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http://hdl.handle.net/11375/28288
Title: | The Epidemiology of Stress and Obesity over the Life Course |
Publication Date: | 2023 |
Abstract: | Background: Obesity and stress share a complex relationship. It has been found that obesity and stress are constantly influencing each other, sharing a cyclical association. Stress can be caused by psychological, social, or physical determinants. Understanding this relationship is particularly of interest as a high proportion of people in Canada have obesity, and obesity is not only a disease itself but is a risk factor for several other diseases. Objectives: The objectives of this thesis were: 1) To understand the impact of disasters, including pandemics, on obesity and cardiometabolic risk; 2) To describe stress during the COVID-19 pandemic by socioeconomic factors; 3) To determine how early life adversity and obesity impacted stress during the COVID-19 pandemic; 4) To evaluate the association between early life adversity and adulthood obesity, and to determine if this association was mediated by nutrition. Methods: To address objective 1 a systematic review was conducted. For objectives 2-4, data from over 50,000 adults aged 45 and older from the Canadian Longitudinal Study on Aging (CLSA) was used. This study is unique as it is a nationally representative cohort with comprehensive measures of both obesity and stress, including adverse childhood experiences (ACEs), as well as in-depth data from the COVID-19 pandemic. For objective 2, a cross-sectional study was conducted and for objectives 3 and 4, longitudinal studies were conducted. Multivariable Poisson, negative-binomial and multinomial logistic regression models were used to evaluate associations. To address objectives 3 and 4, novel epidemiologic methods were applied, including effect modification, evaluated on the additive and multiplicative scales and mediation evaluated using causal mediation methodologies. Results: Overall the results of these theses studies support a strong bidirectional relationship between stress and obesity This was observed for various stressors at different periods throughout the life course. The systematic review identified that the indirect harms of disasters, including pandemics, have lasting effects on cardiometabolic outcomes, including obesity. Stress experienced during the COVID-19 pandemic varied across several socioeconomic factors, and obesity was associated with stress experienced during the pandemic. Although ACEs did not modify this association, it was found to independently be associated with stress during the COVID-19 pandemic. ACEs were found to be strongly associated with adulthood obesity, but there was no evidence to suggest this was mediated by nutrition in later life. Conclusions: The findings from this thesis confirm that regardless of the type of stress, or the timing of exposure, obesity and stress are strongly associated. Using a life course perspective allows for a comprehensive assessment of potential risk factors of experiences that occur during adulthood, such as disease development or experiences during a stressful event. People are susceptible to worse experiences during adulthood, which may be related to a variety of factors including adversity during childhood, socioeconomic factors or chronic disease. This should be considered when developing prevention strategies and interventions targeting those at the highest risk. |
URI: | http://hdl.handle.net/11375/28288 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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De Rubeis_Vanessa_G_2023January_PhD_HRM.pdf | 1.9 MB | Adobe PDF | View/Open |
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