Adverse Experiences, Protective Factors, and Obesity in Latinx and Hispanic Youths

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.