Shamed and angry: The beauty contestant Trump mocked for her weight

For 20 years, Alicia Machado has lived with the agony of what Donald Trump did to her after she won the Miss Universe title: shame her, over and over, for gaining weight.

Private scolding was apparently insufficient. Trump, at the time an executive producer of the pageant, insisted on accompanying Machado, then a teenager, to a gym, where dozens of reporters and cameramen watched as she exercised.

Trump, in his trademark suit and tie, posed for photographs beside her as she burned calories in front of the media. "This is somebody who likes to eat," Trump said from inside the gym.

On Monday night, Hillary Clinton turned Machado's pain into a potent political weapon on the biggest possible stage.

In the process, the first female nominee of a major party elevated a largely forgotten tale of Trump, when his oversight of beauty pageants collided with his unforgiving fixation with female beauty.

And Clinton put a spotlight on Machado, who says she never fully recovered from the experience. Miss Universe 1996, who grew up in Venezuela, said she had eating disorders and psychological trauma as a result of the episode.

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"I was sick — anorexia and bulimia for five years," she said in an interview with The New York Times in May. "I was 18. My personality wasn't created yet. I was just a girl."

Trump has acknowledged pressuring her to lose weight, saying it was her job as Miss Universe to remain in peak physical shape. On Tuesday morning, he made no apologies for that.

"She gained a massive amount of weight and it was a real problem," Trump told Fox News.

On the debate stage, Clinton seized on his conduct. At the end of Monday night's 90-minute confrontation, she reminded viewers of Trump's frequently crude remarks about women and their bodies.

"One of the worst things he said was about a woman in a beauty contest. He loves beauty contests, supporting them and hanging around them," Clinton said, as she slowly unfurled the story.

"And he called this woman 'Miss Piggy.' Then he called her 'Miss Housekeeping,' because she was Latina."

Clinton paused.

"Donald, she has a name: Her name is Alicia Machado."

Trump, clearly furious, interrupted.

"Where did you find this? Where did you find this?"

Clinton concluded with a kicker looking forward to Election Day.

"She has become a U.S. citizen, and you can bet she's going to vote this November."

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Machado, in a series of interviews this year with The Times, recalled the experience and its long-term impact on her life for an article about how Trump treats women.

By her account, she gained about 12 pounds after becoming Miss Universe. Trump was not pleased. He said she had gained even more.

Machado recalled the specific taunts from Trump that Clinton invoked on Monday night during the debate, as well as another sobriquet: "Miss Eating Machine."

Now, Machado is an avid supporter of Clinton. She has appeared in an ad criticizing him. Since her setback in 1996, her career has blossomed. Machado is now a well-known actress throughout Latin America.

But the scar, she says, still remains.

"Over the past 20 years," Machado said, "I've gone to a lot of psychologists to combat this."