PTSD symptoms linked to overweight and obesity in women

By Will Boggs MD

NEW YORK (Reuters Health) - Symptoms of posttraumatic stress disorder (PTSD) in women are associated with an increased risk of becoming overweight or obese, according to researchers reporting on data from the Nurses' Health Study II.

"PTSD is not just about mental health but has long-term physical health consequences," Dr. Karestan C. Koenen from Columbia Mailman School of Public Health in New York City told Reuters Health by email. "Both mental and physical health care providers need to join together to provide the best care for women with PTSD."

"The most surprising finding was that women whose PTSD had remitted did not show increase risk of becoming obese," Dr. Koenen said. "This suggests effective treatment of PTSD will prevent its obesegenic effects."

Dr. Koenen and colleagues used data from the Nurses' Health Study II to investigate whether PTSD symptoms alter the trajectory of weight gain. They considered effects of PTSD symptoms separately from the effects of experiencing trauma and hypothesized that women who develop PTSD symptoms will gain more weight than women who experience trauma but do not develop symptoms.

Among the more than 50,000 women in the final sample, 18.6% experienced no trauma exposure or PTSD symptoms, 30.3% had trauma exposure but no PTSD symptoms, 30.6% had trauma exposure and one to three PTSD symptoms, and 20.5% had trauma exposure and four or more PTSD symptoms, the authors reported online November 20th in JAMA Psychiatry.

Compared to women with no trauma exposure or PTSD symptoms, those with trauma exposure only and those whose symptoms had remitted showed no higher risk of overweight or obesity.

In contrast, the odds of overweight or obesity were increased by 15% for women with trauma and one to three ongoing PTSD symptoms and by 26% for women with four or more ongoing PTSD symptoms.

Among women who entered the study with normal weight at baseline, the odds of becoming overweight or obese were increased by 18% with one to three PTSD symptoms and by 36% with at least four PTSD symptoms, compared to women who had trauma exposure without PTSD symptoms.

At every follow-up year, women who reported trauma and PTSD symptoms at baseline had higher body mass index (BMI) even after controlling for depression and other covariates. BMI increases were greater with greater numbers of PTSD symptoms.

BMI in women with trauma did not differ from that in women without trauma until the onset of PTSD symptoms.

"These findings are the first to demonstrate that PTSD symptom onset is associated with altered BMI trajectories over time," the researchers say.

"PTSD may influence weight gain by behavioral and biological mechanisms, and both mechanisms may operate simultaneously," they explain. "Animal studies suggest that stress upregulates neuropeptide Y, which plays an important role in adipose tissue remodeling and development of abdominal obesity. Thus, high levels of distress may directly alter production and distribution of fat."

"Physical health care providers, particularly primary care physicians, need to be aware that mental health problems could be driving some of their patients' health risk behaviors," Dr. Koenen said. "Health risk behaviors around diet and exercise are known to be very difficult to change. It's possible, although not tested, that effective treatment of mental health problems could reduce health risk behaviors and improve physical health of patients."

"The primary take away is that mental and physical health are not separable," Dr. Koenen said. "As stated by former U.S. Surgeon General David Satcher, MD, 'There is no health without mental health.'"

Dr. Koenen added, "Future research needs to identify the mechanisms via which PTSD leads to obesity. Is it dietary changes? Reduction in exercise? Or something about the dysregulation of the HPA axis in PTSD that impacts weight gain? The other key question that deserves follow-up is whether effective treatment of PTSD has physical health benefits."

Dr. Adrian Lopresti from Murdoch University, Perth, Western Australia, who wasn't involved in the study, told Reuters Health by email, "Medical and other health professionals specifically targeting physical health should also be involved in the support of people suffering from PTSD."

"Not only does the sufferer have to deal with the psychological effects of the trauma but also the potential weight gain associated with it," Dr. Lopresti continued. "Weight loss specialists and professionals encouraging healthier lifestyles may therefore potentially be crucial components to someone's treatment (e.g., dieticians, personal trainers, exercise physiologists)."

Also, Dr. Lopresti pointed out, "This study did not mention the potential effects of medication on weight gain. It is possible that the weight gain may be associated with increased psychiatric medication use in people with PTSD."

Dr. Sherry Pagoto from University of Massachusetts Medical School in Worcester told Reuters Health by email, "Providers often give the 'eat less, move more' prescription but it doesn't address the more complex issues around why this advice is so difficult to follow."

"We need to understand why patients lose control over their eating behavior and the factors that underlie chronic sedentary lifestyles so that we can advise patients accordingly," concluded Dr. Pagoto, who also wasn't involved in the new study. "Physicians and psychologists working together are the ideal team to identify the best way to help a patient achieve control over their lifestyle factors."

SOURCE: http://bit.ly/1hw6jWe

JAMA Psychiatry 2013.

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