Abstract
IMPORTANCE: Pediatric obesity rates are rising, and adverse childhood experiences (ACEs) may contribute by promoting stress-induced weight gain. Few studies have examined the association of ACEs with body mass index (BMI) and youth-reported protective factors, particularly among Latinx and Hispanic youths, who face higher rates of ACEs and obesity. OBJECTIVE: To evaluate the association of ACEs with BMI in a population-based cohort and determine whether youth-reported protective factors (eg, self-coping skills, caregiver or friend support, or overall support) moderate this association, with a focus on Latinx and Hispanic youths. DESIGN, SETTING, AND PARTICIPANTS: This large, cross-sectional study of youths aged 11 to 12 years was conducted using year 2 data (July 2018 to March 2020) of the Adolescent Brain Cognitive Development (ABCD) study, a prospective, 10-year longitudinal, 21-site dataset comprised of a population-cohort of US youths. Data were analyzed between August 2024 and March 2025. EXPOSURES: Cumulative ACEs (12 categories) and youth-reported protective factors (4 categories). MAIN OUTCOME AND MEASURES: The primary outcome was the ability of self-reported protective factors to moderate the hypothesized association of ACEs with BMI in Latinx and Hispanic youths. Linear mixed-effects models explored associations of ACEs, protective factors, and ethnicity (ie, Latinx and Hispanic or non-Hispanic) with BMI, while controlling for confounders (eg, sex, age, puberty, and socioeconomic status). RESULTS: There were 5435 youths with available data at ages 11 to 12 years (1141 Latinx and Hispanic [21.0%]; 2636 female [48.5%]; mean [SD] age, 143.1 [7.6] months). Compared with non-Hispanic youths, Latinx and Hispanic youths had greater BMI (mean [SD], 22.1 [5.0] vs 20.3 [4.6]; P < .001) and more ACEs (mean [SD], 2.1 [1.7] vs 1.7 [1.7]; P < .001). Across all youths, ACEs were significantly associated with BMI, with a 0.431 BMI increase for every 1.7-point increase (1 SD) in ACE score. In Latinx and Hispanic youths only, self-coping (β = -0.74; 95% CI, -1.03 to -0.46; P < .001), caregiver support (β = -0.38; 95% CI, -0.66 to -0.11; P = .006), and overall protective score (β = -0.55; 95% CI, -0.61 to -0.06; P < .001) moderated the association of ACEs with BMI. CONCLUSIONS AND RELEVANCE: These findings highlight the clinical importance of early ACE screening to identify at-risk youths for targeted, trauma-informed weight management interventions, and gather support for the cultivation of resiliency-focused skills like self-coping and caregiver support. Pediatric obesity is a pressing public health issue, and these strategies hold potential to alter weight trajectories, which may improve health outcomes and reduce health disparities.