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Cited by 169Posttraumatic Stress Disorder ResearchEating Disorders and BehaviorsObesity, Physical Activity, Diet

The Weight of Traumatic Stress: A Prospective Study of Posttraumatic Stress Disorder Symptoms and Weight Status in Women

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Kubzansky, Laura D., Bordelois, Paula, Jun, Hee Jin, Roberts, Andrea L., Cerda, Magdalena, Bluestone, Noah, Koenen, Karestan C.·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2013.2798PMC PMC4091890
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Abstract

IMPORTANCE: Posttraumatic stress disorder (PTSD) indicates a chronic stress reaction in response to trauma. This prevalent condition has been identified as a possible risk factor for obesity. Whether PTSD symptoms alter the trajectory of weight gain or constitute a comorbid condition has not been established. OBJECTIVE: To determine whether women who develop PTSD symptoms are subsequently more likely to gain weight and become obese relative to trauma-exposed women who do not develop PTSD symptoms or women with no trauma exposure or PTSD symptoms and whether the effects are independent of depression. DESIGN, SETTING, AND PARTICIPANTS: The Nurses' Health Study II, a prospective observational study initiated in 1989 with follow-up to 2005, using a PTSD screener to measure PTSD symptoms and time of onset. We included the subsample of the Nurses' Health Study II (54 224 participants; ages 24-44 years in 1989) in whom trauma and PTSD symptoms were measured. EXPOSURES: Trauma and PTSD symptoms. MAIN OUTCOMES AND MEASURES: Development of overweight and obesity using body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) cut points 25.0 and 30.0, respectively; change in BMI during follow-up among women reporting PTSD symptom onset before 1989; and BMI trajectory before and after PTSD symptom onset among women who developed PTSD symptoms in 1989 or during follow-up. RESULTS: Among women with at least 4 PTSD symptoms before 1989 (cohort initiation), BMI increased more steeply (b = 0.09 [SE = 0.01]; P < .001) during the follow-up. Among women who developed PTSD symptoms in 1989 or later, BMI trajectory did not differ by PTSD status before PTSD onset. After PTSD symptom onset, women with at least 4 symptoms had a faster rise in BMI (b = 0.08 [SE = 0.02]; P < .001). The onset of at least 4 PTSD symptoms in 1989 or later was also associated with an increased risk of becoming overweight or obese (odds ratio, 1.36 [95% CI, 1.19-1.56]) among women with a normal BMI in 1989. Effects were maintained after adjusting for depression. CONCLUSIONS AND RELEVANCE: Experience of PTSD symptoms is associated with an increased risk of becoming overweight or obese, and PTSD symptom onset alters BMI trajectories over time. The presence of PTSD symptoms should raise clinician concerns about physical health problems that may develop and prompt closer attention to weight status.

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  • Separate studies following up 50,000 women over 20 years found that higher PTSD symptom levels were associated with more future weight gain and with less healthy changes in diet quality over time.

    “For example, separate studies following up 50 000 women over 20 years found that higher PTSD symptom levels were associated with more future weight gain and with less healthy changes in diet quality over time. 136,137”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [137]

    The Results (PTSD Symptoms and Weight Gain) report that higher PTSD symptom levels were associated with greater BMI increases over time. The Methods (Source and Study Population) describe about 50,500 women, but this study assessed outcomes from 1989 through 2005, not over 20 years. It did not assess changes in diet quality; that part of the sentence appears to be offered by the other citation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Longitudinal studies show that negative psychological factors precede and predict poorer health-related behaviors and faster rate of weight gain.

    “Although the question of bidirectionality exists between the presence of negative psychological states and these cardiac risk factors, longitudinal studies show that negative psychological factors precede and predict poorer health-related behaviors and faster rate of weight gain. 136-138”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [137]

    The Discussion (page not provided) reports that PTSD symptom onset preceded faster BMI increases in women, supporting the weight-gain portion of the claim. It also cites associations between PTSD and physical inactivity or unhealthy food consumption, but does not establish that psychological factors preceded and predicted those behaviors. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Those studies found a steeper decline in physical activity after the onset of PTSD symptoms.

    “Moreover, they found a steeper decline in physical activity after the onset of PTSD symptoms. 136-138”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [137]

    The Discussion says prior studies suggest PTSD is associated with physical inactivity, which supports a general link. But the Results section, “PTSD Symptoms and BMI Trajectory,” reports a faster rise in BMI after symptom onset—not a measured decline in physical activity. Our copy therefore does not support the claimed timing or trajectory of physical activity. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C.
Affiliations
  • Harvard University (US)
  • Columbia University (US)
  • Brigham and Women's Hospital (US)
  • Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York
  • Boston University (US)
Corresponding author
Kubzansky, Laura D.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-01-01
Volume
71
Issue
1
Pages
44
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2013.2798
PMC
PMC4091890
OpenAlex
W2035507669
Cited by
169
References
8
Citations by year
2026: 9 · 2025: 6 · 2024: 11 · 2023: 11 · 2022: 11 · 2021: 11 · 2020: 13 · 2019: 15 · 2018: 10 · 2017: 27 · 2016: 14 · 2015: 21 · 2014: 10
FWCI
16.69
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5r01mh093612-03)
  • National Institute of Mental Health (MH093612, R01MH078928, R01-MH093612, MH-078928)
  • National Institute on Drug Abuse (K01DA030449)
  • National Cancer Institute (CA50385, R01CA050385)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
post-traumatic stress disorder, obesity, weight gain, body mass index trajectories, trauma exposure, women, depression, chronic stress, Nurses' Health Study II, overweight risk
MeSH terms
Adult, Female, Humans, Obesity, Prospective Studies, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, Stress Disorders, Post-Traumatic, Weight Gain, Body Mass Index, Overweight

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