Women With PTSD More Likely to Be Obese

Women who have post-traumatic stress disorder (PTSD) gain weight more rapidly than women who do not, according to researchers at the Harvard School of Public Health and Columbia University’s Mailman School of Public Health. Women with PTSD also are more likely to be overweight or obese.

Kubzansky and colleagues used a PTSD screener to measure PTSD symptoms and time of onset in the Nurses’ Health Study II, a prospective observational study initiated in 1989, with follow-up to 2005. They included the subsample of the Nurses’ Health Study II (54,224 participants; age, 24 to 44 years in 1989) in whom trauma and PTSD symptoms were measured.

The researchers assessed the development of overweight and obesity using body mass index (BMI) 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 in whom PTSD symptoms developed in 1989 or during follow-up.

The women were asked about the worst trauma they had experienced and whether they had related post-traumatic stress symptoms. Persistence of 4 or more symptoms over a month or longer was the threshold for PTSD. Common symptoms include re-experiencing the traumatic event, feeling under threat, social avoidance, and numbness.

Among women with at least 4 PTSD symptoms before 1989, BMI increased more steeply during the follow-up. Among women in whom PTSD symptoms developed in 1989 or later, BMI trajectory did not differ by PTSD status before PTSD onset. After PTSD symptom onset, the rise in BMI was faster in women with at least 4 symptoms. The onset of at least 4 PTSD symptoms in 1989 or later also was associated with an increased risk of becoming overweight or obese among women with a normal BMI in 1989. The effects were maintained after adjusting for depression.

The study authors made the following observations:

• Symptoms of PTSD rather than the trauma itself seemed to be behind the weight gain.

• One in 9 women will have PTSD at some point over the course of their lifetime, twice as many as men. Women also are more likely to experience extreme traumatic events, such as rape, that carry a high risk of PTSD.

• PTSD is not just a mental health issue. Its known health risks now include obesity as well as cardiovascular disease and diabetes mellitus.

• It appears that when PTSD symptoms abate, the risk of becoming overweight or obese also is significantly reduced.

• In spite of growing evidence of potential far-reaching problems associated with PTSD, maybe only half of women in the United States are ever treated. Wider recognition that PTSD also can influence physical health could lead to better screening and treatments, including those to prevent obesity.

• The biological pathway for PTSD leading to weight gain is unknown, but it may occur through overactivation of stress hormones. PTSD may lead to disturbances in functioning of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.

The authors concluded that the presence of PTSD symptoms in their patients should raise clinician concerns about physical health problems that may develop and prompt closer attention to weight status.

The study, the first to look at the relationship between PTSD and obesity over time, was published online November 20, 2013, in JAMA Psychiatry. It was supported by NIH grants.