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. Author manuscript; available in PMC: 2015 Dec 1.
Published in final edited form as: Prev Med. 2014 Sep 7;69:49–53. doi: 10.1016/j.ypmed.2014.08.036

Gender Differences in the Impact of Stressful Life Events on Changes in Body-Mass-Index

Tomoko Udo 1, Carlos M Grilo 2, Sherry A McKee 2
PMCID: PMC4312235  NIHMSID: NIHMS627695  PMID: 25204986

Abstract

Objective

The positive association between stress and weight has been consistently demonstrated, particularly in women. The effect of stress on changes in weight, however, is less clear.

Methods

A total of 33,425 participants in Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Condition (NESARC) were included in this study. The study examined the relationship between stressful life events during the 12 months prior to the Wave 2 interview and changes in body-mass-index (BMI) between Wave 1 and Wave 2 interviews.

Results

Women reported significantly greater increases in BMI than men. Stressful life events, particularly job-related changes, legal problems, and death of family or friends, were associated significantly with increases in BMI among women but not men.

Conclusions

In a nationally representative sample, stressful life events were associated with greater weight gain in women. Prevention of weight gain in women should focus on the behavioral and physiological mechanisms underlying female-specific effects of stressful life events on weight gain.

Keywords: Stress, Weight Gain, BMI, Gender Differences, Obesity

Introduction

Despite significant public health efforts to reduce obesity, the prevalence of obesity and the cost of medical care for obesity-related diseases in the United States are still on rise (Flegal et al., 2010). A complex interplay of genetic, behavioral, and environmental factors contributes to the development of obesity (Grilo & Pogue-Geile, 1991). Stress is one factor that has been consistently linked with higher body weight (Brunner, Chandola, & Marmot, 2007; Burdette & Hill, 2008; Hellerstedt & Jeffery, 1997; Laitinen, Ek, & Sovio, 2002; Sinha & Jastreboff, 2013). Gender differences in eating behaviors and weight regulation have been documented (Rolls, Fedoroff, & Guthrie, 1991), and some evidence suggests that the relationship between stress and obesity may be stronger in women than men (Laitinen, et al., 2002; Sinha & Jastreboff, 2013). Stress may also influence weight gain (Block et al., 2009; Harding, et al., 2013; Wardle et al., 2011), and the effect may also differ by gender. A recent meta-analysis evaluating longitudinal relationship between stress and various obesity measures (e.g., body-mass-index [BMI], waist circumference, weight) found that stress was more strongly associated with increased adiposity in men than women, although the magnitude of the effects were small (Wardle, et al., 2011). It is important to note that many studies included in the meta-analysis had relatively small sample sizes with focus on middle-age to older adults with special conditions (e.g., those with diabetes, caregivers of Alzheimer's care recipients, high stress occupations).

The relationship between stress and weight gain in large nationally-representative epidemiological data may clarify gender differences in the role of stress on weight gain in the general population. Using the National Epidemiologic Survey on Alcohol and Related Condition (NESARC) data, Barry and Petry (2008) found that overweight women reported more stressful life events than normal weight women the year prior to the interview, but no such difference was found in men. Obese and extremely obese individuals reported more stressful life events than normal weight individuals, regardless of gender. This study supports that the association between stress and obesity may differ by gender, but gender differences in the effect of stress on changes in BMI still remain unclear. BMI is a surrogate measure of excess weight relative to their height. Thus, changes in BMI may be more useful than changes in weight by providing a standardized estimate for the impact of the stressful life events on weight regardless of height. The present study aimed to advance previous findings by examining gender differences in the relationship between stressful life events in the 12 months prior to the Wave 2 interview and changes in BMI between Wave 1 and Wave 2 interviews. Based on Barry and Petry (Barry & Petry, 2008), we hypothesized that a greater number of stressful life events in the year prior to the Wave 2 interview would be associated with greater increases in BMI, particularly in women.

Methods

Sample

The sample for the current study consisted of 33,425 individuals (mean age=46.0±17.4 at Wave 1) who participated in both of the 2001-2002 Wave 1 and 2004-2005 Wave 2 surveys of the NESARC study. Briefly, in Wave 1 of the NESARC, 43,093 non-institutionalized civilians aged 18 and older completed face-to-face computer-assisted personal interviews. From a roster of individuals living in each house hold, one adult was randomly selected for interview (Grant et al., 2003). Among all eligible respondents from Wave 1, 34,653 U.S. adults were re-interviewed in Wave 2 (see Grant et al., 2003, 2007, for the details about the NESARC Wave 1 and Wave 2 Studies). For this study, we excluded individuals with missing weight information in either Wave 1 or Wave 2 interview, and with missing height information in both Wave 1 and Wave 2, leaving a final sample of 33,425.

Body-mass-index

BMI was calculated as (self-reported weight [lb]/self-reported height [in]2)×703. Participants were categorized into three BMI groups: lean (BMI<25.0), overweight (25.0≤ BMI<30), and obese (BMI≥30).

Stressful life events

The Wave 2 of the NESARC included questions regarding 14 stressful events occurred in the 12 months prior to the Wave 2 interview (1=Yes, 0=No): 1) Did you move or anyone new come live with you in the past year?; 2) Were you fired or laid off from a job in the past year?; 3) Were you unemployed and looking for a job longer than a month in the past year?; 4) Have you had trouble with your boss or coworker in the past year?; 5) Did you change jobs, job responsibilities or work hours?; 6) Did you get separated or divorced or break off a steady relationship?; 7) Have you had serious problems with a neighbor, friend or relative?; 8) Have you experienced a major financial crisis, declared bankruptcy or more than once been unable to pay your bills on time?; 9) Did you have serious trouble with the police or the law?; 10) Was something stolen from you, including things that you carry like a wallet, or something inside or outside your home?; 11) Has anyone intentionally damaged or destroyed property owned by you or someone else in your house?; 12) Did any of your family members or close friends die?; 13) Were any of your family members or close friends physically assaulted, attacked or mugged?; 14) Did any of your family members or close friends have serious trouble with the police or the law? A total number of stressful life events were calculated.

Analysis

To correct skewness and kurtosis, the number of stressful life events was log-transformed. Multiple regression analysis was used to examine whether the relationship between changes in BMI and the number of stressful life events differed by gender. We adjusted for the following Wave 1 baseline characteristics: age, marital status (whether currently married), education (whether ever attended or completed college), race (Caucasian [1=Yes, 0=No], and African American [1=Yes, 0=No]), income (1=$10,000 or less, 2=$10,001-$25,000, 3=$25,001-$50,000, and 4=over $50,000), and BMI. To examine sensitivity/specificity of gender differences in the effect of stressful life events on BMI, the same analyses were conducted by age groups (18-29 years old, 30-45 years old, 46 years old and above), race/ethnicity, and income groups.

Results

Baseline Characteristics

Table 1 summarizes baseline characteristics. All demographic characteristics significantly differed by gender. Men had significantly higher BMI than women at both Wave 1 and Wave 2 interviews. At both interviews, a greater proportion of women were categorized into the lean BMI category (Wave 1: 44.7% vs. 32.3%; Wave 2: 40.7% vs. 29.3%), whereas a greater proportion of men were categorized into the overweight BMI category (Wave 1: 29.6% vs. 43.7%; Wave 2: 29.8% vs. 44.0%). Mean changes in BMI were significantly greater in women than men. Women reported experiencing significantly more stressful life events than men. However, there were no significant gender differences in the proportion of individuals reported no stressful life event, one stressful event, or two or more stressful life events.

Table 1. Sample characteristics by gender.

Men
(n = 14,290)		 Women
(n = 19,135)
Age * 45.4 (16.8) 46.4 (17.8)
Race/Ethnicity (%)*
 Caucasian 61.0 56.2
 African American 15.9 21.1
 Native American 1.7 1.7
 Asian 2.9 2.7
 Hispanic 18.6 18.3
Household income (%) *
 $10,000 or less 6.7 12.9
 $10,001 - $25,000 18.8 25.5
 $25,001 - $50,000 32.4 29.6
 Over $50,000 42.1 32.0
Education (%)*
 Less than high school 16.1 17.0
 Completed high school 27.9 29.2
 Some college or higher 56.0 53.8
Marital status (%)*
 Married 55.3 46.6
 Living with a partner 3.0 2.9
 Single/never married 24.3 20.3
 Widowed 3.6 12.7
 Divorced/separated 13.8 17.5
Mean BMI at the Wave 1 * 27.4 (4.9) 27.0 (6.3)
 Lean (%) 32.3 44.7
 Overweight (%) 43.7 29.6
 Obese (%) 24.0 25.8
Mean BMI at the Wave 2 * 27.9 (5.1) 27.6 (6.5)
 Lean (%) 29.3 40.7
 Overweight (%) 44.0 29.8
 Obese (%) 26.8 29.5
Changes in BMI * 0.45 (2.53) 0.62 (3.26)
 Changes in weight (pounds) * 3.08 (17.65) 3.70 (19.29)
 Changes in height (inches) -0.07 (1.38) -0.10 (1.40)
Mean number of stressful life events * 1.50 (1.68) 1.54 (1.72)
 0 (%) 32.6 32.1
 1 (%) 30.1 29.9
 2+ (%) 37.3 38.0
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Notes. All demographic information is from the Wave 1 interview. BMI = body-mass-index.

*

= significant gender differences at p < .05 based on t-test or chi-square test.

The Impact of Stressful Life Events on Changes in BMI by Gender

The interaction between the number of stressful life events and gender was significant on changes in BMI between the Wave 1 and Wave 2 interviews (β=0.01, B[SE]=0.06[0.03], t=2.11, p<.05). Whereas a greater number of stressful life events was significantly associated with greater increases in BMI in women (simple slope estimate [SE]=0.09[0.04], t=2.62, p<.01), no significant association was found in men (simple slope estimate [SE]=-0.01 [0.04], t=-0.27, p>.05). The main effect of gender was significant (β=0.03, B[SE]=0.08[0.02], t=4.86, p>.05), but the main effect of stressful life events was not significant (β=0.01, B[SE]=0.05[0.03], t=1.92, p>.05).

To further examine the significant stressful life events-by-gender interaction BMI found in the regression analysis, following previous studies (Pickering et al., 2011), we compared changes in BMI between men and women who reported no stressful life events, one stressful life event, and two or more stressful life events, using an analysis of covariance (ANCOVA) with age, marital status, education, income, and BMI at Wave 1 as covariates. There was significant interaction between stressful life events-by-gender interaction on changes in BMI, F=3.40, p<05. Women who experienced two or more stressful life events showed significantly greater increases in BMI than women who experienced no stressful life events (Figure 1). In addition, women who experienced one stressful life event and two or more stressful life events reported significantly greater increases in BMI, compared with their respective male counterparts. The main effects of stressful life events and gender were also significant, F=3.96, p <.05, and F=21.72, p <.05, respectively.

Figure 1.

Figure 1

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Changes in body-mass-index (BMI) by gender by the number of stressful life events (0, 1, or 2+). * = significantly different at p < .05.

We also conducted gender comparisons on 14 stressful life events, using ANCOVA. Among the 14 stressful life events experienced during the year prior to the Wave 2 interview, three items showed gender differences in changes in BMI: changes in job or job responsibilities [F=5.17, p<.05], legal problems [F=10.19, p<.05], and death in family or close friends [F=5.19, p<.05] (Figure 2). Women who experienced these events had greater increases in BMI compared with women who did not experience these events, and compared with men who had experienced the events.

Figure 2.

Figure 2

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Changes in body-mass-index (BMI) by gender by whether experiencing changing in job or job responsibilities (Figure 2a), legal problems (Figure 2b), and death of family or close friends (Figure 2c). * = significantly different at p < .05.

Finally, supplementary multiple regression analyses by demographic characteristics revealed significant stressful life events-by-gender interaction on changes in BMI in women who were 30-45 years old, Caucasian, and with income >$50,000 (see supplemental material).

Discussion

Based on data from the NESARC study, a large nationally-representative sample of U.S. adults over 18 years old, we found that the number of stressful life events was positively and significantly associated with increases in BMI in women but not men. Overall, increases in BMI were significantly greater in women who reported two or more stressful life events than women who reported no stressful life events. In contrast, BMI changes in men appeared to be unrelated to stressful life events. Our supplementary analyses further suggest that women who are 30-45 years old, Caucasian, and income above $50,000 may be particularly susceptible to the effects of stress. A meta-analysis of older adults with special conditions revealed a small but stronger effect of stress on increased adiposity in men than women (Wardle, et al., 2011). However, our study is the first to examine the relationship between stress and changes in BMI using a representative sample of the U.S. population. Our findings suggest that stress life events are not only associated with obesity (Barry & Petry, 2008), they are also associated with greater weight gain, particularly for women reporting multiple events. The current study supports the greater vulnerability to stress-induced weight gain in women, compared with men.

Both men and women showed increased BMI over the course of three years, which was at similar rates to previously reported increases in BMI in the U.S. adult population (men from 27.49 to 28.86, women from 26.29 to 27.89 over ∼9 years; Block et al., 2009; men +1.82 BMI, women +2.40 BMI over ∼ 16 years, Truong & Strum, 2005). At both Wave 1 and Wave 2, average BMI for the overall sample was higher in men than women. A greater proportion of men were categorized into the overweight BMI group, whereas a greater proportion of women were categorized into the lean BMI group. However, women had significantly greater increases in BMI men from Wave 1 to Wave 2, and these increases were associated with changes in job responsibilities, legal problems, and the death of family or friends. Stress may promote weight gain through several different pathways (Sinha & Jastreboff, 2013). For example, stress has been shown to increase food intake, particularly energy-dense, palatable foods (i.e., comfort foods) (Cools, Schotte, & McNally, 1992; Ely, et al., 1997; Grunberg & Straub, 1992; Habhab, Sheldon, & Loeb, 2009; Lattimore & Caswell, 2004; Oliver & Wardle, 1999; Oliver, Wardle, & Gibson, 2000; Pankevich & Bale, 2008; Wansink, Cheney, & Chan, 2003; Zellner, et al., 2006). Stress has also been linked with reduced physical activity (Mouchacca, Abbott, & Ball, 2013; Stults-Kolehmainen & Sinha, 2013). Stress may also increase central adiposity by up-regulation of glucocorticoids, which in turn alters lipid homeostasis (Dallman, et al., 2003; Spencer & Tilbrook, 2011). There is evidence suggesting stronger association between stress and comfort eating in women than men (Grunberg & Straub, 1992; Keski-Rahkonen, et al., 2007; Pankevich & Bale, 2008; Zellner, et al., 2006; Zellner, Saito, & Gonzalez, 2007). However, why women are more susceptible to stress-related weight gain compared with men is still unclear partly because much of the research of obesity and unhealthy eating behaviors has focused only on women. Therefore, further research is needed to clarify the observed female-specific relationship between stress and increases in BMI by enhancing inclusion of both genders in research, and collecting information that can inform underlying mechanisms, such as food intake and stress hormones.

There are important strengths of this study. In addition to a large sample size, our sample was more socioeconomically and geographically diverse than previous studies on the longitudinal relationship between stress and adiposity. The follow-up rate of the NESARC study is also high (> 80%). These increased generalizability of the results. Limitations of the current study include measurement issues. First, use of self-reported height and weight are based on self-report might have introduced some bias into the results. It appears common for individuals to underestimate their weight and overestimate their height (Shields, Gorber, & Tremblay, 2008), and there are some reports suggesting systematic errors (e.g., women under-report more than men and misreport is associated with greater BMI) (Masheb & Grilo, 2001; Villanueva, 2001). Thus, use of objective measures would be preferred, although this may not be practical or feasible in large population-based studies such as the NESARC, obtaining objective measures may be impractical. While self-reported measures of height and weight are thus considered generally suitable given high correlation between self-reported and measured height and weight (Kuczmarski, Kuczmarski, & Najjar, 2001; Spencer et al., 2002), this comes at the cost of potentially under-estimating the prevalence rates of overweight/obesity categories (Gorber et al., 2007). Our analyses, which focused on continuous weight and BMI data, may be less vulnerable to such biases which impact more on categorical findings. Second, the assessment of stressful life events relied on retrospective recall and was limited to the year prior to Wave 2. It is possible that some of these stressful life events could be recurring for certain individuals, or weight gain occurred prior to the 12 months before the Wave 2 interview. The current study thus cannot address the causal relationship between stressful life events and weight gain. Women might have perceived life events more stressful than men, particularly the items that showed female-specific effects. However, we could not address this question as the severity of stressful life events, was not assessed in the NESARC study, which can inform whether any particular stressful life events have stronger association with weight gain than the others.

Conclusions

This is the first epidemiological study documenting a female-specific relationship between stressful life events and weight gain in a nationally-representative sample of the general U.S. population. Our study also found greater increases in BMI in women in general than men. Our findings suggest that stressful life events may accelerate weight gain among women supports the need for better prevention of stress-related weight gain in women. Future research should include both men and women to investigate potential behavioral and physiological mechanisms underlying the female-specific association between stressful life events and weight gain, as well as psychologically-related symptoms that lead to behaviors contributing to weight change (e.g., depression, eating disorders).

Supplementary Material

supplement

Highlights.

  • Gender differences in the relationship between stress and BMI changes were examined

  • We used the participants from the NEARC Wave 1 and Wave 2 Studies

  • Women reported significantly greater increases in body-mass-index (BMI) than men

  • Stressful life events were associated with increases in BMI only in women

Acknowledgments

This research was supported, in part, by grants from the National Institutes of Health (K24 DK070052, K12 DA031050, P50 DA033945). The funding agency (NIH) had no role in the preparation or the content of this paper.

Footnotes

Conflict of Interest Statement: The authors report no conflicts of interest or any competing interests. Dr. Grilo reports that he has received grants from the National Institutes of Health, has received consulting fees from Shire, and honoraria from the American Psychological Association, University of Reading, University of Pennsylvania, and University of Connecticut Health Sciences Center, and royalties from Guilford Press and Taylor and Francis Books (for academic books).

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