Association of Adverse Childhood Experiences and Obesity in Emerging Adulthood: Mediating Roles of Self-Esteem and Economic Hardship

Background and Purpose: Adverse childhood experiences have long-standing effects on health outcomes. The body of literature shows that child maltreatment increases the risks of obesity in adulthood. While various mechanisms address how it occurs, self-esteem and stress coping strategies provide plausible explanations supporting the pathways. Children with adverse experiences are less likely to develop a positive self-concept and stress-coping skills, which leads to health problems. Recognizing the cumulative effects, our study aims to investigate (1) how adverse childhood experiences are associated with obesity in emerging adulthood and (2) whether self-esteem and economic hardship mediate the association of adverse childhood experiences and obesity. We expand childhood adversities beyond maltreated experiences by including family dysfunctions.     

Methods: We used the National Longitudinal Study of Adolescent and Adult Health (ADD Health). We selected study participants who responded all four waves of data from adolescence to adulthood (N=6,916). The dependent variable was obesity status (1=BMI at 30 or higher, 0=BMI lower than 30) measured when the sample was 28 years old on average. The independent variable is adverse childhood experiences (ACEs) experienced before age 18. ACEs were measured with nine binary variables indicating each of the following adversities experienced in early childhood and/or adolescence: physical abuse, physical neglect, emotional abuse, emotional neglect, sexual abuse, or living a family member(s) with concerning problems of intimate partner violence, incarceration, mental illness, or suicide attempt. The mediating variables were two continuous variables reported in adulthood: self-esteem and the number of economic hardship (e.g., fail to pay for utility or housing or eviction due to lack of money in the past 12 months). Control variables included individual characteristics (age, gender, race, education, income, and physical activity). We ran Structural Equation Modeling (SEM) to test the pathways from ACEs to later obesity status through self-esteem and economic hardship in adulthood.

Results: The sample consists of 58.55% Whites, 19.32% Blacks, 14.73% Hispanics, 5.15% Asian, and 2.26% of Native American in race and ethnicity, and 55.32% females. Those with obesity was 36%. The SEM analysis showed adequate model fit (χ² (220) = 1970.2, p < .001, CFI = .89, TLI = .86, RMSEA = .03). The latent variable ACES was significantly associated with obesity status (β=.06, p=.01), controlling for other factors. ACES significantly lowered self-esteem (β= -.18, p< .001) and increased the number of economic hardship in emerging adulthood (β=.20, p< .001). Similarly, self-esteem (β= -.04, p=.04) and economic hardship (β=.07, p< .001) showed significant relationships with obesity. Finally, the association between ACES and obesity was significantly mediated by self-esteem (β=.01, p=04) and adulthood economic hardship (β=.01, p<.01) respectively.   

Discussion and Implications: This study provides the important evidence that child adversity is a significant predictor of obesity and the detrimental pathway occurs by decreasing self-esteem and elevating economic hardship in adulthood. Practitioners and policy-makers should consider childhood life experiences and potential effects of poor self-assessment and financial stress in health prevention and intervention strategies. We will discuss implications and challenges for rigorous research and practice.