Physical health and the complex role of PTSD symptoms in obesity: evidence from an Italian cohort of maltreated children and adolescents

Background: Childhood maltreatment represents a significant risk factor for both mental and physical health problems, yet the interplay betyween post-traumatic stress disorder (PTSD) symptoms and obesity in pediatric populations remains underexplored. This study examined the distribution of selected physical health problems in a large cohort of maltreated children. Moreover, it investigated the potential mediating role of psychopathological symptoms in the relationship between PTSD symptoms and body mass index (BMI). Methods: This was a retrospective, cross-sectional study including 307 children and adolescents (aged 3-18 years) with documented histories of maltreatment. Data were collected from a file review of children and adolescents referred for a clinical evaluation at the Neuropsychiatry Unit of a pediatric Hospital. Results: Overweight/obesity was the most frequent condition (35.2%), followed by respiratory infections (9.8%), gastrointestinal symptoms (6.8%), and headaches (5.5%). Age emerged as a significant predictor of BMI, with older children showing a higher likelihood of overweight or obesity. Mediation analysis confirmed a partial indirect effect of PTSD symptoms on BMI through internalizing problems, alongside a direct negative effect on BMI, indicating the coexistence of opposing pathways linking maltreatment to weight outcomes. However, after controlling for age, PTSD symptoms only remained significantly associated with internalizing problems. Conclusions: These findings highlight the heterogeneity of children's responses to adversity, with some exhibiting weight loss, while others develop internalizing symptomatology associated with weight gain. Therefore, the assessment of internalizing symptoms when evaluating obesity risk in maltreated children and adolescents may be crucial. Integrating mental and physical health interventions is essential for preventing long-term adverse outcomes in this vulnerable population.