About Adverse Childhood Experiences and Adult BMI

Dr. David Wiss

July 4, 2021


The Adverse Childhood Experiences (ACE) questionnaire captures specific exposures that can occur in the household. ACEs include childhood maltreatment such as physical, sexual, or emotional abuse, neglect, and various forms of household dysfunction such as parental separation, drug use, incarceration, and mental illness. It is well-established that ACEs can become biologically embedded and disrupt neurodevelopment, leading to adopting health risk behaviors. This life-course trajectory can eventually lead to disease, disability, and a wide range of social and behavioral problems.

While we understand that the term “obesity” has become controversial in conversations around weight stigma, in this article we review recent evidence that provides an explanation for this phenomenon that may actually reduce stigma around weight and BMI. In other words, body weight is not as much of a “choice” as most people seem to think. Contrary to popular belief, this understanding can actually reduce “diet culture” and disordered eating patterns. 

Multiple studies have shown that the presence of elevated ACE scores predicts obesity in adulthood. A recent systematic review and meta-analysis of ten observational studies (n=118,691) reported a 46% increase in the odds of adult obesity following exposure to multiple ACEs [1]. One proposed explanation is food addiction, which is based on strong evidence linking trauma and all forms of addiction. Links between addiction and trauma have received considerable attention in recent years and the role of food and eating behavior should not be ignored in this conversation. 

Efforts to explain the relationship between childhood adversity and adult obesity often focus on stress-induced overeating [2]. Many people with trauma histories are looking for stress-eating help. Many people turn to comfort food when feeling stressed, and this may have origins in developmental processes. 

Other proposed mediators include depression, self-criticism, dissociation, post-traumatic stress disorder symptoms, specific interpersonal factors such as attachment quality, eating disorder symptoms, and neurobiological factors [3]. Other mechanisms might include cortisol dysfunction following repeated stress [4] or sleep problems combined with less fruit and vegetable consumption [5]. Multiple pathways are possible and likely to be interrelated. 

According to the recent systematic review and meta-analysis, the most common explanations for the relationship between ACEs and obesity were social disruption and changes in health behaviors. It was pointed out that many authors did not explicitly mention biological factors, nor did they consider the role of addiction-like eating, which is related to the brain’s dopamine system and the over-assignment of “value” (i.e., salience) to “highly palatable food.” It is under debate if this phenomenon is relevant to individuals with binge eating disorder and bulimia nervosa. 

From a broad perspective, four characteristics define biological embedding [6]: Life experiences translate into neurobiological adaptations:

  • Adaptions vary according to the intensity 

  • Effects are stable and long-term 

  • Effects influence behavioral patterns or mental health outcomes over the lifespan 

In recent years it has become clear that ACEs can become biologically embedded through inflammatory pathways, epigenetic modification, structural and functional brain changes, and altered reward pathways (e.g., dopamine) [7]. All of these can increase the risk of weight gain. For this reason, the types of foods that one eats during recovery from trauma and addiction do matter. Importantly, it is important to find ways to reduce stress, improve body image, and identify sources of internalized weight bias.  

Awareness of these biological embedding pathways may reduce obesity-related weight stigma. At Wise Mind Nutrition, we challenge the common assumption that all eating behavior is simply a “choice.” Instead, some individuals may experience weight gain because of chronic exposure to highly palatable foods as a biological-based coping mechanism for trauma. 

In other words, some people have been exposed to adversity in ways that altered their physiology and subsequently promote weight gain over time. Thus, generic messages of “eat less and exercise more” that are still common in some nutrition and medical circles do not fit people with multiple ACEs. A better message is treating the trauma, reducing stressors, and stopping to carry the shame of “personal responsibility” failure. It is not just about willpower but about biology. So let us take a trauma-informed dive into nutrition together, where we are paying attention to eating habits and your relationship with food with the goal of recovery. 


1. Wiss DA, Brewerton TD. Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies. Physiol Behav. 2020;112964.

2. Vámosi M, Heitmann B, Kyvik K. The relation between an adverse psychological and social environment in childhood and the development of adult obesity: a systematic literature review. Obesity Reviews. 2010;11(3):177–84.

3. Palmisano G, Innamorati M, Vanderlinden J. Life adverse experiences in relation with obesity and binge eating disorder: A systematic review. Journal of behavioral addictions. 2016;5(1):11–31.

4. Anda R, Felitti V, Bremner J, Walker J, Whitfield Ch, Perry B, et al. The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience. 2006;256(3):174–86.

5. Windle M, Haardörfer R, Getachew B, Shah J, Payne J, Pillai D, et al. A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students. Journal of American College Health . 2018;66(4):246–51.

6. Hertzman C. Putting the concept of biological embedding in historical perspective. Proceedings of the National Academy of Sciences. 2012;201202203.

7. Wiss DA, Avena N, Gold M. Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients. 2020;12(11):3521.