Family Health Study: Stress and Obesity

Duration: 2015 - 2020
Funding: National Institutes of Health / National Institute on Child Health and Human Development (NICHD)
Principal Investigator: Lori Francis
Co-Investigator: Mark T. Greenberg
Co-Investigator: Nilam Ram
Partners: University of North Carolina, Chapel Hill



The prevalence of obesity among children is of national concern. Evidence suggests that numerous factors, such as poverty, race, and gender can all impact disordered eating, physical activity, and weight status. Understanding developmental trajectories for obesity and their predictors is particularly important, given the tracking of overweight from childhood to adulthood, negative health outcomes associated with obesity, and its detrimental effects over the lifespan on physical health and psychosocial functioning.

The Family Health Study provides critical data regarding obesity trajectories in a sample of families experiencing poverty, which could inform the design of intervention programs to prevent the development of obesity in childhood and adolescence.


  • To examine relations among children’s biological responses to stress, behavioral regulation, and dysregulated eating in high- and low-stress conditions, and the extent to which these relations are linked to obesity and the trajectory of body mass index (BMI) over time.
  • To examine relations among exposure to early stressful family environmental factors and children’s biobehavioral and eating dysregulation, and eating in response to stress.
  • To examine the extent to which relations outlined above vary by maternal race, poverty level, gender and biobehavioral risk for obesity.
  • To examine the moderating effects of parenting styles/practices on relations outlined above. 


Data were drawn from the Family Life Project, a longitudinal, birth cohort study of predominantly poor youth and families residing in rural communities in the United States. Extensive details about study recruitment and data collection procedures are provided on the study website. Pregnant, English-speaking mothers residing in six poor rural counties in eastern North Carolina and Central Pennsylvania were recruited between 2003 and 2004 at the time that they gave birth; low-income families and Black families were oversampled. A total of 1,292 youth were followed from birth to 12 years of age. A subsample of 509 of the 1,292 families (39.4%) participated in the Family Health Study when the youth were approximately 14 years old.


The research used a planned missingness design in which measures were collected in-home visits alongside measures of the same constructs via web-based surveys. Home visit families completed two 2.5-hour visits that were ~1 week apart, which varied based on youth exposure to a psychosocial stress task (i.e., one low-stress visit, one high-stress visit).

Following the completion of each home visit, links to individual web surveys were sent to youth and parents. A wide variety of measures were collected with both methods including those aimed at measuring family adversity / stress, biological regulation (e.g., salivary cortisol, heart rate data), behavioral regulation (e.g., delay of gratification, executive function tasks), eating regulation, and obesity/BMI. Physical activity and dietary intake were also assessed.

Key Findings

  • Despite the sample being at high risk for obesity, the majority of youth maintained non-overweight from early childhood through adolescence. 
  • Rapid weight gain in infancy and early introduction of solid foods is associated with an accelerated growth trajectory and risk for developing severe obesity in adolescence. 
  • Executive function confers obesity resilience; children with greater executive function in early childhood (~age 3 years) maintained a normal weight gain trajectory throughout childhood. 

Project Team


Measuring adolescents’ eating in the absence of hunger in the home environment: Validation of subjective vs. objective measures (forthcoming)

Francis, L. A., Rollins, B. Y., & Lozinski, R. H.

Executive function and BMI trajectories Among rural, poor youth at high risk for obesity

Rollins, B. Y., Riggs, N. R., Francis, L. A., & Blair, C. B. (2021). Obesity, 29(2), 379-387.

Off the charts: Identifying and visualizing body mass index trajectories of rural, poor youth

Rollins, B. Y., & Francis, L. A. (2021). The Journal of Pediatrics, 228, 147-154.e2.