Psychological stress predisposes children to bad eating habits

Prolonged psychological stress in children may affect their eating habits, with a tendency toward increased hedonic behaviour, suggests an observational study.

"Food stimulus exposure and leisure access can be targeted for intervention during periods of prolonged stress,” the investigators said.

Data were collected from caregivers of 5- to 12-year-old children from three diverse groups, assessing sociodemographic, economic, and perceived stress, from October 2020 to June 2021. The Strengths and Difficulties Questionnaire (SDQ) and the Family Eating and Activity Habits Questionnaire revised (FEAHQ-R) were also used. 

The investigators compared the SDQ subscales with US child norms. They also explored the association between the SDQ subscales and FEAHQ-R domains using mixed models, adjusting for socioeconomic covariates.

In total, 361 families, including 496 children, completed the SDQ and FEAHQ-R. The SDQ subscale scores were higher than those of age/gender norms (p=0.006 to p<0.001), with eating style (p<0.001) and food stimulus exposures scores (p=0.005 to p=0.01) correlating with the SDQ subscales, but not satiety response. [Obesity 2025;33:134-145]

Notably, perceived stress was found to be a significant covariate (p<0.001), whereas baseline obesity status of the children showed no statistical significance.

“This study identified that prolonged psychological stressors experienced by children increased behavioural, emotional, and relationship problems and were associated with changes in their obesogenic eating behaviours but did not have any association with the biologically regulated domain of satiety responses, regardless of the presence of obesity,” the investigators said. 

“Perceived child and family stress plays a significant role in this association, and racial disparities exist in the current obesogenic environment ripe for individual- and policy-level intervention,” they added.

Mental health

Parental mental health has a significant impact on children’s lives, as shown by the association between perceived family stress and obesogenic eating styles and habits. It remains unclear whether such link was driven by a lack of financial and other support resources seen in the baseline survey.

In longitudinal models, economic stress showed no significance, so these findings may be seen as an indication of the parental response to perceived stress, as shown in previous studies. [J Nutr Educ Behav 2022;54:660-669; Appetite 2021;161:105119]

“Responsive feeding is an important tool in childhood obesity management, and the American Academy of Pediatrics guidelines for the management of childhood obesity emphasize the role of family participation,” the investigators said. [Pediatrics 2023;151:e2022060640]

“The family systems theory emphasizes the interconnected nature of family members and the importance of family-level interventions in both clinical practice and research,” they added. [Clin Obes 2023;13:e12614]

“The use of the FEAHQ-R allowed us to capture the role of family, highlighting the importance of food parenting during periods of enhanced stress,” according to the investigators. 

COVID-19

The current study assessed the emotional and behavioural measures in children aged 5 to 12 years during the first 6 months of the COVID-19 pandemic. These measures were then validated in follow-up assessments completed within the same academic year.

The findings underscore the long-term impact of COVID-19 pandemic-related stress and restrictions across the demographic and socioeconomic groups.

"[T]he COVID-19 pandemic served as a natural model for assessing the impact of emotional and behavioural stress on eating behaviours,” the investigators said.