Posttraumatic stress disorder and risk of obesity: Systematic review and meta-analysis

Objective: To examine the association between posttraumatic stress disorder (PTSD) and obesity in the literature to date. Data Sources: We systematically searched PubMed, Embase, Scopus, Web of Science, and ProQuest from database inception until September 2013. Search phrases combining the terms Obesity and Post-Traumatic Stress Disorder were used. Study Selection: We selected observational studies estimating obesity prevalence in samples of people with PTSD, as well as in comparison groups without PTSD. Data Extraction: Obesity rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. Results: A total of 113, 395, 59, 115, and 400 records were generated from PubMed, Embase, Scopus, Web of Science, and ProQuest, respectively. Thirteen studies were eligible according to inclusion criteria. The pooled crude odds ratio (OR) and 95% confidence interval (CI) for obesity among people with PTSD, based on 589,781 subjects, was 1.55 (1.32-1.82). A large heterogeneity was found (I2 = 90%), and risk of publication bias was statistically significant (P = .002). However, subgroup and sensitivity analyses including only studies with most accurate methods to assess obesity (OR = 1.35; 95% CI,1.05-1.74; I2 = 47%) and PTSD (OR = 1.82; 95% CI, 1.33-2.50; I2 = 75%) also confirmed the association between PTSD and obesity. Conclusions: Despite some limitations, individuals suffering from PTSD seem more likely, relative to controls, to suffer from obesity. As such, individuals with this comorbidity should be targeted for intensive prevention and treatment focused on both disorders. Future research is needed to identify the role of unknown factors and mediators that might clarify the nature of this association.