Research Articles Posttraumatic Stress Disorder and Obesity Evidence for a Risk Association Axel Perkonigg, PhD, Toshimi Owashi, MD, Murray B. Stein, MD, MPH, Clemens Kirschbaum, PhD, Hans-Ulrich Wittchen, PhD Background: There is evidence from cross-sectional studies that posttraumatic stress disorder (PTSD) may be associated with obesity. The aim of this study was to examine prospective longitudinal associations between PTSD and obesity in a community sample. Methods: A prospective, longitudinal, epidemiologic study with a representative community sample of adolescents and young adults (N=3021, aged 14 –24 years at baseline) was conducted in Munich, Germany. Participants were assessed four times between 1995 and 2005 with the Munich-Composite International Diagnostic Interview. Associations between obesity (BMI 30) and DSM-IV PTSD were evaluated in 2007, using cross-sectional and prospective data during young adulthood. Results: The cumulative lifetime incidence of obesity in the sample at 10-year follow-up during young adulthood was 4.3% (women, 4.6%; men, 4.0%). Among women but not among men, obesity was associated with a lifetime history of PTSD (OR=3.8; 95% CI=1.4, 10.7) in the cross-sectional analyses. Prospective longitudinal analyses from 4-year follow-up to 10-year follow-up confirmed that obesity was predicted by antecedent subthreshold and full PTSD (OR=3.0; 95% CI=1.3, 7.0) among women but not among men. There were no associations between other mental disorders and obesity in the prospective analyses. Conclusions: The findings indicate a possible causal pathway for the onset of obesity in females with PTSD symptoms. These findings need replication with regard to the pathophysiologic and behavioral mechanisms underlying this relationship. (Am J Prev Med 2009;36(1):1– 8) © 2009 American Journal of Preventive Medicine Introduction O besity, as defined by a BMI of 30.0 (or other cut-offs and measures), 1,2 is a serious public health problem associated with elevated mor- bidity 3–5 and mortality. 6 Several population-based stud- ies 7–9 have reported that mental disorders are associ- ated with obesity, but most such studies have failed to incorporate exposure to traumatic events and posttrau- matic stress disorder (PTSD) into their models. 8,9 In the context of an increasing number of findings on associations between PTSD and adverse health (includ- ing metabolic) outcomes, 10 –11 a better understand- ing of the nature of the relationship among trauma- tic events, PTSD, and obesity becomes particularly important. Several clinical observational studies 12–14 have re- ported higher rates of obesity in military veterans with PTSD. David et al. 12 found, in a sample from a rehabil- itation unit, that male military veterans with PTSD were more frequently obese compared to veterans with alco- hol dependence. Dobie and colleagues 13 reported an association between current PTSD and obesity among female military veterans who received care at a U.S. Department of Veterans Affairs hospital. Vieweg et al. 14 found a higher percentage (45.7%) of obesity among male military veterans with PTSD compared to preva- lence estimates in the U.S. general population (30.5%), but there was no association with PTSD severity. Thus, although the limited literature that has ad- dressed the topic has found associations between PTSD and obesity in military veterans, these studies have tended to be small and of potentially limited general- izability. In particular, the role of trauma exposure itself and that of PTSD symptoms is unclear, and it is questionable whether obesity is related to PTSD in other traumatized populations such as, for example, the victims of natural catastrophes, severe accidents, or violence. Further, it is unclear whether associations From the Department of Clinical Psychology and Psychotherapy (Perkonigg, Wittchen), the Department of Biological Psychology (Kirschbaum), Technical University of Dresden, Dresden; the Max Planck Institute of Psychiatry (Perkonigg, Owashi, Wittchen), Mu- nich, Germany; the Department of Psychiatry, Showa University Fujigaoka Hospital (Owashi), Yokohama, Japan; and the Depart- ments of Psychiatry and Family and Preventive Medicine, University of California San Diego (Stein), La Jolla, California Address correspondence and reprint requests to: Axel Perkonigg, PhD, Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Strasse 46, 01187 Dresden, Germany. E-mail: axelp11@gmx.net. 1 Am J Prev Med 2009;36(1) 0749-3797/09/$–see front matter © 2009 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2008.09.026