the spiritual and creative potential from beneath the insulating layers is a moving and exhilarating experience for any therapist. Seeing what it is like to be at the receiving end of society’s disgust and revulsion at extreme overweight means taking a sobering look at hidden cruelty in our culture.

*All names and identifying information have been changed.

Note: This article reflects the opinions of the author and not necessarily those of
East Bay CAMFT.