In this study, clinical data from 22 obese women who reported a history of sexual abuse were compared to clinical data from 22 obese women who denied a history of sexual abuse. Subjects were matched for body mass index (BMI), sex, and age. All subjects were enrolled in a multidisciplinary outpatient hospital-based very-low-calorie diet (VLCD) weight-management program. Subjects completed a structured clinical interview, the Beck Depression Inventory (BDI), and the Weight Efficacy Life-Style Questionnaire (WEL). Subjects with a history of sexual abuse lost significantly less weight and reported more episodes of nonadherence. Possible explanations for these findings include both psychiatric distress and low weight self-efficacy. The difference between the groups in self-efficacy was greatest in situations involving negative affect or physical discomfort.