Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study.

Background: Despite potential protective and mitigating effects of positive childhood experiences (PCEs) on poor health outcomes, limited research has identified relevant PCEs and examined their individual and cumulative associations with weight status, or their mitigating effects on the associations between adverse childhood experiences (ACEs) and obesity in children. This study aims to develop an exploratory PCEs Index with the potential to protect against or mitigate the association between ACEs and unhealthy weight status.

Methods: Data came from the Growing Up in New Zealand study. The analytic sample was restricted to those who provided obesity data at age 8 and one child per mother, resulting in a sample of 4,895 children. Nine individual ACEs and their cumulative scores, a newly developed PCEs index consisting of six individual PCEs and (their) cumulative scores, and an overweight/obesity variable were included in the analyses.

Results: By age eight, experience of at least 3 PCEs was reported by 72.1% of the sample. However, the experience of the highest number of PCEs (5-6) was only reported by 23% of the sample. Four out of six assessed PCEs were associated with decreased likelihood of overweight/obesity. A dose-response effect was observed where experience of three or more PCEs was associated with decreased odds for obesity (AORs decreased from 0.77 for 3 PCEs to 0.54 for 5-6 PCEs). No consistent mitigating effects were found for individual PCEs; however interactions were found between reporting at least four of the six PCEs, experience of cumulative ACEs, and reduced odds for overweight/obesity at age 8.

Conclusions: A critical number of PCEs may be required to mitigate the detrimental impacts of ACEs on weight status among children. These findings reinforce the need to consider a constellation of strength-focused ecological domains to alleviate the burden of childhood obesity, particularly for children exposed to multiple adversities.