Preschool-aged children of mothers who have been chronically abused by their partners have an increased risk of developing obesity, according to a cohort trial from the Fragile Families and Child Well-being Study (FFCWS).

In fact, 16.5% of the children with mothers reporting any form of intimate partner violence (IPV) were obese at the age of 5 years — and those with mothers reporting chronic IPV were 80% more likely to be obese than those with no maternal IPV, report the study authors.

“To our knowledge, no study has explored [this] impact,” write lead study author Renée Boynton-Jarrett, MD, ScD, assistant professor of pediatrics at the Boston University School of Medicine in Massachusetts, and colleagues.

On the basis of these findings, “medical and public health practitioners must consider the impact of family violence on obesity risk when designing and implementing primary obesity prevention interventions,” they add.

“Routine screening is also important,” Dr. Boynton-Jarrett told Medscape Psychiatry. “Screening and intervening early might not only lead to a reduction in the violence within the family, but we may also be improving a range of child health outcomes.”

The study is published in the June issue of Archives of Pediatric and Adolescent Medicine.

3 Million to 10 Million Children Witness IPV

“Obese youth are more likely to become obese adults and disproportionately experience cardiovascular and metabolic comorbidities, reproductive dysfunction, and emotional sequelae,” the investigators write.

They add that 3 million to 10 million children between the ages of 3 and 17 years witness IPV annually, “with a disproportionate number aged 5 years and younger.”

“Both exposure to [IPV] and childhood obesity are major public health problems,” said Dr. Boynton-Jarrett. “We have learned over time that early childhood adversities have long-lasting consequences for both the health of the child and their health trajectory as they enter adulthood, including chronic illness risk.”

Although past studies have linked obesity with patterns of family dysfunction, “there has been a paucity of research to date that has explored the impact of family violence on obesity risk in early life.”

For this study, the investigators examined data from the FFCWS on 1595 children (51.2% male) from 20 large cities in the United States, born between 1998 and 2000, and their parents.

Mothers were interviewed in the hospital shortly after giving birth and by telephone at 12, 36, and 60 months after giving birth about restrictive, sexual, and physical abuse they may have received from an intimate partner. Chronic IPV was defined as “any maternal IPV exposure during both pregnancy or infancy (0-12 months) and early childhood (36-60 months).”

Home visits were also conducted at the 36- and 60-month points, which included body mass index measurements taken of the children.

In addition, mothers were asked during the 36-month home visit about the safety of their neighborhoods based on questions from the Neighborhood Environment for Children Rating Scale.

Elevated Risk for Obesity

Results showed that 49.4% of the mothers evaluated had experienced some form of IPV, with 16.8% experiencing chronic IPV.

A significantly elevated risk for obesity at the age of 5 years was found for the children of mothers who reported chronic IPV compared with those whose mothers reported no IPV exposure (adjusted odds ratio [OR], 1.80; 95% confidence interval [CI], 1.24 – 2.61).

Girls with a maternal history of IPV also showed an increased risk for obesity by the age of 5 years (adjusted OR, 2.21; 95% CI, 1.30 – 3.75) compared with boys in the same situation (adjusted OR, 1.66; 95% CI, 0.94 – 2.93).

Finally, an increased obesity risk was found among the children with mothers who reported any IPV and living in less safe neighborhoods (adjusted OR, 1.56; 95% CI, 1.03 – 2.36).

Overall, these findings persisted even when controlling for confounders such as maternal depression, maternal smoking during pregnancy, and child birth weight.

The study authors note that possible reasons for these associations could include that feeding practices may be influenced when IPV disrupts the mother’s responsiveness to the socioemotional needs of the child and that witnessing family violence may lead to self-soothing with food.

Also, chronic stress “may alter hypothalamic-pituitary axis functioning, lead to dysregulation of neuroendocrine systems controlling appetite, and influence hormonal regulation of visceral fat distribution,” write the investigators.

Dr. Boynton-Jarrett reported that her team also found that when the children were exposed to IPV at a very young age only, the obesity risk was not elevated compared with those with no violence reported in the home.

“I think that’s a little bit surprising and perhaps encouraging,” she noted. “It may suggest that if there is violence in the home and the violence is removed, or there is an intervention that takes place, then we can improve or minimize risks to child health. That should really push us to do more screenings from a clinical perspective and from a public health perspective.”

Confirms Physical Health Problems

“I would say that this is an extremely important study that was very well done,” Jacqueline Campbell, PhD, RN, professor and Anna D. Wolf Chair of the Department of Community-Public Health in the School of Nursing at Johns Hopkins University in Baltimore, Maryland, told Medscape Psychiatry.

“This study helps confirm the physical health problems we see in children who are raised in violent homes. Some of their emotional and behavioral problems have been well documented, but the physical health problems have not yet been well documented in really persuasive studies,” added Dr. Campbell, who was not involved with this trial.

She explained that she’d like to see future studies that focus on other physical problems that may be attributable at least in part to violence in the home and further research to better understand some of the physiologic mechanisms at play in these situations.

“Is this a stress response? Is it through an immune system alteration that happens with ongoing trauma? Those are important questions that need to be answered,” said Dr. Campbell. “It’s so important that we understand the part that violence plays in eating issues and nutrition issues and weight issues for kids. And we won’t know about that underlying problem unless we ask.”

“It’s not that pediatricians have negated these issues or failed to recognize that it is problematic, but they have not deemed it important enough of a contributor to physical health problems to routinely ask about it,” she added. “That’s the piece of the puzzle that this kind of study helps point us toward.”

She noted that further research is also needed on the best way to ask a parent about violence in the home. “How do we do it in a way that doesn’t contribute to the trauma for a child? And then how do we do effective short interventions that can be done in a pediatric setting? This includes not only referrals to domestic violence advocacy networks but also other kinds of interventions that can help that family become nonviolent.”

The study was funded by the William T. Grant Foundation, the Boston University Building Interdisciplinary Research Careers in Women’s Health, the Academic Pediatric Association Young Investigator Award, and a grant from the National Institutes of Health. The study authors and Dr. Campbell have disclosed no relevant financial relationships.

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Arch Pediatr Adolesc Med. 2010;164:540-546.
Deborah Brauser
From Medscape Medical News