ABSTRACT

Introduction .................................................................................................................................... 192 Defining Stress .......................................................................................................................... 192 Prevalence of Stress in Children and Youth .............................................................................. 192

External Stressors ................................................................................................................. 192 Psychological Stress ............................................................................................................. 192

Conceptual Model of Childhood Stress and Obesity Risk ........................................................ 193 Exposure to Stressors and Child Obesity Risk .............................................................................. 193

Community/Neighborhood-Level Stressors .............................................................................. 193 Crime and Violence .............................................................................................................. 193 Socioeconomic Status (SES) ................................................................................................ 194

Family-Level Stressors .............................................................................................................. 194 Racial/Ethnic Minority Status .............................................................................................. 194 Negative Family Events ........................................................................................................ 194 Parental Stress ...................................................................................................................... 194

Individual-Level Stressors ......................................................................................................... 195 Victimization/Bullying ......................................................................................................... 195 Maltreatment ........................................................................................................................ 195

Response to Stress and Child Obesity Risk ................................................................................... 195 Psychological Stress .................................................................................................................. 195

Preschool-Age Children (Ages 0-6 Years) .......................................................................... 195 School-Age Children (Ages 6-10 Years) ............................................................................. 195 Preadolescents (Ages 10-12 Years) ..................................................................................... 196 Adolescents (Ages 13-20 Years) .......................................................................................... 196

Behavioral Pathways Linking Stress and Obesity Risk ............................................................ 196 Stress and Eating .................................................................................................................. 196 Stress and Physical Activity ................................................................................................. 197 Interactions between Stress, Eating, Physical Activity, and Obesity ................................... 197

Biological Pathways Linking Stress and Obesity Risk ............................................................. 197 Reciprocal Effects and Bidirectionality .................................................................................... 197

Research Challenges ...................................................................................................................... 198 Challenges in Obesity Outcome Measurement ......................................................................... 198 Challenges in Stress Measurement............................................................................................ 198

Research Gaps and Recommendations for Future Research ......................................................... 198 Longitudinal Studies and Natural Experiments ........................................................................ 198 Research during Early Childhood ............................................................................................. 198

This chapter explores the extent to which stress influences the development of obesity in pediatric populations. Our focus is on the types of stressors and stress, both objectively and subjectively measured, which have been associated with adverse weight outcomes in children and youth. We also discuss two broad pathways, behavioral and biological, through which stress may operate on the genesis and maintenance of obesity. This chapter concludes with an overview of the limitations of the current literature, as well as recommendations for future research in the area to address these gaps.