Children and teenagers who have experienced stressful or traumatic events are more likely to be overweight or obese, according to a recent study by researchers at the University of Minnesota.
The study also found that the greater the number of adverse experiences in children’s lives, the stronger the likelihood they will be overweight or obese.
Previous research has already shown a link between childhood adversity and weight problems later in life, but this new study suggests that the relationship begins earlier, during childhood itself.
“People who provide health care for youth need a better understanding about this issue, and better preparation,” said Laurel Davis, the study’s lead author and a research associate at the U of M, in an interview with MinnPost. “They need to understand that the experience of adversity does have a profound effect on the health of youth — the physical health, not just the mental health.”
Obesity during childhood puts young people at increased risk for a range of medical conditions, according to the Centers for Disease Control and Prevention (CDC). These include higher blood pressure and high cholesterol (which are risk factors for heart disease), type 2 diabetes, asthma, sleep apnea and joint problems. In addition, young people more likely to experience depression, anxiety and low self-esteem.
Being obese during childhood also raises the risk of being obese during adulthood — with lifelong health consequences.
A detailed survey
The U of M study, published last month in the Journal of Pediatrics, used data collected from more than 105,000 participants in the latest (2016) Minnesota Study Survey, an anonymous survey administered every three years to students in the eighth, ninth and 11th grades across the state. The longest-running youth survey in the country, it assesses a variety of health-related behaviors and risk factors.
The data included the students’ height and weight, which enabled the U of M researchers to determine each student’s body mass index (BMI) and put them into one of five categories: underweight, normal (healthy) weight, overweight, obese or severely obese.
The survey collected other demographic information as well, including whether the students lived in urban or rural areas and whether they had been exposed to poverty. To determine the latter, the students were asked two questions that are stand-ins for family financial stress: “Do you currently get free or reduced-price lunch at school?” or “During the last 30 days, have you had to skip meals because your family did not have enough money to buy food?”
Through a series of yes/no questions, the survey also allowed the researchers to assess the students’ exposure to six adverse childhood experiences, or ACEs: psychological abuse, physical abuse, sexual abuse, family substance abuse, domestic violence and parent incarceration. Among the questions were these: “Does a parent or other adult in your home regularly swear at you, insult you, or put you down?” “Do you live with someone who drinks too much alcohol?” and “Have your parents or other adults in your home every slapped, hit, kicked, punched, or beat each other up?”
Of the students surveyed, 70.9 percent had a BMI within the healthy range, while 15.3 percent were overweight, 7.8 percent were obese, 3.2 percent were severely obese and 2.8 percent were underweight.
Being male, older, living in a rural area and living in poverty were all associated with having a higher BMI.
Most of the students reported no ACEs, but more than a third (35.4) percent had one or more. Being female, living in a rural area and living in poverty were all associated with a higher number of ACEs.
Davis and her colleagues then looked to see if there were any associations between the students’ ACEs and their BMIs. They found that young people with more ACEs were much more likely to be overweight, obese or severely obese than their peers with fewer or no ACEs.
Specifically, students who reported a single ACE were 1.2 times more likely to be overweight, 1.4 times more likely to be obese and 1.5 times more likely to be severely obese than their peers who reported no ACEs.
The relationship became stronger as the number of ACEs increased. For example, students who reported six ACEs were 1.5 time more likely to be overweight, 2.0 times more likely to be obese and 4.2 times more likely to be severely obese as students who reported none.
These findings suggest, write Davis and her colleagues in their paper, that childhood obesity, particularly severe obesity, may be at least partially explained by adverse childhood experiences.
Limitations and implications
“The study is correlational,” Davis pointed out. “So although we show that there is a relationship between weight status and experiences in childhood, this study doesn’t show us why that can be.”
Other research gives us hints, however. It may be, said Davis, that exposure to adverse experiences raises the risk of childhood obesity by epigenetically modifying the expression of children’s DNA in ways that encourages excess weight.
Psychological distress is also likely to be involved.
“People who are experiencing depression may cope with that by overeating or indulging in unhealthy foods,” Davis explained. “That’s a typical response to stress.”
Davis and her study co-authors say their study suggests that having pediatricians screen for ACES — and then, when appropriate, referring children and their families to social services — may be important part of treating childhood obesity.
The study’s finding that more than a third of Minnesota’s students have experienced at least one serious adversity in their young lives should concern all of us, Davis said.
“We are serving some young people well, and we are not serving other young people,” she added. “That desperately needs to change.”
FMI: You can find an abstract of the U of M study on the Journal of Pediatrics’ website, but the full study is behind a paywall.