Investigating the Role of Chronic Stressors in Obesity Among Autistic Adolescents and Emerging Adults

Autistic individuals are 40% more likely to experience obesity than the general population. Obesity rates among this group increase during adolescence and emerging adulthood. Chronic stressors defined as persistent and cumulative stressful experiences over the life course are key mechanisms underlying obesity in the general population because they elicit chronic stress responses leading to obesity including chronically elevated concentrations of the stress hormone cortisol and increased food consumption and sedentariness. Chronic stressors have not been tested as mechanisms underlying obesity in autistic individuals which is potentially why obesity interventions remain ineffective. This proposal leverages one of the largest available datasets of autistic individuals--as well as autistic individuals who are Black Indigenous and People of Color (BIPOC)--to address this critical gap. This research directly aligns with MCHB's Strategic Issues and the IACC Strategic Plan.

Goals and objectives:

The goals of this research pertain to ameliorating health inequities for a vastly underserved target population: autistic adolescent and emerging adult Medicaid beneficiaries experiencing obesity. We will generate new evidence to: 1) Inform interventions that can address needs of the target population by testing the mediating role of chronic stressors in the association between autism and obesity; 2) Address health inequities within the target population by a) assessing sub-group differences (short-term) and b) devising a secondary data analysis research agenda through collaborative mentorship (long-term); and 3) Contribute to a broad public health impact through robust translation and dissemination efforts. Across these goals the objectives are: 1) Completion of a secondary data analysis research project in autism; 2) Submission of two manuscripts to peer-reviewed journals; and 3) Mentorship of a junior investigator.

Proposed data sets and target populations:

We will utilize Medicaid claims data from 2008 to 2019 to test the mediating role of chronic stressors--determined by clinical record encounters reflecting psychosocial challenges; social isolation and discrimination; experiences of abuse and trauma; and challenges in healthcare--in the association between autism and obesity in adolescents and emerging adults (age 15 -- 30). We will test mediation through a series of nested models on autistic and matched samples; we will test moderation of sex race co-occurring psychiatric diagnoses presence of intellectual disability and medication usage.

Products:

This research will generate two peer-reviewed manuscripts. Findings will be translated into infographics blog posts and videos by our active inclusive public health communication student team--Neurodiversity Health Chats--which operates under UC-LEND. Findings will be disseminated on multiple platforms via the investigators' leadership positions on the HRSA Autism Intervention Research Network on Physical Health-- which leverages the full Association of University Centers on Disabilities' network-- as well as the Autism Transitions Research Project.

Evaluation:

We will use a combination of process and outcome measures to assess the effectiveness and efficiency in attaining all goals and objectives.