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Stress- and PTSD-associated obesity and metabolic dysfunction: A growing problem requiring further research and novel treatments

      Obesity and its associated metabolic problems are increasing in prevalence and pose a tremendous threat to human health nationally and worldwide [
      • Hotamisligil G.
      Inflammation and metabolic disorders.
      ]. Approximately a third of the US population is obese, another third overweight, and a quarter of the population have metabolic syndrome [
      • Imes C.C.
      • Burke L.E.
      The obesity epidemic: the United States as a cautionary tale for the rest of the world.
      ]. Posttraumatic stress disorder (PTSD) has emerged as predictor of obesity and metabolic dysfunction in more recent years. Both obesity and PTSD are growing concerns within both the general and veteran populations. The lifetime prevalence rates of PTSD are high and the implications of the associations between PTSD and obesity have a wide reach. For instance, PTSD is estimated to have lifetime prevalence rates of up to 30% in US Vietnam War veterans, with current prevalence rates of around 15% [
      • Kulka R.A.
      • Schlenger W.E.
      • Fairbank J.A.
      • et al.
      Trauma and the Vietnam War generation: report of findings from the National Vietnam Veterans Readjustment Study.
      ]. Other studies find similar rates (11.2–17.1%) among more recent US veterans returning from Iraq and Afghanistan, making PTSD an ever-present concern for veterans [
      • Hoge C.W.
      • Castro C.A.
      • Messer S.C.
      • et al.
      Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.
      ]. Among the general population, prevalence rates of PTSD have been found to be about 7.8%, which represents a decent impact on the populace at large [
      • Kessler R.C.
      • Sonnega A.
      • Bromet E.
      • et al.
      Posttraumatic stress disorder in the National Comorbidity Survey.
      ]. Slightly over a third (35%) of both the veteran and general populations are obese, regardless of PTSD status [
      • Johnelle Sparks P.
      • Bollinger M.
      A demographic profile of obesity in the adult and veteran us populations in 2008.
      ]. However, PTSD may be a key predictor of obesity. Indeed, PTSD has been associated with higher BMI/obesity and its complications, including high blood pressure and metabolic syndrome, not only when compared to the healthy state, but also when compared with other psychiatric disorders such as schizophrenia, mood disorders, and dementia [
      • Jin H.
      • Lanouette N.M.
      • Mudaliar S.
      • et al.
      Association of posttraumatic stress disorder with increased prevalence of metabolic syndrome.
      ,
      • Scott K.M.
      • Bruffaerts R.
      • Simon G.E.
      • et al.
      Obesity and mental disorders in the general population: results from the world mental health surveys.
      ]. There is a large health cost associated with obesity that places a burden on the individual and health care system and an increased urgency to develop new and effective treatments to target this substantial problem [
      • Arterburn D.E.
      • Maciejewski M.L.
      • Tsevat J.
      Impact of morbid obesity on medical expenditures in adults.
      ,
      • Bell J.F.
      • Zimmerman F.J.
      • Arterburn D.E.
      • et al.
      Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort.
      ]. There is no current therapy for treating PTSD-associated obesity or metabolic syndrome. Taken together, it is imperative 1) to gain a better understanding of the mechanism underlying the relationship between PTSD and obesity and 2) to address the challenges of treating PTSD-associated obesity and metabolic dysfunction, with the goal of eventually developing effective treatment options.
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