Parent-Perceived Stress and Its Association with Children's BMI and Obesity-Related Behaviors

Abstract

Background: Stress is associated with greater rates of obesity in adult and pediatric populations. Few studies have examined the relationship between parent stress and child obesity and related behaviors. Methods: We studied 689 pairs of parents and children ages 2-12 years with body mass index (BMI)≥85th percentile in eastern Massachusetts. We asked parents a single question about their perceived stress and categorized responses into low, moderate and high levels. We examined associations of parent’s stress with children’s BMI z-scores and obesity-related behaviors using multivariable regression models adjusted for child/parent characteristics and stratified results by child age, race/ethnicity and household income. Results: In fully-adjusted models, the association we observed between high (vs. low) parent reported stress and children’s age/sex-adjusted BMI z-scores only remained significant for children in lower-income households (β=0.22 [95% CI 0.08, 0.37]) and of Non-Hispanic Black race/ethnicity (0.29 [0.10, 0.47]). Parents with high or moderate (vs. low) stress were less likely to report that their children met recommendations for fast-food consumption (Prevalence Ratio=0.79 [0.65, 0.96] and 0.70 [0.59, 0.82]), but parents with high vs. low stress were more likely to endorse daily physically activity (1.21 [1.01, 1.45]). Parent-perceived stress was not associated with other obesity-related behaviors. Conclusion: Among children with overweight/obesity, parent-perceived stress was associated with greater fast-food consumption and physical activity, and with higher child BMI among children in low-income households and of Non-Hispanic Black race/ethnicity. Obesity interventions should consider parent-perceived stress and potential differences in the nature of stress experienced by parents of different racial/ethnic and socioeconomic backgrounds.