title: The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women.
abstract: OBJECTIVE
  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 trajectory of weight gain or constitute a comorbid condition has not been established.
  
  
  OBJECTIVE
  To determine whether women who develop PTSD symptoms are subsequently more likely to gain weight and become obese relative to trauma-exposed women who do not develop PTSD symptoms or women with no trauma exposure or PTSD symptoms and whether the effects are independent of depression.
  
  
  METHODS
  The Nurses' Health Study II, a prospective observational study 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.
  
  
  METHODS
  Trauma and PTSD symptoms.
  
  
  METHODS
  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 trajectory before and after PTSD symptom onset among women who developed PTSD symptoms in 1989 or during follow-up.
  
  
  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 trajectory did not differ by PTSD status before PTSD onset. After PTSD symptom onset, women with at least 4 symptoms had a faster rise 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.
  
  
  CONCLUSIONS
  Experience of PTSD symptoms is associated with an increased risk of becoming overweight or obese, and PTSD symptom onset alters BMI trajectories over time. The presence of PTSD symptoms should raise clinician concerns about physical health problems that may develop and prompt closer attention to weight status.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York.
authors.forename: Paula
authors.initials: P
authors.lastname: Bordelois
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts4Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Jun
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Roberts
authors.affiliation: Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerda
authors.affiliation: graduate student at Boston University, Boston, Massachusetts.
authors.forename: Noah
authors.initials: N
authors.lastname: Bluestone
authors.affiliation: Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D009765:Obesity / Q000209:etiology* / Q000523:psychology; D050177:Overweight / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D011795:Surveys and Questionnaires; D015430:Weight Gain