Early Obesity Risk in Neglected Children: Attachment Security As a Protective Factor

Introduction: Children who experience maltreatment are at heightened risk for developing obesity as adolescents and adults (Danese & Tan, 2014). Children who experience early adversity may become overweight or obese as early as 2 years old (Helton & Liechty, 2014), and those who are overweight or obese in early childhood are likely to develop weight problems in adolescence and adulthood (Nader et al., 2006). Research on non-maltreated children has shown that secure attachment serves as a protective factor from obesity onset, with securely-attached preschoolers less likely to be overweight or obese compared to children with insecure attachments (Anderson & Whitaker, 2011). The current study aimed to extend this work to a high-risk sample, by examining whether attachment security protects from early risk for obesity following neglect.

Methods: Participants included 216 children (120 male) who were involved with Child Protective Services during infancy due to allegations of neglect. Sixty-five percent of participants were African American, 12% were Hispanic, 9% were Caucasian, and 14% were multi-racial. Children were enrolled in a longitudinal study examining the effectiveness of a parenting intervention. Attachment security was measured during infancy using the Strange Situation Procedure. Children’s height and weight were measured at 6-month intervals from 12 months old to 48 months old, and used to compute body mass index (BMI) at each assessment point.

Results: Hierarchical linear modeling was conducted to examine BMI trajectories over time. Children with secure attachments showed a steeper decline in BMI than children with insecure attachments (effect of attachment on linear slope: β = -1.29 p = .007; quadratic slope: β = -0.16 p = .006). The BMI trajectory observed for children with secure attachment appears consistent with the healthy pattern of BMI change based on normative data. By age 4, there was a significant difference in BMI between children with secure attachments [M = 15.25, Average range] and children with insecure attachments [M = 17.33, Overweight range], β = -1.89, p = .029. 

Conclusions: These findings illustrate that attachment security may buffer the risk of obesity for children who experience chronic stress, such as maltreatment. Prevention of obesity at an early age is critical to children’s health across the lifespan. Attachment security may represent a key target for future interventions addressing physical health in maltreated children.