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BACKGROUND. Food insecurity affects one in seven households with children in the United States, disproportionately impacts households headed by women and minorities, and is associated with childhood comorbidities, including obesity. While food insecurity likely contributes to poor health through its effect on diet, such a simplistic understanding likely obscures the effects of poverty-related stress and other Adverse Childhood Experiences, on metabolic health. METHODS. Over two summers, 100 children, ages 8-12 years, will be recruited from low-income households in an urban, Rhode Island community, to participate in an 8-week trial designed to isolate the experience of food insecurity. Summer represents a natural risk period of food insecurity in children, such that children will be randomized to receive weekly shipments of five breakfast and lunch meals that mimic school meals or to experience the likely onset of summertime food insecurity and receive a weekly newsletter on community resources that is not expected to affect food insecurity. Through assessment visits at baseline, mid-summer and end of summer, we will examine group differences in change in diet quality, biomarkers of Metabolic Syndrome, inflammation, and stress, BMI z-scores, and child measures of behavior and anxiety and depression symptoms. We will also explore the impact of caregiver mood and stress on the health effects of food insecurity. CONCLUSIONS. Findings stand to clarify the mechanisms by which food insecurity affects child health outcomes and to inform how to best address food insecurity in the context of poverty-related stress. TRIAL REGISTRATION. This trial has been registered at ClinicalTrials.gov (NCT04968496).

OBJECTIVE: Stress negatively impacts adolescent weight status and eating behaviors. Previous research investigating this association has focused on traumatic events in childhood, but little is known about the impact of commonly experienced stressful life events and weight-related outcome. The aim of this cross-sectional study was to examine the association between negative life events and weight-related outcomes (i.e., weight status, disordered eating behaviors, insulin sensitivity) in a sample of treatment-seeking adolescents with overweight and obesity. A further aim of the study was to examine the potential mediating role of depression. METHOD: Adolescents (N = 170; M age = 14.8; 62% female) presenting to an interdisciplinary weight management program completed measures related to negative life events, disordered eating patterns, and depressive symptoms prior to initiating treatment. Weight status and insulin sensitivity (using fasting glucose and fasting insulin) were objectively measured. RESULTS: Stressful experiences during childhood were significantly related to weight status, F = 2.78, p < .05, and disordered eating, F = 5.51, p < .001, in regression analyses. Stressful life events were not related to insulin sensitivity. Depressive symptoms mediated the association between stressful experiences and disordered eating (b = 0.001, [CI = 0.0002, 0.0011]). Depressive symptoms did not mediate this association for weight status or insulin sensitivity. DISCUSSION: Findings from the present study suggest that relatively common stressful events may be associated with development of disordered eating patterns in adolescents with overweight or obesity presenting to treatment. Providers working in weight management settings should consider assessing a range of potentially stressful life events and their potential weight-related implications.