Research ArticleChildhood Maltreatment and BMI Trajectory: The Mediating Role of Depression
Introduction
Approximately 30% of the U.S. population experiences maltreatment during childhood.1, 2 Childhood maltreatment is associated with faster gain in BMI from adolescence to adulthood3 and with elevated risk of incident visceral obesity,4 severe obesity,5, 6 and cardiovascular disease.7 The pathways through which maltreatment during childhood may promote excessive weight gain are largely unexplored, but may include depression, as recently highlighted.8 Childhood maltreatment is associated with higher risk of early onset depressive symptoms,9 depression, and suicidality.10, 11, 12, 13, 14 In turn, in some types of depression, elevated appetite and psychomotor retardation15, 16 can promote weight gain. However, the mediating role of depression has not been tested.
Furthermore, childhood maltreatment can take many forms, ranging from supervisory or emotional neglect to physical or sexual abuse. Depression may play a stronger role for maltreatment types that induce cognitive precursors to depression such as shame and guilt. For example, sexual abuse is predictive of adult obesity, theoretically by triggering overeating behaviors and altering neural systems,17 which are also linked to depression. Other types of childhood maltreatment are less studied, but may involve different behavioral pathways such as substance use or risky behaviors.18, 19
This study addresses three corresponding gaps in understanding of pathways leading from childhood maltreatment to obesity. First, defining subtypes of maltreatment is critical for studying distinct pathways, but is complicated by the co-occurrence of multiple maltreatment types which may interact in their effects on mental and physical health.20 Second, boys and girls may respond differently to maltreatment; for example, to cope with stress, girls more often engage in emotional eating or binge eating, whereas boys are more likely to exhibit aggressive behavior.21, 22 Third, different maltreatment pathways may incur health effects at different life stages. For example, disordered eating may impact early weight gain whereas depression may have delayed impacts on weight gain emerging in adolescence or adulthood.
Study objectives are to test the hypotheses that more severe types of maltreatment, such as sexual abuse, are (1) more strongly associated with depression and BMI trajectory and (2) more strongly mediated by depression earlier in adolescence, and that (3) these pathways are stronger in girls than boys. Latent class analysis (LCA) is used to account for comorbidity between maltreatment types. Gender-stratified latent growth curve (LGC) analysis is used to examine how depression trajectories contribute to associations between childhood maltreatment and BMI trajectories from adolescence to adulthood. LGCs model age-related differences within the critical periods of adolescence and young adulthood using an accelerated cohort design.23
Section snippets
Study Population
Data were obtained from the National Longitudinal Study of Adolescent to Adult Health (Add Health).24 Initially a school-based study, the sample is representative of adolescents attending U.S. public, private, and parochial schools in grades seven to twelve in the 1994–1995 school year, with over-sampled groups (e.g., non-Hispanic blacks with a college-educated parent). The Wave I in-home participant and parental interview was conducted in 1994–1995 (aged 11–21 years, N=20,745; Appendix Figure 1
Results
Participants were, on average, approximately aged 15 years at Wave I (Appendix Table 3, available online). Girls and boys had similar demographic characteristics, though boys tended to earn more income and girls tended to have higher education by Wave IV. Girls and boys had similar BMI across waves. Depression was higher in girls in all Waves, but decreased over time in boys and girls.
Overall maltreatment prevalence was 55% in girls and boys. Supervisory neglect was the most common (Girls,
Discussion
This study investigated depression as a potential mechanism by which discrete classes of childhood maltreatment may impact BMI trajectory from adolescence to adulthood. Although maltreatment was associated with both depression and, to a lesser extent, BMI trajectories from adolescence to adulthood, the relationship between physical abuse dominant maltreatment and faster BMI gain was mediated by depression only among girls.
The study findings partially support the hypotheses that depression
Conclusions
A recent call for “trauma-informed obesity prevention” recommends development of secondary prevention strategies that mitigate the adverse health consequences of childhood maltreatment.8 This study investigated depression as a potential secondary prevention focus. Although childhood maltreatment was consistently associated with depression in adolescence, less improvement in depression mediated the relationship between only one type of maltreatment— physical abuse dominant—and faster BMI gain in
Acknowledgments
This research uses data from National Longitudinal Study of Adolescent to Adult Health (Add Health), a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is given to Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested
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Adverse Childhood Experiences and BMI: Lifecourse Associations in a Black–White U.S. Women Cohort
2024, American Journal of Preventive MedicineMentorship in adolescence and subsequent depression and adiposity among child maltreatment survivors in a United States nationally representative sample
2023, Preventive MedicineCitation Excerpt :CM is associated with various adverse mental and physical health outcomes over the lifecourse, including in racially/ethnically diverse populations (Llabre et al., 2017; Boynton-Jarrett et al., 2012; Pierce et al., 2020; Danese et al., 2007; Suglia et al., 2014). Two outcomes widely associated with CM are depression/depressive symptoms and obesity (Alvarez et al., 2007; Greenfield and Marks, 2009; Holshausen et al., 2016; Vallati et al., 2020), which are both public health crises and associated with multiple types of CM (meta-analysis based ORs for any CM = 1.36, 95% CI:1.26–1.47 and 2.03 95% CI:1.37–3.01 for obesity and depression, respectively) (Li et al., 2016; Danese and Tan, 2014) in several studies, such as The National Longitudinal Study of Adolescent to Adult Health (“Add Health”) (Sokol et al., 2019; Sacks et al., 2017; Kim et al., 2022) Obesity is highly prevalent in the United States (2019 prevalence = 42.4%), and the prevalence has been steadily increasing from prior decades (Centers for Disease Control and Prevention, 2022b). Depression has experienced a particularly pronounced increase in recent years and during the COVID-19 pandemic (Lancet., 2021).
Child and Adolescent Abuse Patterns and Incident Obesity Risk in Young Adulthood
2022, American Journal of Preventive MedicineCitation Excerpt :Although these increases in risk are relatively modest, they may translate into substantial effects at the population level because an estimated 25% of children in the U.S. experience abuse.7 Some evidence suggests that associations of child abuse with obesity may be stronger for women than for men8–10 possibly because women are more likely than men to experience sexual abuse,11 which is more severe, or because women are more likely to develop psychiatric disorders that are associated with obesity risk, such as depression.9 There are several important limitations to the previous literature on child abuse and adult obesity.
Maltreatment experience in childhood and average excess body mass from adolescence to young adulthood
2019, Child Abuse and NeglectChild maltreatment and body mass index over time: The roles of social support and stress responses
2019, Children and Youth Services ReviewCitation Excerpt :Research has linked the stress responses of depressive symptoms and impulsivity to poor weight outcomes in adolescence, as both depression and impulsivity are associated with weight-related disturbances (Korczak, Lipman, Morrison, & Szatmari, 2013; Thamotharan, Lange, Zale, Huffhines, & Fields, 2013). Using Add Health, Sacks and colleagues also found that depression mediated the relationship between physical abuse in childhood and BMI trajectories in girls (Sacks et al., 2017). These findings align with TMSC, which suggests stress responses can result in decreased functional health, including poor weight outcomes (Heatherton & Baumeister, 1991).