Original Investigation |

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

Laura D. Kubzansky, PhD1; Paula Bordelois, MPH2; Hee Jin Jun, DrPH3,4; Andrea L. Roberts, PhD1; Magdalena Cerda, DrPH2; Noah Bluestone, BA5; Karestan C. Koenen, PhD2
[+] Author Affiliations
1Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
2Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York
3Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
4Department of Medicine, Harvard Medical School, Boston, Massachusetts
5graduate student at Boston University, Boston, Massachusetts
JAMA Psychiatry. 2014;71(1):44-51. doi:10.1001/jamapsychiatry.2013.2798.
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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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Figure 1.
Overall Design for Nurses’ Health Study II (NHS II) Assessment of Posttraumatic Stress Disorder (PTSD) and Body Mass Index (BMI)

Modified from Roberts et al.20

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Figure 2.
Unadjusted Mean Body Mass Index Trajectory Over Time by Trauma Exposure and/or Posttraumatic Stress Disorder (PTSD) Group

Includes women with trauma exposure and/or PTSD symptoms before 1989 or with no trauma exposure and no PTSD symptoms through 2005 (n = 41 976).aCalculated as weight in kilograms divided by height in meters squared.

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