# Independent and Mediated Associations of Adverse Childhood Experiences With Overweight and Obesity in Adults From the United States: Insights From the 2023 Behavioral Risk Factor Surveillance System (BRFSS) Data

## TL;DR

This study explores how childhood trauma may indirectly affect adult obesity through socioeconomic and behavioral factors using U.S. health data.

## Contribution

This is one of the first studies to use 2023 BRFSS data with multilevel modeling to isolate ACE effects on obesity.

## Key findings

- Participants with ≥3 ACEs had higher crude overweight/obesity prevalence (69.7%) compared to those with no ACEs (67.0%).
- ACEs were not significantly associated with overweight/obesity in fully adjusted models.
- Adult factors like race, income, and physical inactivity were stronger predictors of obesity than ACEs.

## Abstract

Adult overweight and obesity remain an urgent public health concern in the United States. While adverse childhood experiences (ACEs) are recognized as risk factors, it remains unclear whether their influence persists independently of adult socioeconomic and behavioral conditions. To our knowledge, this study is among the first to analyze the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data with multilevel modeling to isolate ACE effects from adult risk factors. Using data from the 2023 BRFSS (n=269,521), this study employed multilevel logistic regression to examine the relationship between ACEs and adult overweight/obesity (BMI≥25), adjusting for demographic, socioeconomic, health access, behavioral, and chronic disease variables. ACEs were categorized as 0, 1-2, or ≥3.

Out of the total 269,521 respondents, 67.5% (n=182,008) were classified as overweight or obese. Participants with three or more ACEs (n=9,677) had a higher crude prevalence of overweight/obesity (69.7%) compared to those with no ACEs (n=12,786, 67.0%; p=0.02). However, in fully adjusted models, ACEs were not significantly associated with overweight/obesity (OR for ≥3 ACEs=1.08; 95% CI: 0.92-1.27). Independent predictors included race/ethnicity, income, education, physical inactivity, diabetes, and healthcare access. These findings suggest that ACEs may influence obesity indirectly, primarily through their impact on adult socioeconomic and behavioral factors. Interventions that address adult-level risk factors, particularly in populations with high ACE exposure, combined with trauma-informed care, may be more effective in reducing obesity prevalence.