Psychosocial stress and change in weight among US adults

Abstract

The association of psychosocial stress with weight gain may have important implications for clinical practice and workplace and public health interventions. To determine whether multiple domains of psychosocial stress were associated with weight gain from 1995 to 2004, the authors analyzed a nationally representative longitudinal cohort of 1,355 men and women in the United States. Change in body mass index was assessed for multiple domains of psychosocial stress related to work, personal relationships, life constraints, and finances, controlling for other factors associated with weight gain. All analyses were stratified by sex and weighted to account for the complex survey design. Among men with high baseline body mass index, weight gain was associated with increasing levels of psychosocial stress related to job-related demands (P < 0.001 for interaction with baseline body mass index), lack of skill discretion (P = 0.014), lack of decision authority (P = 0.026), and difficulty paying bills (P = 0.004). Among women with high baseline body mass index, weight gain was associated with job-related demands (P < 0.001 for interaction with baseline body mass index), perceived constraints in life (P < 0.001), strain in relations with family (P = 0.016), and difficulty paying bills (P = 0.010). Interventions to address psychosocial stress may limit weight gain among overweight and obese men and women.

Figure 1.

Adjusted change in body mass index from 1995 to 2004 for job-related demands among US men and women. Increasing job-related demands were associated with increasing weight gain among obese men (A) and women (B) and less weight gain among normal weight men and women. Results were adjusted for baseline body mass index (BMI); age; race; income; presence of generalized anxiety disorder, panic attack, or depression; smoking status; quitting smoking; presence of diabetes; self-rated health; and self-rated relative health. Trend lines represent predictions from the fitted model for specified body mass index values, set to the body mass index mean for each baseline body mass index category. In A, mean body mass index values are 22.8 (normal weight), 27.1 (overweight), and 33.8 (obese) kg/m². In B, mean body mass index values are 21.7 (normal weight), 27.3 (overweight), and 35.4 (obese) kg/m².

Figure 2.

Adjusted change in body mass index from 1995 to 2004 for difficulty paying bills among US men and women. Increasing difficulty paying bills was associated with a steeper gradient of weight gain among obese men (A) and women (B) than for normal weight men and women. Results were adjusted for baseline body mass index; age; race; income; presence of generalized anxiety disorder, panic attack, or depression; smoking status; quitting smoking; presence of diabetes; self-rated health; and self-rated relative health. Trend lines represent predictions from the fitted model for specified body mass index (BMI) values, set to the body mass index mean for each baseline body mass index category. In A, mean body mass index values for men are 22.8 (normal weight), 27.1 (overweight), and 33.8 (obese) kg/m². In B, mean body mass index values for women are 21.7 (normal weight), 27.3 (overweight), and 35.4 (obese) kg/m².

Figure 3.

Adjusted change in body mass index from 1995 to 2004 for perceived constraint in life and strain in relations with family among US women. Increasing perceived constraint in life (A) and increasing strain in relations with family (B) were associated with increasing weight gain among obese women and less weight gain among normal weight women. Results were adjusted for baseline body mass index; age; race; income; presence of generalized anxiety disorder, panic attack, or depression; smoking status; quitting smoking; presence of diabetes; self-rated health; and self-rated relative health. Trend lines represent predictions from the fitted model for specified body mass index (BMI) values, set to the body mass index mean for each baseline body mass index category: 21.7 (normal weight), 27.3 (overweight), and 35.4 (obese) kg/m².

Figure 4.

Adjusted change in body mass index from 1995 to 2004 for lack of skill discretion and lack of decision authority among US men. Lower levels of job-related skill discretion (A) and lower levels of decision authority (B) were associated with increasing weight gain among obese men and less weight gain among normal weight men. Results were adjusted for baseline body mass index; age; race; income; presence of generalized anxiety disorder, panic attack, or depression; smoking status; quitting smoking; presence of diabetes; self-rated health; and self-rated relative health. Trend lines represent predictions from the fitted model for specified body mass index (BMI) values, set to the body mass index mean for each baseline body mass index category: 22.8 (normal weight), 27.1 (overweight), and 33.8 (obese) kg/m².