Str e ss & Child obe sity: Die tar y pathways in the c onte - - PowerPoint PPT Presentation

Str e ss & Child obe sity: Die tar y pathways in the c onte xt of str e ss

E le a no r T a te Sho nko ff, PhD Ca ndida te

8t 8th B h Bienni ennial al C Chi hildhood dhood O Obes besity Conf

• nferenc

nce

July 2, 2015

What is str e ss?

A stre sso r disrupts ho me o sta sis a nd re q uire s a n o rg a nism to adapt a nd re sto re e q uilib rium

Selye, H. (1950). Stress and the general adaptation syndrome. British medical journal, 1(4667), 1383. Ursin, H., & Eriksen, H. R. (2004). The cognitive activation theory of stress. Psychoneuroendocrinology, 29(5), 567-592. Wilson, S. M., & Sato, A. F. (2014). Stress and Paediatric Obesity: What We Know and Where To Go. Chemphyschem, 15(5), 91-102.

Ac ute vs. Chro nic I nte rna l vs. E xte rna l Me a sure me nt: Sub je c tive , Ob je c tive , Bio lo g ic a l

Ar e c hildr e n str e sse d?

• f 12–17 ye a r o lds ha d

“me nta lly unhe a lthy da ys”

• n a lmo st ha lf o f the da ys

in the la st mo nth

Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C., . . . Schieve, L. A. (2013). Mental health surveillance among children— United States, 2005–2011.

8.3% 5%

• f 13-18 ye a r o lds ha d e ve r

e xpe rie nc e d Po st- tra uma tic Stre ss Diso rde r

T he or y: T r ansac tional Mode l

• f Str

e ss and Coping

Lazarus, R. S., & Cohen, J. B. (1977). Environmental stress Human behavior and environment (pp. 89-127): Springer.

Stressor Appraisal & coping efforts Coping

• utcomes:

Health behaviors Obesity risk

Could str e ss affe c t c hildr e n’s we ight- r e late d be havior s?

Craigie, A. M., Lake, A. A., Kelly, S. A., Adamson, A. J., & Mathers, J. C. (2011). Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas, 70(3), 266-284. Lazarus, R. S., & Cohen, J. B. (1977). Environmental stress Human behavior and environment (pp. 89-127): Springer.

Stressor Appraisal & coping efforts Coping

• utcomes:

Health behaviors Obesity risk

E a ting b e ha vio r Physic a l a c tivity

He a lth b e ha vio r le a rne d in c hildho o d te nds to tra c k to a dultho o d

E a ting b e ha vio r

Stre ss ma y c ha ng e e a ting be ha vior

• Stre ss ma y le a d to :

– hig he r swe e ts c o nsumptio n (o lde r a g e ; g irls) – e mo tio n-drive n e a ting & hig h-c a lo rie / lo w-

nutrie nt fo o ds

• E

mo tio n-fo c use d c o ping & unhe a lthy sna c ks

• Hig h-re a c tive / hig h-re stra int:

– mo re c a lo rie s (≈173 kcals) – e a t fo r lo ng e r (> 3 mins)

Balantekin, & Roemmich, (2012). Children’s coping after psychological stress. Choices among food, physical activity, and television. Appetite, 59(2), 298-304. Michels N. et al. (2015). Longitudinal Association Between Child Stress and Lifestyle. Health Psychology, 34(1), 40-50. Shimai, S., et al. (2000). Snacking behavior among elementary and junior high school students and its relationship to stress-coping. Japanese journal of public health, 47(1), 8-19.

Str e ss may inc r e ase obe sity r isk

• Chro nic stre ss ha s b e e n a sso c ia te d

with hig he r o b e sity risk

• Mo re like ly fo r g irls
• Stre ss-e a ting & hig he r sub se q ue nt
• dds o f o b e sity

De Vriendt et al. (2012). European adolescents' level of perceived stress and its relationship with body adiposity-The HELENA Study. European Journal of Public Health, 22(4), 519-524. Jaaskelainen et al. (2014). Stress-related eating, obesity and associated behavioural traits in adolescents: a prospective population-based cohort study. Bmc Public Health, 14. Wilson & Sato, 2014

Could obe sity a lso a ffe c t stre ss re a c tivity a nd e a ting be ha vior?

Obesity Stress Eating behavior

Obe sity ma y a ffe c t stre ss re sponse s a nd e a ting be ha vior

• Ove rwe ig ht/ o b e se yo uth:

– hig he r c o rtiso l re spo nse to so c ia l stre sso rs – mo re hig h-de nsity sa lty fo o ds fo llo wing

so c ia l stre ss

Horsch et al. (2015). Impact of physical activity on energy balance, food intake and choice in normal weight and obese children in the setting of acute social stress: a randomized controlled trial. Bmc Pediatrics, 15. Verdejo-Garcia et al. (2015). Social Stress Increases Cortisol and Hampers Attention in Adolescents with Excess Weight. Plos One, 10(4).

Bauer et al. (2012). Parental employment and work-family stress: Associations with family food environments. Social Science & Medicine, 75(3), 496-504 Hurley et al. (2008). Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC

• participants. Journal of Nutrition, 138(4), 799-805.

Parks et al. (2012). Influence of Stress in Parents on Child Obesity and Related Behaviors. Pediatrics, 130(5), E1096-E1104.

Me thods

• Ma te rna l stre ss a fte r the c hild’ s b irth
• 17 studie s; 19 inde pe nde nt e ffe c t

size s

• Mo the r-c hild dya ds

– M = 2,462

• Child a g e a t ma te rna l stre ss

me a sure

– c ro ss-se c tio na l (M = 6.36 yrs., SD = 3.23) – lo ng itudina l (M = 1.68 yrs., SD = 1.38)

Study qua lity, Public a tion bia s a nd Ana lysis

• T
• o l to Asse ss Risk o f Bia s in Co ho rt

Studie s (mo difie d)

• E

g g e r’ s te st; Duva l & T we e die ’ s trim a nd fill

• Mixe d e ffe c ts mo de ls
• Ove ra ll e ffe c t size , Sub g ro up, Me tho d o f

Mo me nts re g re ssio n

Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2011). Introduction to meta-analysis: Wiley. de Moraes, V. Y., Godin, K., dos Santos, J. B. G., Faloppa, F., Bhandari, M., & Belloti, J. C. (2013). Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis. Patient safety in surgery, 7(1), 1.

Positive e ffe c t size be twe e n ma te rna l stre ss &c hild obe sity risk

Cro ss-se c tio na l d = .20, p < .01 L

• ng itudina l

d = .18, p =.05 Mo de ra to rs in lo ng itudina l studie s:

Child stre ss Study q ua lity Child a g e

Child Age at Mate r nal Str e ss Me asur e

Cross- se c tiona l

R e g re s s io n

• f tim

e _ s tre s s

• n

P

• in

t e s tim a te

Point estimate

.3 .0 6 .4 2 .7 8 1 .1 4 1 .5 1 .8 6 2 .2 2 2 .5 8 2 .9 4 3 .3 .6 .5 3 .4 6 .3 9 .3 2 .2 5 .1 8 .1 1 .0 4

.0 3

.1

L

• ng itudina l

R e g re s s io n

• f a

v g _ a g e

• n

P

• in

t e s tim a te

Point estimate

1 .8 5 3 .0 3 4 .2 5 .3 7 6 .5 4 7 .7 1 8 .8 8 1 .0 5 1 1 .2 2 1 2 .3 9 1 3 .5 7 1 .0 .8 9 .7 8 .6 7 .5 6 .4 5 .3 4 .2 3 .1 2 .0 1

.1

Child age Effect size Effect size Child age

Ma te rna l stre ss is a ssoc ia te d with hig he r c hild obe sity risk

E ffe c t size d ≈ .19

E ffe c t ma y b e stro ng e r fo r to ddle rs tha n infa nts

Eating context

Child obesity Child stress Child eating behavior Parent stress

Conc lusions & Implic ations

• He lping fa milie s a nd c hildre n c o pe with

stre ss ma y he lp pre ve nt o b e sity

– E

duc a tio n in stre ss-ma na g e me nt te c hniq ue s

– Be a ttune d to e a ting ha b its fo r c hildre n in

hig h-stre ss e nviro nme nts

• F

uture re se a rc h:

– F

a mily/ e xte rna l stre sso rs vs. pe rc e ive d stre ss

• vs. stre ss re a c tivity (e x. c o rtiso l)

– I

nte rve ntio ns