Perceived stress, unhealthy eating behaviors, and severe obesity in low-income women
Richardson et al. Nutrition Journal
Perceived stress, unhealthy eating behaviors, and severe obesity in low-income women
Andrea S. Richardson 3
Joanne E. Arsenault 1
Sheryl C. Cates 0
Mary K. Muth 0
0 RTI International, Food and Nutrition Policy Research Program , 3040 E. Cornwallis Rd., Research Triangle, Park, NC 27709-3910 , USA
1 U.C. Davis, Program in International and Community Nutrition , 3217A Meyer Hall One Shields Ave., Davis, CA 95616 , USA
2 600 , Pittsburgh, PA 15213 , USA
3 RAND Health, RAND Corporation , 570 Fifth Ave
Background: Stress has been associated with poor eating behaviors and diet quality, as well as high body mass index (BMI). Low-income women may be particularly vulnerable to stress and severe obesity. Yet it is unknown how stress increases the risk of severe obesity through disordered eating behaviors and poor diet quality or through mechanisms independent of diet. Methods: We examined cross-sectional data from women (n = 101) with a child enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in Cumberland County, North Carolina (spring 2012). We collected measured heights and weights to calculate BMI. Using structural equation modeling, we differentiated pathways from stress to weight status: (1) indirectly through eating behaviors (cognitive restraint, emotional eating, and uncontrolled eating) and diet quality, which we examined with the Healthy Eating Index 2010 and 24-h dietary recalls, and (2) directly through possible unmeasured risk factors independent of diet. The analysis controlled for race/ethnicity, income, age, whether the dietary recall day was typical, and whether the respondent completed one or two 24-h dietary recalls. Results: Perceived stress was positively associated with uncontrolled eating (β = 0.38, p < 0.001) and emotional eating (β = 0.50, p < 0.001). However, higher stress was not associated with weight status through eating behaviors and diet quality. Independent of eating behaviors and diet quality, stress was positively associated with severe obesity (β = 0.26, p = 0.007). Conclusions: Improving stress coping strategies for low-income women may improve eating behaviors and reduce severe obesity.
Stress; Obesity; Severe obesity; Eating behaviors; Diet; WIC
Background
Obesity prevalence remains high; approximately 35 % of
American adults 20 years of age or older are obese [
1
].
Severe obesity prevalence, defined by a body mass index
(BMI) of 40 kg/m2 or more, is rising faster than
moderate obesity [
2–7
] and is expected to increase 130 % in
the adult U.S. population by 2030 [8]. Severely obese
individuals experience serious health complications such
as diabetes, hypertension, hyperlipidemia, asthma,
arthritis [
9
], and even reductions in life expectancy [
10, 11
].
Stress has been associated with weight gain [12] and
with potentially obesogenic eating behaviors, including
higher energy intake [
13
], increased saturated fat and
sugar intake [
14
], and poor diet quality [
15, 16
].
However, stress increases physiologic responses that are
independent of eating behaviors and diet. For example,
cortisol increases lipogenesis [
17, 18
]. Thus, stress might
influence severe obesity through the following pathways:
(1) through eating behaviors and diet quality and (2)
through biological processes. Yet few studies have been
able to disentangle how stress may be associated with
severe obesity through eating behaviors and diet quality
from other stress-related risk factors that are
independent of diet. Low-socioeconomic women are a particularly
vulnerable population that is also disproportionately
burdened by severe obesity [
19
]. Given the difficulty of
treating severe obesity [
20, 21
], as well as its serious
cardiometabolic [
9, 11
] and psychological comorbidities
[
22–24
], it is critical to identify risk factors that may
contribute to severe obesity.
A pathway from stress to severe obesity may operate
through eating behaviors [
25
] if people turn to less healthy
and obesogenic dietary behaviors as a means of coping
with stress. High perceived stress (upper quartile), versus
normal stress, has been associated with worse diet quality
[
26
], greater intake of snack foods and lower intake of fruit
[
27, 28
], increased disinhibition [29], and binge eating
[
30
]. The association between stress and increased food
intake was once thought to occur through impaired
cognitive restraint; however, the evidence supporting that
association has recently been questioned [
31
]. Instead, stress
may activate reward signal pathways in the brain that
increase intake of highly palatable foods [
32
], high-fat foods
[
33
], and snack foods and decrease intake of fruit [
28
].
Three eating behavior constructs are restraint,
disinhibition, and hunger, which can be assessed by a
psychometric questionnaire [
34
]. Restraint is the conscious
restriction of food intake to control body weight. (...truncated)