Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology and Population Health

The longitudinal association between chronic stress and (visceral) obesity over seven years in the general population: The Hoorn Studies

Abstract

Background

We aimed to study the mediating role of diet quality, physical activity, smoking, and alcohol intake in the association of stressful life events with visceral obesity over a seven-year period and assessed effect modification by sex and SES. Methods: In total, 2416 participants with a mean age of 56.1 (±7.3) years, of which 51.4% were women, and 12.5% had a lower educational level from the Hoorn studies were followed for seven years. Stress was measured with a ‘Serious Life Events’ questionnaire, which was summed into a total score (range zero to ten events) and stratified to account for nonlinearity. Changes in visceral obesity were assessed by changes in BMI (kg/m2) and waist circumference (cm) in seven years. We used the product of coefficient approach to assess mediation of the following lifestyle factors: diet, physical activity, smoking, and alcohol intake. We analyzed associations between stressful life events and change in BMI and waist circumference with linear regression models.

Results

Within the low education group, we observed a significant association between ≥3 stressful life events and a change in BMI (0.60 kg/m2 (CI: 0.05, 1.14)) and waist circumference (2.23 cm (CI: 0.19, 4.48)), compared to experiencing no events. For both BMI and waist circumference, no significant associations were observed when experiencing 1 or 2 events. In the moderate to high education group, we observed only statistically significant associations for waist circumference when experiencing ≥3 stressful life events (0.86 cm (CI: 0.05, 1.41)) and not for the other event groups. Our mediation analyses showed that the proportion mediated by smoking was 13.2%, while the other lifestyle factors showed no mediating effect.

Conclusions

Multiple stressful life events are associated with an increase in waist circumference and BMI in those with lower education. Smoking might play a mediating role in this association.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1
Fig. 2: Directed Acyclic Graph including the direct and indirect pathways of the mediation model of the association between stressful life events (x) and weight change (y).

Data availability

Due to privacy regulations and informed consent of the participants, the dataset generated for this study cannot be made publicly available. However, the steering committee of the Hoorn Studies will consider sharing data upon request.

References

  1. Bjorntorp P. Neuroendocrine factors in obesity. J Endocrinol. 1997;155:193–5.

    CAS  PubMed  Google Scholar 

  2. Overgaard D, Gyntelberg F, Heitmann BL. Psychological workload and body weight: is there an association? A review of the literature. Occup Med (Lond). 2004;54:35–41.

    CAS  Google Scholar 

  3. Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23:887–94.

    PubMed  Google Scholar 

  4. Nieuwenhuizen AG, Rutters F. The hypothalamic-pituitary-adrenal-axis in the regulation of energy balance. Physiol Behav. 2008;94:169–77.

    CAS  PubMed  Google Scholar 

  5. Bose M, Olivan B, Laferrere B. Stress and obesity: the role of the hypothalamic-pituitary-adrenal axis in metabolic disease. Curr Opin Endocrinol Diabetes Obes. 2009;16:340–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. De Vriendt T, Moreno LA, De Henauw S. Chronic stress and obesity in adolescents: scientific evidence and methodological issues for epidemiological research. Nutr Metab Cardiovasc Dis. 2009;19:511–9.

    PubMed  Google Scholar 

  7. Block JP, He Y, Zaslavsky AM, Ding L, Ayanian JZ. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170:181–92.

    PubMed  PubMed Central  Google Scholar 

  8. Harding JL, Backholer K, Williams ED, Peeters A, Cameron AJ, Hare MJ, et al. Psychosocial stress is positively associated with body mass index gain over 5 years: evidence from the longitudinal AusDiab study. Obesity (Silver Spring). 2014;22:277–86.

    Google Scholar 

  9. Wardle J, Chida Y, Gibson EL, Whitaker KL, Steptoe A. Stress and adiposity: a meta-analysis of longitudinal studies. Obesity. 2011;19:771–8.

    PubMed  Google Scholar 

  10. Gerace TA, George VA. Predictors of weight increases over 7 years in fire fighters and paramedics. Prev Med. 1996;25:593–600.

    CAS  PubMed  Google Scholar 

  11. Stone AA, Brownell KD. The stress-eating paradox—multiple daily measurements in adult males and females. Psychol Health. 1994;9:425–36.

    Google Scholar 

  12. Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sports Med. 2014;44:81–121.

    PubMed  PubMed Central  Google Scholar 

  13. Oliver G, Wardle J, Gibson EL. Stress and food choice: a laboratory study. Psychosom Med. 2000;62:853–65.

    CAS  PubMed  Google Scholar 

  14. Groesz LM, McCoy S, Carl J, Saslow L, Stewart J, Adler N, et al. What is eating you? Stress and the drive to eat. Appetite. 2012;58:717–21.

    PubMed  Google Scholar 

  15. Epel E, Lapidus R, McEwen B, Brownell K. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001;26:37–49.

    CAS  PubMed  Google Scholar 

  16. Van Strien T, Rookus MA, Bergers GP, Frijters JE, Defares PB. Life events, emotional eating and change in body mass index. Int J Obes. 1986;10:29–35.

    PubMed  Google Scholar 

  17. Laitinen J, Ek E, Sovio U. Stress-related eating and drinking behavior and body mass index and predictors of this behavior. Prev Med. 2002;34:29–39.

    PubMed  Google Scholar 

  18. Kivimaki M, Head J, Ferrie JE, Shipley MJ, Brunner E, Vahtera J, et al. Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. Int J Obes. 2006;30:982–7.

    CAS  Google Scholar 

  19. Oliver G, Wardle J. Perceived effects of stress on food choice. Physiol Behav. 1999;66:511–5.

    CAS  PubMed  Google Scholar 

  20. Larsen SC, Horgan G, Mikkelsen MK, Palmeira AL, Scott S, Duarte C, et al. Consistent sleep onset and maintenance of body weight after weight loss: An analysis of data from the NoHoW trial. PLoS Med. 2020;17:e1003168.

    PubMed  PubMed Central  Google Scholar 

  21. Kuo WC, Bratzke LC, Oakley LD, Kuo F, Wang H, Brown RL. The association between psychological stress and metabolic syndrome: A systematic review and meta-analysis. Obes Rev. 2019;20:1651–64.

    PubMed  Google Scholar 

  22. Shaikh RA, Siahpush M, Singh GK, Tibbits M. Socioeconomic status, smoking, alcohol use, physical activity, and dietary behavior as determinants of obesity and body mass index in the United States: Findings from the National Health Interview Survey. Int J MCH AIDS. 2015;4:22–34.

    PubMed  PubMed Central  Google Scholar 

  23. Fogelman N, Magin Z, Hart R, Sinha R. A longitudinal study of life trauma, chronic stress and body mass index on weight gain over a 2-year period. Behav Med. 2020;17:1–9.

    Google Scholar 

  24. Suglia SF, Pamplin JR 2nd, Forde AT, Shelton RC. Sex differences in the association between perceived stress and adiposity in a nationally representative sample. Ann Epidemiol. 2017;27:626–31.

    PubMed  PubMed Central  Google Scholar 

  25. Pampel FC, Krueger PM, Denney JT. Socioeconomic disparities in health behaviors. Annu Rev Sociol. 2010;36:349–70.

    PubMed  PubMed Central  Google Scholar 

  26. Kristenson M, Eriksen HR, Sluiter JK, Starke D, Ursin H. Psychobiological mechanisms of socioeconomic differences in health. Soc Sci Med. 2004;58:1511–22.

    CAS  PubMed  Google Scholar 

  27. Finkelstein DM, Kubzansky LD, Capitman J, Goodman E. Socioeconomic differences in adolescent stress: the role of psychological resources. J Adolesc Health. 2007;40:127–34.

    PubMed  PubMed Central  Google Scholar 

  28. Tenk J, Matrai P, Hegyi P, Rostas I, Garami A, Szabo I, et al. Perceived stress correlates with visceral obesity and lipid parameters of the metabolic syndrome: A systematic review and meta-analysis. Psychoneuroendocrinology. 2018;95:63–73.

    CAS  PubMed  Google Scholar 

  29. Rutters F, Nijpels G, Elders P, Stehouwer CDA, van der Heijden AA, Groeneveld L, et al. Cohort Profile: The Hoorn Studies. Int J Epidemiol. 2018;47:396-j.

    Google Scholar 

  30. Mooy JM, Grootenhuis PA, de Vries H, Valkenburg HA, Bouter LM, Kostense PJ, et al. Prevalence and determinants of glucose intolerance in a Dutch caucasian population. The Hoorn Study. Diabetes Care. 1995;18:1270–3.

    CAS  PubMed  Google Scholar 

  31. Roohafza H, Ramezani M, Sadeghi M, Shahnam M, Zolfagari B, Sarafzadegan N. Development and validation of the stressful life event questionnaire. Int J Public Health. 2011;56:441–8.

    PubMed  Google Scholar 

  32. Seidell JC, Oosterlee A, Deurenberg P, Hautvast JG, Ruijs JH. Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. Eur J Clin Nutr. 1988;42:805–15.

    CAS  PubMed  Google Scholar 

  33. Snijder MB, Dekker JM, Visser M, Bouter LM, Stehouwer CD, Kostense PJ, et al. Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. Am J Clin Nutr. 2003;77:1192–7.

    CAS  PubMed  Google Scholar 

  34. den Braver NR, Rutters F, van der Spek A, Ibi D, Looman M, Geelen A, et al. Adherence to a food group-based dietary guideline and incidence of prediabetes and type 2 diabetes. Eur J Nutr. 2020;59:2159–69.

    Google Scholar 

  35. Grootenhuis PA, Westenbrink S, Sie CM, de Neeling JN, Kok FJ, Bouter LM. A semiquantitative food frequency questionnaire for use in epidemiologic research among the elderly: validation by comparison with dietary history. J Clin Epidemiol. 1995;48:859–68.

    CAS  PubMed  Google Scholar 

  36. Siebelink E, Geelen A, de Vries JH. Self-reported energy intake by FFQ compared with actual energy intake to maintain body weight in 516 adults. Br J Nutr. 2011;106:274–81.

    CAS  PubMed  Google Scholar 

  37. Looman M, Feskens EJ, de Rijk M, Meijboom S, Biesbroek S, Temme EH, et al. Development and evaluation of the Dutch Healthy Diet index 2015. Public Health Nutr. 2017;20:2289–99.

    PubMed  Google Scholar 

  38. Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol. 2003;56:1163–9.

    PubMed  Google Scholar 

  39. VanderWeele TJ. Mediation analysis: A Practitioner’s Guide. Annu Rev Public Health. 2016;37:17–32.

    PubMed  Google Scholar 

  40. VanderWeele TJ, Vansteelandt S. Mediation analysis with multiple mediators. Epidemiol Methods. 2014;2:95–115.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8:3–15.

    CAS  PubMed  Google Scholar 

  42. Mehlig K, Nehmtallah T, Rosvall M, Hunsberger M, Rosengren A, Lissner L. Negative life events predict weight gain in a 13-year follow-up of an adult Swedish population. J Psychosom Res. 2020;132:109973.

    CAS  PubMed  Google Scholar 

  43. Isasi CR, Parrinello CM, Jung MM, Carnethon MR, Birnbaum-Weitzman O, Espinoza RA, et al. Psychosocial stress is associated with obesity and diet quality in Hispanic/Latino adults. Ann Epidemiol. 2015;25:84–9.

    PubMed  Google Scholar 

  44. Cuevas AG, Chen R, Thurber KA, Slopen N, Williams DR. Psychosocial stress and overweight and obesity: findings from the Chicago Community Adult Health Study. Ann Behav Med. 2019;53:NP.

    PubMed  PubMed Central  Google Scholar 

  45. Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obes Rev. 2014;15:769–79.

    CAS  PubMed  Google Scholar 

  46. Bale TL, Epperson CN. Sex differences and stress across the lifespan. Nat Neurosci. 2015;18:1413–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Kouvonen A, Kivimaki M, Cox SJ, Cox T, Vahtera J. Relationship between work stress and body mass index among 45,810 female and male employees. Psychosom Med. 2005;67:577–83.

    PubMed  Google Scholar 

  48. Roberts CJ, Campbell IC, Troop N. Increases in weight during chronic stress are partially associated with a switch in food choice towards increased carbohydrate and saturated fat intake. Eur Eat Disord Rev. 2014;22:77–82.

    PubMed  Google Scholar 

  49. Meule A, Reichenberger J, Blechert J. Smoking, stress eating, and body weight: the moderating role of perceived stress. Subst Use Misuse. 2018;53:2152–6.

    PubMed  Google Scholar 

  50. Masood S, Cappelli C, Li Y, Tanenbaum H, Chou CP, Spruijt-Metz D, et al. Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults. Int J Public Health. 2015;60:891–9.

    PubMed  Google Scholar 

  51. Safaei M, Sundararajan EA, Driss M, Boulila W, Shapi’i A. A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity. Comput Biol Med. 2021;136:104754.

    PubMed  Google Scholar 

  52. Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007;91:449–58.

    CAS  PubMed  Google Scholar 

  53. Jewett DC, Cleary J, Levine AS, Schaal DW, Thompson T. Effects of neuropeptide Y, insulin, 2-deoxyglucose, and food deprivation on food-motivated behavior. Psychopharmacology. 1995;120:267–71.

    CAS  PubMed  Google Scholar 

  54. Zellner DA, Loaiza S, Gonzalez Z, Pita J, Morales J, Pecora D, et al. Food selection changes under stress. Physiol Behav. 2006;87:789–93.

    CAS  PubMed  Google Scholar 

  55. Lemmens SG, Rutters F, Born JM, Westerterp-Plantenga MS. Stress augments food ‘wanting’ and energy intake in visceral overweight subjects in the absence of hunger. Physiol Behav. 2011;103:157–63.

    CAS  PubMed  Google Scholar 

  56. Epel ES, McEwen B, Seeman T, Matthews K, Castellazzo G, Brownell KD, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62:623–32.

    CAS  PubMed  Google Scholar 

  57. Korkeila M, Kaprio J, Rissanen A, Koshenvuo M, Sorensen TI. Predictors of major weight gain in adult Finns: stress, life satisfaction and personality traits. Int J Obes Relat Metab Disord. 1998;22:949–57.

    CAS  PubMed  Google Scholar 

  58. Connor Gorber S, Tremblay M, Moher D, Gorber B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8:307–26.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful for the dedication of the participants and all individuals that contribute to the Hoorn Studies.

Author information

Authors and Affiliations

Authors

Contributions

NZS conceptualized and designed the study, performed the formal analysis, drafted the initial manuscript, and reviewed and revised the manuscript. JWJB conceptualized, designed, and reviewed the manuscript. NvdV contributed to drafting the initial manuscript. NRdB contributed to harmonizing the data and reviewed the manuscript. PJME reviewed the manuscript. FR conceptualized and designed the study and reviewed the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Noreen Z. Siddiqui.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

41366_2022_1179_MOESM1_ESM.docx

Supplemental Table 1 Descriptive characteristics of the Hoorn study participants with missing stressful life events, N = 2721

41366_2022_1179_MOESM2_ESM.docx

Supplemental Table 2 Mediation analyses of stressful life events measured at baseline and change in BMI (kg/m2) after seven years follow-up, with DHD15-index (energy intake), physical activity, smok

41366_2022_1179_MOESM3_ESM.docx

Supplemental Table 3 Mediation analyses of stressful life events measured at baseline and change in waist circumference (cm) after seven years follow-up, with DHD15-index (energy intake), physical ac

41366_2022_1179_MOESM4_ESM.docx

Supplemental Table 4 Linear regression models per stressful life events item measured at baseline and follow-up and change in BMI (kg/m2) and waist circumference (cm) after 7 years in the general po

41366_2022_1179_MOESM5_ESM.docx

Supplemental Table 5 Linear regression models of number of stressful life events measured at baseline and change in BMI (kg/m2) and waist circumference (cm) after 7 years in the general population

41366_2022_1179_MOESM6_ESM.docx

Supplemental Table 6 Linear regression models of number of stressful life events measured at baseline plus follow-up and outcome change in BMI (kg/m2) adjusted for waist circumference and outcome wa

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Siddiqui, N.Z., Beulens, J.W.J., van der Vliet, N. et al. The longitudinal association between chronic stress and (visceral) obesity over seven years in the general population: The Hoorn Studies. Int J Obes 46, 1808–1817 (2022). https://doi.org/10.1038/s41366-022-01179-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-022-01179-z

Search

Quick links