Increased stress may lead to poor eating behaviors and severe obesity among low-income women

Introduction. Stress has been associated with poor eating behaviors and diet quality, and body mass index (BMI), especially in severely obese women. Low-income women may be particularly vulnerable to stress. Yet, it is unknown how stress may impact obesity through eating behaviors and diet quality or through physiologic processes independent of diet (e.g., cortisol).

Methods. Using structural equation modeling we differentiated pathways from stress to weight status (underweight: BMI ≤ 18, normal weight: BMI 18-24 kg/m², moderate obesity: BMI 30-39 kg/m², severe obesity: BMI ≥ 40 kg/m²):  (1) indirectly through eating behaviors (cognitive restraint, emotional eating, and uncontrolled eating) and diet quality (Healthy Eating Index) and (2) directly to capture unmeasured risk factors independent of diet. We examined cross-sectional data from women (n=101) with a child enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in Cumberland County, North Carolina (Spring 2012). We administered the Perceived Stress Scale survey, collected eating behaviors using the Three-Factor Eating Questionnaire, and we constructed the Healthy Eating Index from a 24-hour dietary recall. We collected measured heights and weights to calculate BMI. The analysis controlled for usual intake, race/ethnicity, income, and age).

Results. Stress was positively associated with uncontrolled eating (β=0.38, p<0.001) and emotional eating (β=0.50, p<0.001). However, stress was not indirectly associated with weight status through eating behaviors and diet quality. Independent of eating behaviors and diet quality, stress was positively associated with severe obesity (β=0.26, p=0.02).

Conclusions. Improving stress coping strategies for low-income women may improve eating behaviors and reduce severe obesity.