Cortisol, dehydroepiandrosterone, and depressive symptoms as pathways from child abuse to obesity

Child abuse has been linked with obesity throughout the lifespan. The aim of the current study was to test two competing mechanisms underlying the association between child abuse exposure and obesity in childhood. Specifically, we examined whether depressive symptoms and the ratio of cortisol to dehydroepiandrosterone (DHEA), two hormones central to the stress response system, mediated the link between child abuse and obesity.

This study employed a sample of 1,229 children all experiencing poverty (63.5% Black, 49.1% biological females). Approximately 40% of the participants were exposed to childhood physical, sexual, and/or emotional abuse (n = 471, 38.3%), as evidenced by coded Child Protective Service records. Cortisol and DHEA were measured with saliva samples taken in the morning across multiple days.

Results of structural equation modeling indicated that children with abuse histories evidenced a lower cortisol/DHEA ratio, which was associated with a greater likelihood of childhood obesity. Importantly, this pathway held while controlling for a depressive symptom pathway, pointing to the unique influence of adrenocortical dysregulation in the child abuse-obesity link. Although child abuse was associated with greater depressive symptoms, depressive symptoms were not related to obesity.

These findings underscore that childhood adversity can "get under the skin" to affect health, even as early as childhood, and highlight that trauma-informed approaches to the clinical care of children with abuse histories represent a promising avenue for obesity prevention. Preventing child abuse occurrence and supporting children following abuse exposure may both be critical points of intervention for obesity prevention. (PsycInfo Database Record (c) 2025 APA, all rights reserved).