Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-23T11:40:08.348Z Has data issue: false hasContentIssue false

Post-traumatic stress disorder and the association with overweight, obesity, and weight change among individuals exposed to the World Trade Center disaster, 2003–2016

Published online by Cambridge University Press:  07 May 2020

Erin Takemoto*
Affiliation:
Department of Health & Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Suite 414, Long Island City, NY11101, USA
Katherine R. Van Oss
Affiliation:
Department of Health & Mental Hygiene, Center for Health Equity and Community Wellness, 42-09 28th St., Long Island City, NY11101, USA
Shadi Chamany
Affiliation:
Department of Health & Mental Hygiene, Center for Health Equity and Community Wellness, 42-09 28th St., Long Island City, NY11101, USA
Jennifer Brite
Affiliation:
Department of Health & Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Suite 414, Long Island City, NY11101, USA
Robert Brackbill
Affiliation:
Department of Health & Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Suite 414, Long Island City, NY11101, USA
*
Author for correspondence: Erin Takemoto, E-mail: etakemoto@health.nyc.gov

Abstract

Background

Among Veterans, post-traumatic stress disorder (PTSD) has been shown to be associated with obesity and accelerated weight gain. Less is known among the general population. We sought to determine the impact of PTSD on body mass index (BMI) and weight change among individuals with exposure to the World Trade Center (WTC) disaster.

Methods

We examined individuals from the WTC Health Registry. PTSD symptoms were assessed on multiple surveys (Waves 1–4) using the PTSD Checklist-Specific. Three categories of post-9/11 PTSD were derived: no, intermittent, and persistent. We examined two outcomes: (1) Wave 3 BMI (normal, overweight, and obese) and (2) weight change between Waves 3 and 4. We used multivariable logistic regression to assess the association between PTSD and BMI (N = 34 958) and generalized estimating equations to assess the impact of PTSD on weight change (N = 26 532). Sex- and age-stratified analyses were adjusted for a priori confounders.

Results

At Wave 3, the observed prevalence of obesity was highest among the persistent (39.5%) and intermittent PTSD (36.6%) groups, compared to the no PTSD group (29.3%). In adjusted models, persistent and intermittent PTSD were consistently associated with a higher odds of obesity. Weight gain was similar across all groups, but those with persistent and intermittent PTSD had higher estimated group-specific mean weights across time.

Conclusions

Our findings that those with a history of PTSD post-9/11 were more likely to have obesity is consistent with existing literature. These findings reaffirm the need for an interdisciplinary focus on physical and mental health to improve health outcomes.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adam, T. C., & Epel, E. S. (2007). Stress, eating and the reward system. Physiology & Behavior, 91(4), 449458. doi:10.1016/j.physbeh.2007.04.011.CrossRefGoogle ScholarPubMed
Appelhans, B. M. (2009). Neurobehavioral inhibition of reward-driven feeding: Implications for dieting and obesity. Obesity (Silver Spring), 17(4), 640647. doi:10.1038/oby.2008.638.CrossRefGoogle ScholarPubMed
Association, A. P. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC.Google Scholar
Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub.CrossRefGoogle Scholar
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34(8), 669673. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8870294.CrossRefGoogle Scholar
Brackbill, R. M., Hadler, J. L., DiGrande, L., Ekenga, C. C., Farfel, M. R., Friedman, S., … Thorpe, L. E. (2009). Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA, 302(5), 502516. doi:10.1001/jama.2009.1121.CrossRefGoogle ScholarPubMed
Buta, E., Masheb, R., Gueorguieva, R., Bathulapalli, H., Brandt, C. A., & Goulet, J. L. (2018). Posttraumatic stress disorder diagnosis and gender are associated with accelerated weight gain trajectories in veterans during the post-deployment period. Eating Behaviors, 29, 813. doi:10.1016/j.eatbeh.2018.01.002.CrossRefGoogle ScholarPubMed
CDC. (2018 a). Adult Obesity Causes & Consequences. Retrieved from https://www.cdc.gov/obesity/adult/causes.html.Google Scholar
CDC. (2018 b). Adult Obesity Factors. Retrieved from https://www.cdc.gov/obesity/data/adult.html.Google Scholar
CDC. (2020). Preventing Weight Gain. Retrieved from https://www.cdc.gov/healthyweight/prevention/index.html.Google Scholar
Chooi, Y. C., Ding, C., & Magkos, F. (2019). The epidemiology of obesity. Metabolism: Clinical and Experimental, 92, 610. doi:10.1016/j.metabol.2018.09.005.CrossRefGoogle ScholarPubMed
Chwastiak, L. A., Rosenheck, R. A., & Kazis, L. E. (2011). Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psychosomatics, 52(3), 230236. doi:10.1016/j.psym.2010.12.009.CrossRefGoogle ScholarPubMed
Cook, N. R., & Ware, J. H. (1983). Design and analysis methods for longitudinal research. Annual Review of Public Health, 4, 123. doi:10.1146/annurev.pu.04.050183.000245.CrossRefGoogle ScholarPubMed
Farfel, M., DiGrande, L., Brackbill, R., Prann, A., Cone, J., Friedman, S., … Thorpe, L. (2008). An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center health registry enrollees. Journal of Urban Health, 85(6), 880909. doi:10.1007/s11524-008-9317-4.CrossRefGoogle ScholarPubMed
Farr, O. M., Ko, B. J., Joung, K. E., Zaichenko, L., Usher, N., Tsoukas, M., … Mantzoros, C. S. (2015). Posttraumatic stress disorder, alone or additively with early life adversity, is associated with obesity and cardiometabolic risk. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, 25(5), 479488. doi:10.1016/j.numecd.2015.01.007.CrossRefGoogle ScholarPubMed
Fava, M. (2000). Weight gain and antidepressants. Journal of Clinical Psychiatry, 61 (Suppl 11), 3741. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10926053.Google ScholarPubMed
Ferguson, J. M. (2001). SSRI Antidepressant medications: Adverse effects and tolerability. Primary Care Companion To the Journal of Clinical Psychiatry, 3(1), 2227. doi:10.4088/pcc.v03n0105.CrossRefGoogle ScholarPubMed
Goran, M. I., Ball, G. D., & Cruz, M. L. (2003). Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. Journal of Clinical Endocrinology and Metabolism, 88(4), 14171427. doi:10.1210/jc.2002-021442.CrossRefGoogle ScholarPubMed
Gunderson, E. P., Murtaugh, M. A., Lewis, C. E., Quesenberry, C. P., West, D. S., & Sidney, S. (2004). Excess gains in weight and waist circumference associated with childbearing: The Coronary Artery Risk Development in Young Adults Study (CARDIA). International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity, 28(4), 525535. doi:10.1038/sj.ijo.0802551.CrossRefGoogle Scholar
Hirth, J. M., Rahman, M., & Berenson, A. B. (2011). The association of posttraumatic stress disorder with fast food and soda consumption and unhealthy weight loss behaviors among young women. Journal of Women's Health (Larchmt), 20(8), 11411149. doi:10.1089/jwh.2010.2675.CrossRefGoogle ScholarPubMed
Hruby, A., & Hu, F. B. (2015). The epidemiology of obesity: A big picture. Pharmacoeconomics, 33(7), 673689. doi:10.1007/s40273-014-0243-x.CrossRefGoogle ScholarPubMed
Huang, W. S., Hsu, J. W., Huang, K. L., Bai, Y. M., Su, T. P., Li, C. T., … Chen, M. H. (2018). Post-traumatic stress disorder and risk of osteoporosis: A nationwide longitudinal study. Stress and Health, 34(3), 440445. doi:10.1002/smi.2806.CrossRefGoogle ScholarPubMed
Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress: A prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry, 71(1), 4451. doi:10.1001/jamapsychiatry.2013.2798.CrossRefGoogle ScholarPubMed
Lagarde, G., Doyon, J., & Brunet, A. (2010). Memory and executive dysfunctions associated with acute posttraumatic stress disorder. Psychiatry Research, 177(1-2), 144149. doi:10.1016/j.psychres.2009.02.002.CrossRefGoogle ScholarPubMed
Launer, L. J., Harris, T., Rumpel, C., & Madans, J. (1994). Body mass index, weight change, and risk of mobility disability in middle-aged and older women. The epidemiologic follow-up study of NHANES I. JAMA, 271(14), 10931098. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8151851.CrossRefGoogle ScholarPubMed
Lin, C. J., DeRoo, L. A., Jacobs, S. R., & Sandler, D. P. (2012). Accuracy and reliability of self-reported weight and height in the sister study. Public Health Nutrition, 15(6), 989999. doi:10.1017/S1368980011003193.CrossRefGoogle ScholarPubMed
Maguen, S., Madden, E., Cohen, B., Bertenthal, D., Neylan, T., Talbot, L., … Seal, K. (2013). The relationship between body mass index and mental health among Iraq and Afghanistan veterans. Journal of General Internal Medicine, 28 Suppl 2, S563S570. doi:10.1007/s11606-013-2374-8.CrossRefGoogle ScholarPubMed
Martin, C. B., Herrick, K.A., Sarafrazi, N., & Ogden, C.L. (2018). Attempts to lose weight among adults in the United States, 20132016. Hyattsville, MD: National Center for Health Statistics: NCHS Data Brief, no 313.Google Scholar
Masodkar, K., Johnson, J., & Peterson, M. J. (2016). A review of posttraumatic stress disorder and obesity: Exploring the link. The Primary Care Companion for Cns Disorders, 18(1). doi:10.4088/PCC.15r01848.Google ScholarPubMed
Mastorakos, G., & Zapanti, E. (2004). The hypothalamic-pituitary-adrenal axis in the neuroendocrine regulation of food intake and obesity: The role of corticotropin releasing hormone. Nutritional Neuroscience, 7(5–6), 271280. doi:10.1080/10284150400020516.CrossRefGoogle ScholarPubMed
McLaren, L. (2007). Socioeconomic status and obesity. Epidemiologic Reviews, 29, 2948. doi:10.1093/epirev/mxm001.CrossRefGoogle ScholarPubMed
Michopoulos, V., Vester, A., & Neigh, G. (2016). Posttraumatic stress disorder: A metabolic disorder in disguise? Experimental Neurology, 284(Pt B), 220229. doi:10.1016/j.expneurol.2016.05.038.CrossRefGoogle ScholarPubMed
Mitchell, K. S., Porter, B., Boyko, E. J., & Field, A. E. (2016). Longitudinal associations among posttraumatic stress disorder, disordered eating, and weight gain in military men and women. American Journal of Epidemiology, 184(1), 3347. doi:10.1093/aje/kwv291.CrossRefGoogle ScholarPubMed
Murphy, J., Brackbill, R. M., Thalji, L., Dolan, M., Pulliam, P., & Walker, D. J. (2007). Measuring and maximizing coverage in the World Trade center health registry. Statistics in Medicine, 26(8), 16881701. doi:10.1002/sim.2806.CrossRefGoogle ScholarPubMed
North, C. S., Suris, A. M., Davis, M., & Smith, R. P. (2009). Toward validation of the diagnosis of posttraumatic stress disorder. American Journal of Psychiatry, 166(1), 3441. doi:10.1176/appi.ajp.2008.08050644.CrossRefGoogle Scholar
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA, 311(8), 806814. doi:10.1001/jama.2014.732.CrossRefGoogle ScholarPubMed
Ogden, C.L., Lamb, M. M., Carroll, M.D., & Flegal, K.M. (2010). Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics.Google Scholar
Ogden, C. L., Yanovski, S. Z., Carroll, M. D., & Flegal, K. M. (2007). The epidemiology of obesity. Gastroenterology, 132(6), 20872102. doi:10.1053/j.gastro.2007.03.052.CrossRefGoogle ScholarPubMed
Padilla Colon, C. J., Molina-Vicenty, I. L., Frontera-Rodriguez, M., Garcia-Ferre, A., Rivera, B. P., Cintron-Velez, G., & Frontera-Rodriguez, S. (2018). Muscle and bone mass loss in the elderly population: Advances in diagnosis and treatment. Journal of Biomedicine (Syd), 3, 4049. doi:10.7150/jbm.23390.CrossRefGoogle ScholarPubMed
Pagoto, S. L., Schneider, K. L., Bodenlos, J. S., Appelhans, B. M., Whited, M. C., Ma, Y., & Lemon, S. C. (2012). Association of post-traumatic stress disorder and obesity in a nationally representative sample. Obesity (Silver Spring), 20(1), 200205. doi:10.1038/oby.2011.318.CrossRefGoogle Scholar
Pagoto, S. (Ed.). (2011). Psychological co-morbidities of physical illness: A behavioral medicine perspective. Springer Science & Business Media.CrossRefGoogle Scholar
Palta, M., Prineas, R. J., Berman, R., & Hannan, P. (1982). Comparison of self-reported and measured height and weight. American Journal of Epidemiology, 115(2), 223230. doi:10.1093/oxfordjournals.aje.a113294.CrossRefGoogle ScholarPubMed
Perkonigg, A., Owashi, T., Stein, M. B., Kirschbaum, C., & Wittchen, H. U. (2009). Posttraumatic stress disorder and obesity: Evidence for a risk association. American Journal of Preventive Medicine, 36(1), 18. doi:10.1016/j.amepre.2008.09.026.CrossRefGoogle ScholarPubMed
Pi-Sunyer, X. (2009). The medical risks of obesity. Postgraduate Medicine, 121(6), 2133. doi:10.3810/pgm.2009.11.2074.CrossRefGoogle ScholarPubMed
Richards, C. (2008). Ranges for valid height, weight, and BMI based on 1999–2006 NHANES clinical measures. Retrieved from.Google Scholar
Rowland, M. L. (1990). Self-reported weight and height. American Journal of Clinical Nutrition, 52(6), 11251133. doi:10.1093/ajcn/52.6.1125.CrossRefGoogle ScholarPubMed
Ruggiero, K. J., Del Ben, K., Scotti, J. R., & Rabalais, A. E. (2003). Psychometric properties of the PTSD checklist-civilian version. Journal of Traumatic Stress, 16(5), 495502. doi:10.1023/A:1025714729117.CrossRefGoogle ScholarPubMed
Scherer, P. E., & Hill, J. A. (2016). Obesity, diabetes, and cardiovascular diseases: A compendium. Circulation Research, 118(11), 17031705. doi:10.1161/CIRCRESAHA.116.308999.CrossRefGoogle ScholarPubMed
Shapses, S. A., & Sukumar, D. (2012). Bone metabolism in obesity and weight loss. Annual Review of Nutrition, 32, 287309. doi:10.1146/annurev.nutr.012809.104655.CrossRefGoogle ScholarPubMed
Shrivastava, A., & Johnston, M. E. (2010). Weight-gain in psychiatric treatment: Risks, implications, and strategies for prevention and management. Mens Sana Monographs, 8(1), 5368. doi:10.4103/0973-1229.58819.CrossRefGoogle ScholarPubMed
Stenholm, S., Vahtera, J., Kawachi, I., Pentti, J., Halonen, J. I., Westerlund, H., … Kivimaki, M. (2015 ). patterns of weight gain in middle-aged and older US adults, 1992–2010. Epidemiology (Cambridge, Mass.), 26(2), 165168. doi:10.1097/EDE.0000000000000228.CrossRefGoogle Scholar
Tirosh, A., de Souza, R. J., Sacks, F., Bray, G. A., Smith, S. R., & LeBoff, M. S. (2015). Sex differences in the effects of weight loss diets on bone mineral density and body composition: POUNDS LOST trial. Journal of Clinical Endocrinology and Metabolism, 100(6), 24632471. doi:10.1210/jc.2015-1050.CrossRefGoogle Scholar
Twisk, J. W. (2004). Longitudinal data analysis. A comparison between generalized estimating equations and random coefficient analysis. European Journal of Epidemiology, 19(8), 769776. doi:10.1023/b:ejep.0000036572.00663.f2.CrossRefGoogle ScholarPubMed
Vickers, A. J. (2001). The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: A simulation study. BMC Medical Research Methodology, 1, 6. doi:10.1186/1471-2288-1-6.CrossRefGoogle Scholar
Vieweg, W. V., Levy, J. R., Fredrickson, S. K., Chipkin, S. R., Beatty-Brooks, M., Fernandez, A., … Pandurangi, A. K. (2008). Psychotropic drug considerations in depressed patients with metabolic disturbances. American Journal of Medicine, 121(8), 647655. doi:10.1016/j.amjmed.2007.08.043.CrossRefGoogle ScholarPubMed
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th Annual Conference of the ISTSS, San Antonio, TX.Google Scholar
Williams, G. N., Higgins, M. J., & Lewek, M. D. (2002). Aging skeletal muscle: Physiologic changes and the effects of training. Physical Therapy, 82(1), 6268. doi:10.1093/ptj/82.1.62.CrossRefGoogle Scholar
Williamson, D. F. (1993). Descriptive epidemiology of body weight and weight change in U.S. Adults. Annals of Internal Medicine, 119(7 Pt 2), 646649. doi:10.7326/0003-4819-119-7_part_2-199310011-00004.CrossRefGoogle ScholarPubMed
Zeger, S. L., & Liang, K. Y. (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42(1), 121130. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3719049.CrossRefGoogle ScholarPubMed
Zheng, Y., Manson, J. E., Yuan, C., Liang, M. H., Grodstein, F., Stampfer, M. J., … Hu, F. B. (2017). Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA, 318(3), 255269. doi:10.1001/jama.2017.7092.CrossRefGoogle ScholarPubMed
Supplementary material: File

Takemoto et al. supplementary material

Takemoto et al. supplementary material

Download Takemoto et al. supplementary material(File)
File 31.5 KB