Is there a link between childhood trauma and obesity? University of Colorado School of Medicine researchers Carmelle Wallace, MD, and Richard Krugman, MD, are among the growing number of experts exploring the connection between the two.
“There’s a history of trauma in our patients, and we see elevated BMI in many of our patients as well,” says Wallace, an assistant professor in the CU Department of Pediatrics Section of Emergency Medicine and the Kempe Center, which provides treatment and therapy for abused and neglected children and their families.
“We began to wonder what kind of evidence exists in the medical literature about a potential correlation, because in my training, that’s not something we are taught to ask about or explore when a patient does have elevated BMI issues,” Wallace says. “Obesity is a multifactorial problem, and it's not surprising that there is a growing body of evidence suggesting that child maltreatment is one of those potential correlating factors.”
Compiling the research
Krugman’s and Wallace’s analysis of the literature on the topic resulted in a paper, “More Than What You Eat: A Review on the Association Between Childhood Maltreatment and Elevated Adult BMI,” published in June in the journal Current Nutrition Reports.
“Obesity is an increasingly prevalent public health problem with significant medical, mental health sequelae and societal implications including cardiovascular disease, diabetes, cancer, premature death, and an estimated economic health care burden of $172.74 billion annually,” the CU researchers note in their introduction. “A breadth of medical literature has further explored the implications of toxic childhood stress and the specific association between childhood maltreatment and elevated body mass index and obesity.”
Physical and sexual abuse, psychological and verbal abuse, and child neglect all have been associated with obesity, Krugman and Wallace note, in ways ranging from the cellular and neurobiological to the psychological.
“There is developing research in what we call a dose-response relationship, which in a medication means if you give a higher dose, does that result in a difference in the effect of the medication?” Wallace says. “In this case, they are studying the change associated with increasing amounts of child maltreatment. It could be useful in helping clinicians risk-stratify their patients and understand how much of an interplay that particular risk factor may have in their treatment planning.”
Important questions
Krugman and Wallace say one of the goals of their paper is moving the conversation from the pediatric venue into the world of adult medicine, where asking questions about past abuse may help health professionals better treat obesity in adults.
“Adults who have experienced abuse as children do not talk about it,” says Krugman, former vice chancellor for health affairs and dean at the CU School of Medicine and distinguished professor in pediatrics and child abuse and neglect at the Kempe Center. “There’s a lot of shame, a lot of stigma, and if they’re not asked, they won’t volunteer it. Our adult patient-practicing community needs to understand this area and needs to talk about it.”
The CU School of Medicine researchers also hope their study leads to more funding for research on the connection between childhood maltreatment and obesity, as pediatricians look for ways to help their high-BMI patients.
“Obesity is a very complex issue, and we’re not suggesting that child maltreatment is the one direct causal link,” Wallace says. “But it is definitely an important piece of that landscape and that multidisciplinary thinking. One thing that child abuse pediatricians are very well trained to do is to think broadly about our patients and their social determinants of health. It’s not just thinking about what medications they take and how their genetics determine their outcomes; it’s also their social circumstances and their adverse life events. It’s also whether they’ve experienced maltreatment.”
