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1.Title: Associations between body weight and depression, social phobia, insomnia, and self -

esteem among Taiwanese adolescents

By:Jia-In Lee, Cheng-Fang Yen* (2014)

ELEMENT CONTENT Introduction 1. Background: What’s the issue?

-Overweight/obese children and adolescents and their parents report a decrease in health related quality of life such as in physical, emotional, social, and school functioning when compared to average weight children and adolescents. -The levels of health related quality of life among severely obese children and adolescents are even s imilar to those reported by children and adolescents with cancer.

- the psychosocial consequences of overweight/obesity in childhood are also widespread -Whi le obesity can increase the risk of depression, depression can also predict the development of obesity -Compared with average weight adolescents, overweight/obese adolescents had lower self -esteem. Objective The a ims of this cross-sectional study were to examine the association between body weight and

mental health indicators including depression, social phobia, insomnia, and self -esteem in Taiwanese adolescents in Grades 7-21.

Li terature Review ISSUES -the relationships between body weight s tatus and social phobia and insomnia in adolescents have not

been well examined. It is therefore reasonable to hypothesize that overweight/obese adolescents may have a higher level of social phobia than those of average body weight; however, further research is

needed to confirm this hypothesis. - One s tudy found that an increase in body weight was s ignificantly associated with an increase in the

length of sleep and rapid eye movement. These results also suggested that insomnia was associated with low body weight in patients with anorexia nervosa

- Very few studies have examined the relationship between underweight and mental health problems in adolescents. The relationship between underweight and mental health problems in Asian adolescents

needs further s tudy. - The risk of psychosocial problems among overweight/obese youths increases with increasing age and is greater among girls than boys . The level of parental education or residential background have a

moderating effect on the relationship between body weight and mental health problems in adolescents requires further study.

Method - chi ldren and adolescents living in four counties and three metropolitan areas in southern Ta iwan

-s tratified random sampling strategy was used to ensure that there was proportional representation of districts, schools, and grades. -6703 s tudents in Grades 7-12 were randomly

selected based on the ratio of s tudents in each grade.

Procedure use of passive consent from parents and students. Prior to conducting the s tudy, we prepared a leaflet explaining

i ts purpose and procedures. Students took the leaflet home

for their parents or principal caretakers who could then telephone the researchers, write in a communications book, or ask their children directly to refuse to join the s tudy. The students also had the right to refuse to participate in this study by returning blank questionnaires.

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Result -No s ignificant differences in the levels of depression, social phobia, and insomnia were found between those who were overweight and those of average

weight or between those who were obese and those of average weight. -No s ignificant differences in the levels of depression, social phobia, insomnia, or self-esteem were found between those who were underweight and those of average weight. - interactive variables were not significantly associated with self-esteem; this indicated that gender, age, residential background, and level of maternal education did not have moderating effects on the association of overweight and obesity with self-esteem.

Discussion -This s tudy found that both overweight and obese adolescents had a lower level of self -esteem than did those of average weight.

-5185 chi ldren and adolescents aged 10e13 years also found that overweight/ obese children and adolescents had s ignificantly lower selfesteem on all self -esteem related i tems on

the Self-Perception Profile for Children than did children of average weight; disturbed eating and the experience of being bullied were also significantly related to

low selfesteem in the overweight/obese group -overweight/obesity may result in adolescents’

low satisfaction with physical appearance as well as with low scholastic, social, and athletic self-esteem - The present study did not find s ignificant associations between underweight and depression,

social phobia, insomnia, or low self-esteem. Further s tudy i s needed to replicate the results found in the present s tudy.

- previous s tudies found that age and gender did have moderating effects on the association between overweight/ obesity and psychological problems among young

-Further s tudy i s needed to determine the

possible moderators of the relationship between body weight and psychological problems in adolescents.

Limitation Firs t, the s tatus of body weight was determined by adolescents’ selfreported height and weight. Recall bias should be considered.

More objective indicators such as blood pressure, l ipid profile, and other blood parameters could be utilized.

Second, the cross-sectional research design of this study l imited our ability to draw conclusions regarding the causal

inferences between self-esteem and overweight/obesity. Third, this study investigated the relationship between

body weight and global self-esteem but not with domainspecific self-esteem. Fourth, there may be factors that

moderate the relationship between body weight and psychological

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health in adolescents that have not been examined in this s tudy.

Conclusion In conclusion, mental health and school professionals

must take the association between overweight/obesity and self-esteem into consideration when approaching the issue of mental health among adolescents. Well-designed, longitudinal s tudies relating body weight and mental health are warranted.

Reference

2. Title: Obesity and mental illness in a representative sample of young women

By:ES Becker, J Margraf, V Tu¨rke, USoeder and S Neumer (2001)

ELEMENT CONTENT

Introduction OBJECTIVE: To investigate the relation between mental disorders and weight, especially obesity. -Obesity i s known to contribute to a variety of physical health problems. It is widely assumed that obesity i s

closely associated with certain mental problems and even that these problems might be the cause for being overweight. -However, the correlations between BMI (body mass index) and depression are often weak, and with anxiety they are sometimes nonexistent. -BMI was positively related to depression in females but inversely related in males. Furthermore,

BMI was positively related to poor physical health and conduct disorder.

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Li terature Review -There is clearly a lack of studies with representative samples, and an even more pressing concern is the lack

of s tudies utilizing s tandardized diagnostic instrument for psychological disorders. -We studied a representative sample of young

women, and we assessed mental illness using a s tructured interview, allowing for DSM-IV diagnoses, administered by

tra ined interviewers.

Method DESIGN: Epidemiological study of mental disorders with a representative sample of young women.

SUBJECTS: A tota l of 2064 women, age 18 – 25 y, l iving in Dresden, Germany. MEASUREMENTS: Verbal reports of body mass index, s tructured cl inical interview for psychological

disorders. Sample German females between 18 – 24 y of age at the time of sampling. 2064 took part in the interview, and 998 fi l led out questionnaires (a response rate of 58.8%).

Interviewers were either medical doctors or psychology s tudents in their last years of training. Verbal reports of the height and weight of the respondents were obtained and recorded by the interviewers.

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Result RESULTS: We found an association between psychological disorders and weight. Obese women had the highest rate of mental

disorders overall, and they had higher rates of all subgroups of mental disorders, a lthough many di fferences were not s tatistically s ignificant. Most importantly, obese women suffered from an anxiety disorder significantly more often than women who were

not obese. The observed differences were independent of socioeconomic s tatus. The

percentages of other mental disorders in the underweight women were s till higher than for the normal weight group,

but the obese women still had the highest rate of mental disorders. Regarding the psychological disorders, obese women had the highest rates of anxiety disorders, affective

disorders, somatoform disorders and disorders of childhood (separation anxiety, attention-deficit and disruptive behavior

disorders, elimination disorders). In Having

a BMI of or above 30 tended to a lmost double the risk of having any psychological disorder. Obesity s ignificantly enhanced the likelihood of anxiety disorders at any time in l i fe. The risk of an anxiety disorder was more than twice as

high for obese women as for women with a lower BMI. Moreover, a high SES was significantly related to the occurrence of affective disorders and substance-related disorders.

Low SES and disorders of childhood were significantly related.

Discussion Obese women had the highest

rates of mental disorders overall as well as for a ll subgroups of mental disorders. Furthermore, they had higher rates of comorbidity.

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have examined the relation between mental disorders and weight, especially with non-clinical samples and reliable diagnostic measures. Thus i t is not surprising that the relation of anxiety and

overweight has not been reported yet. Non-clinical samples are of great interest, because the relations among mental problems and obesity are not overestimated as easily as in cl inical samples. On the other hand, the present s tudy conta ined few obese women, and the majority of the participants

had no mental disorder. Furthermore, self-reports of BMI might tempt women to underestimate their weight,

reducing the statistical power of our design. Despite these l imitations, we believe that our findings may be replicable and are certainly of great interest.

Obes ity

goes along with a low SES. Only the disorders of childhood

were related to a lower SES. There was no association of SES and anxiety disorders. Therefore it may be concluded that

the relationship of anxiety disorders and obesity i s independent of SES. Obesity has its own significant relation to mental disorders.

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We found a significantly higher rate of anxiety disorders

in obese women. Conclusion CONCLUSIONS: In young women, obesity i s related to increased rates of mental disorders, most notably

anxiety disorders. Future longitudinal research will have to determine the causal relationships behind this correlation.

Reference

3. Title: The Relationship between Body Mass Index and Mental Health Among Iraq and Afghanistan Veterans

By:ShiraMaguen, Erin Madden, Beth Cohen, Daniel Bertenthal, Thomas Neylan, Lisa Talbot, Carl Grunfeld, and Karen Seal,

(2013)

ELEMENT CONTENT

Abstract BACKGROUND: Obesity is a growing public health concern and is becoming an epidemic among veterans

in the post-deployment period. OBJECTIVE: To explore the relationship between body mass index (BMI) and posttraumatic s tress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate tra jectories of change in BMI over 3 years . MAIN MEASURES: BMI, mental health diagnoses.

Introduction -Whi le individuals in the military must pass certain fitness s tandards before serving in theArmed Forces, there i s mounting

evidence that obesity i s becoming an epidemic among veterans in the post-deployment period and as they age. -Some studies have found that veterans experience a burst of weight gain after

mi l itary discharge, which may be a particularly vulnerable time in which post-deployment eating patterns may be established. -There is already preliminary evidence that being

overweight and high body mass index (BMI) is becoming a problem for Iraq and Afghanistan veterans.

Li terature Review -s tudies exploring the link between PTSD

and obesity markers, such as BMI, have found mixed

results, with the majority finding no association between BMI and PTSD,

-Whi le a few studies have supported the relationship between BMI and PTSD, these studies were

conducted with older and predominantly male veterans -One s tudy conducted with both men and women found a relationship between obesity and PTSD for women, but not for men.

Method DESIGN: Retrospective, longitudinal cohort analysis of

veterans’ health records

PARTICIPANTS: A tota l of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and

weight were recorded at the Department of Veterans Affa i rs (VA) healthcare system a t least once after the end of their last deployment and whose first post-deployment

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outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31,

2011).

Result KEY RESULTS: Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four tra jectories were observed: “stable overweight” represented the largest class; followed by “stable obese;” “overweight/obese gaining;” and “obese los ing.” During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest ri sk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certa in mental health diagnoses. Al though BMI tra jectories

were s imilar in men and women, some gender di fferences were observed. For example, the risk of

being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.

Discussion -Those with PTSD and depression, as well as those with

multiple other mental health conditions, had the greatest l ikelihood of being in the highest ri sk groups, the s table obese and overweight/obese gaining classes.

-One possibility i s that these weight changes coincide with the time that veterans with mental health problems engage in minimally adequate mental health treatment; -those with mental health conditions weremore l ikely to be in

the overweight or obese groups, -We a lso found that depression was the mental health condition with the highest risk of belonging to the s table obese class among women, but among men, the highest risk

was found in those with PTSD. -This is contrary to a study of community dwelling adolescents and young adults in Germany,

which found a relationship between obesity and PTSD for women, but not for men. -

Conclusion CONCLUSIONS: The growing number of overweight or obese returning veterans is a concerning problem for cl inicians who work with these patients. Successful

intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental

l imitation There are several l imitations of our work. First, veterans returning from recent deployments may have

higher BMI due to muscle mass rather than truly being overweight or obese, and we were not able to include measurements of body fat or other more specific

indicators of obesity. Second, the number of BMI measures differed across our subjects. Third, rates of

PTSD may be greater in our cohort, given that these

veterans a ll sought primary care within the VA. Fourth, mental health conditions were assessed by diagnostic

codes rather than clinical interviews. Finally, given that we used administrative data, our analyses measured associations, rather than cause-and-effect relationships, between

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mental health and BMI trends.

4. Title:Body Mass Index and Risk of Suicide Among Men

By: Kenneth J. Mukamal, Ichiro Kawachi,; Matthew Miller, Eric B. Rimm, (2007)

ELEMENT CONTENT Abstract Background: Body mass index (BMI; calculated as

weight in kilograms divided by height in meters squared) has been linked to depression and the risk of suicide attempts and deaths in conflicting directions.

Introduction oBESITY AND DEPRESSION, extremely common

causes of morbidity, Li terature Review -depression has been associated

with subsequent obesity in some studies,5 obesity has also been associated with depressive symptoms

-Al though the mechanism of

this relationshipisunclear,somehavespeculated thatahighintakeofcarbohydratesmay ameliorate or prevent depressivesymptoms

but a lso lead to weight gain.

-A small number of studies with limited information on anthropomorphic measures and potentially confounding factors have suggested

exactly the opposite, at least among men,15,16 a lthough an inverse association has not been detected in all studies.

Method Methods: In a prospective cohort s tudy of 46 755 men

free of cancer enrolled in the Health Professionals Follow- up Study, participants reported their height, weight, diet, and physical activity on repeated occasions beginning in 1986 and were followed up until death or until February 2002. A subsample of 1829 men reported their mental health–related quality of life with the Mental Component Summary Scale of the 36-Item Short-Form Health Survey in 1998.

Result Results: A tota l of 131 men died from suicide during follow- up. A higher BMI was related to a graded decline in

the suicide mortality rate, from 52 per 100 000 personyears among men with a BMI of less than 21 to 13 per 100 000 among men with a BMI of 30 or higher; the adjusted

hazard ratio per 1-U BMI increment was 0.89 (95% confidence interval, 0.84-0.95; P_.001). The relationship

was consistent when baseline or updated measures of BMI were used and with adjustment for medical illness, dietary factors , antidepressant use, physical activity, or social

support. Height and physical activity were not strongly associated with risk. Analyses of mental health–related quality

of l i fe showed a similar positive relationship with BMI. Discussion

Conclusion Conclusions: Among men, risk of death from suicide is s trongly inversely related to BMI, but not to height or to

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phys ical activi ty. Although obesity cannot be recommended on the basis of i ts detrimental effects, further research

into the mechanisms of lower risk among overweight and obese men may provide insights into effective methods of suicide prevention.

Reference

5. Title: Concurrent trajectories of BMI and mental health patterns in emerging adulthood

By: Elizabeth A. Mumford*, Weiwei Liu, Elizabeth C. Hair, Tzy-Chyi Yu (2013)

ELEMENT CONTENT

Abstract

Introduction Affective disorders and weight status have been consistently l inked in childhood and adult research, and this comorbidity has synergistic effects leading to more severe health consequences.

There is s ignificant comorbidity between obesity and affective disorders among adults. Bidirectional relationship This relationship i s important to understand from both clinical and policy perspectives, as use of health services increases and quality of life decreases for individuals (ages 15 and older) with comorbid unhealthy weight and depression

Epidemiologic research reveals substantial synergistic effects leading to more severe health

consequences for persons who are both obese and suffering from mental health problems, depression in particular

Aim we investigate the longitudinal codevelopmentbetween BMI and mental health (specifically, depression

and anxiety) through models of concurrent BMI and mental health tra jectories, and the population heterogeneity within these co-developmental patterns.

Outcome expected to be useful to public health professionals attempting to target populations most at risk for longer term health consequences associated with weight and mental health problems.

Li terature Review Two recent papers propose

cognitive and biological models to explain the relationship. In addition to psychological and behavioral variables from stress levels to exercise and eating disorders, Maxwell and Cole (2009) detail biological mechanisms of the following categories: secretion of gonadal and peripheral hormones; hypothalamic activation and neuropeptide levels; and regulation of the reward system as regulators of the

bidirectional relationship between weight and depression. Longitudinal research of children passing through puberty highlights early gender differences in the

association between depressive symptoms and weight potentially attributable to hormonal differences (Louise et a l., 2012).

Method cohort ages 15 to 27

BMI i s calculated as weight in kilograms divided by height in meters squared. Selfreported height (in feet and inches) and weight (in pounds)

The second outcome is mental health status, measured in the NLSY97 through the 5-i tem Mental

Health Inventory (MHI-5)

Result Fi t s tatistics

indicate a 5-class parallel process model for the concurrent tra jectories of BMI and mental health.

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The concurrent trajectories model reveals latent class trajectories of "stable normal weight, s table good mental health" (82.2%); "consistently obese, stable good mental health" (6.8%); "overweight becoming

obese, declining mental health" (5.6%); "s table normal weight, improving mental health" (3.3%); and "morbid obesity, s table good mental health" (2.1%).

Discussion The risk of developmental tra jectories of poor mental health and BMI outcomes is greater for females, blacks, Hispanics, and individuals living below the poverty l ine. These results should help public health professionals to better target subpopulations approaching or already experiencing developmental pathways of ri sk for poor mental health and weight comorbidities. from ages 15 to 27, our results indicate that most individuals reported s table, good mental health and s table normal weight. Almost all members of the cohort ga ined weight over the s tudy period, consistent with adolescent growth

Regarding changes in mental health,

one in twenty respondents exhibited declining mental health, and a s l ightly smaller proportion experienced improvement. The generally good mental health of most of the s tudy population coincides

with unhealthy weight for some individuals, which in turn is a ri sk factor for depression

Conclusion Multi level investigation of lifestyle and contextual factors will foster further refinement of public health interventions.

Reference

6. Ti tle: Gender Differences in Body Mass Index, Body Weight Perception and Weight Loss Strategies among Undergraduates in Universiti Malaysia Sarawak By: Kuan PX 1*, Ho HL 1, Shuhaili MS1, Siti AA1 &Gudum HR2 (2011)

Element Content

Abstract Introduction This study was carried out among undergraduate s tudents in

Universiti Malaysia Sarawak with the objective of examining gender differences in body mass index (BMI), body weight perception, eating attitudes and weightloss s trategies.

Li terature Review

Method Subjects consisted of 600 undergraduates (300 males and 300 females) recruited from the various faculties between September 2008 unti l mid-November 2008. The Original Figure Rating Scale: Body Weight Perception, Body Shape Questionnaire (BSQ) and Eating Atti tudes Test-26 (EAT- 26) were used as assessment tools.

Result Overa l l, 52.8% of students had normal BMI, with approximately an equal number of both sexes. More males than females were overweight (33.7%), while more females were underweight (25.3%). Males were more likely to perceive themselves as overweight, and fail to see themselves as underweight. More than half of the females preferred their ideal figure to be underweight, whereas about 30% males chose an overweight figure as their

ideal model. Females were generally more concerned about body weight, body

shape and eating than males. They diet more frequently, had self-induced vomiting, and used laxatives and exercise as their weight-loss strategies.

Discussion

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Limitation

Conclusion Issues pertaining to body weight perception, eating attitudes and weight-loss s trategies exist with differences among male and female undergraduates. Thus, in order to correct misperceptions among young adults,

a more ta ilored intervention programme and more in-depth studies into thevarious factors involved are requi red.

Reference

7. Ti tle: Depression and anxiety among US adults: associations with body mass index G Zhao1, ES Ford1, S Dhingra1, C Li1, TW Strine1 and AH Mokdad2 (2009)

Element Content

Abstract Introduction Li terature Review

Method Result

Discussion Limitation

Conclusion Reference

8. Ti tle: Obesity and Physical and Emotional Well-Being: Associations between Body Mass Index, Chronic I llness, and the Phys ical and Mental Components of the SF-36 Questionnaire Helen A. Doll, Sophie E. K. Petersen,* and Sarah L. Stewart-Brown (2000)

Element Content Abstract Objective: To clarify the associations between obesity and

health-related quality of l ife by exploring the associations between physical and emotional well-being in relation to obesity and the presence of other chronic illness.

Introduction Obes ity represents a major public health problem in developed

countries (1). It is an independent risk factor for a variety of chronic diseases such as diabetes, hypertension, and coronary heart disease and is thus associated with high levels of potentially avoidable health care costs (2,3). Estimates

of prevalence suggest that between 7% and 15% of subjects in developed countries are obese (4,5); the figure for the United States is markedly higher at around 33% (6).

OD: Health has been defined as a state of complete physical,

psychological, and social well-being (9), reflected in the ability to be “confident and positive and able to cope with the ups and downs of life” (10). Although the importance of emotional

wel l-being for health has recently been emphasized (10), the concept of emotional well-being is less well defined than that

of phys ical well-being (11).

Li terature Review Other s tudies, however, have not found any association between BMI and psychological disturbances, finding little

di fference between obese and non-obese individuals in terms of scores on s tandard psychological tests (20), even after adjusting for waist:hip ratio (22).

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In addition, some

studies have found changes in weight not to be associated with changes in psychosocial functioning (23). Al though obesity i s no doubt associated with some loss of

quality of life, particularly in terms of physical well-being (14), epidemiological and cl inical s tudies do not support the idea that overweight individuals are as a group more emotionally

dis turbed than lighter individuals (24). In this regard, one s tudy found that obesity was associated with

impaired physical but not emotional well-being, as assessed us ing both a general and an obesity-specific measure (25), and another found that in women, but not in men, BMI was

not related to the impact of weight on self-esteem, which was substantial even in those of low BMI (17). It has thus

been suggested that obesity affects the emotional health of only some obese persons (26), for example those that have associated binge eating (20,27–29) or other chronic conditions

such as chronic pain (30).

Method Research Methods and Procedures: The s tudy data were col lected as part of a postal-survey within the old Oxford Regional Health Authority of England in 1997. Completed questionnaires were returned by 8889 of 13,800 randomly selected adults aged 18 to 64 years. The main outcome measures were body mass index in five categories (underweight, normal weight, overweight, moderately obese, morbidly obese); chronic illness status (any vs . none and number of such illnesses 0, 1 to 2, 31); and mean SF-36 questionnaire score in two summary component measures reflecting physical and emotional well-being.

Result Results: Of the subjects, 31% were overweight and an additional 11% were obese. Body mass index was significantly

associated with health status, but the pattern varied according to whether the measure reflected physical or emotional well-being. Physical, but not emotional, wellbeing

deteriorated markedly with increasing degree of overweight and was limited in subjects who were obese but had

no other chronic condition; subjects with chronic illnesses other than obesity were compromised in both dimensions. In terms of the number of chronic illnesses reported, the

additional presence of obesity was associated with a significant deterioration in physical but not emotional well-being.

Discussion Discussion: Overweight and obesity are associated with

poor levels of subjective health s tatus, particularly in terms of phys ical well-being. The limitations in emotional wellbeing that are reported here and in other s tudies may be a

result of confounding by the presence of accompanying chronic illness.

Limitation the lack of association remains after adjusting for the frequency of health service utilization, which suggests that

the relationship is not attenuated by the effect of medical treatment for the conditions.

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Conclusion

Reference 9. Ti tle: TheWeight of Traumatic Stress A Prospective Study of Posttraumatic Stress Disorder Symptoms and Weight Status

In Women Laura D. Kubzansky, PhD; Paula Bordelois, MPH; Hee Jin Jun, DrPH; Andrea L. Roberts, PhD;

Magdalena Cerda, DrPH; Noah Bluestone, BA; Karestan C. Koenen, PhD (2013)

Element Content

Abstract 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 tra jectory of weight gain or constitute a comorbid condition has not been established.

Introduction 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 tra jectory of weight gain or constitute a comorbid condition has not been established.

Li terature Review

Method DESIGN, SETTING, AND PARTICIPANTS The Nurses’ Health Study II, a prospective observational s tudy 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.

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 tra jectory before and after PTSD symptom onset among women who developed PTSD symptoms in 1989 or during follow-up.

Result 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 tra jectory did not differ by PTSD status before PTSD onset. After PTSD symptom onset, women with at least 4 symptoms had a faster ri se 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.

Discussion

Limitation Conclusion CONCLUSIONS AND RELEVANCE Experience of PTSD symptoms is associated with an

increased risk of becoming overweight or obese, and PTSD symptom onset alters BMI tra jectories over time. The presence of PTSD symptoms should raise clinician concerns about phys ical health problems that may develop and prompt closer attention to weight s tatus.

Reference

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