College of Science and Health Theses and Dissertations

Date of Award

Summer 8-20-2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Joanna Buscemi, PhD

Second Advisor

Jocelyn Carter, PhD

Third Advisor

Kathryn Grant, PhD


INTRODUCTION: Childhood obesity is a risk factor for long term heath consequences such as diabetes, asthma, high cholesterol, and heart disease. However, causes for pediatric obesity are complex and include many variables such as calorie-dense diets, sedentary behavior, and short sleep duration. In addition to these variables, variances in homeostasis, can also impact obesity risk in pediatric populations. One of these variances of interest in the obesity and health literature is stress response. Relationships among these variables are not fully understood. Therefore, the purpose of this study was to systematically review the literature exploring predictive relationships between objective measures of stress response (e.g., cortisol) and obesity/health behaviors (e.g., sleep, diet, physical activity, and sedentary behavior). A meta-analysis was conducted to estimate the magnitude of these relationships, along with an exploratory analysis of moderators associated with these pathways. METHOD: Articles were retrieved from three databases based on exclusionary (e.g., eating disorder population, non-experimental studies) and inclusionary (e.g., ages 2-18, written in English) criteria. Articles were assessed via abstract and full-text review. Effect sizes were extracted from articles for analysis. ANALYSIS: Effect sizes calculated using Cohen’s d and were assessed via a multilevel approach to meta-analysis to determine dependency among effect sizes. Three levels of analysis were used to assess the variance of the model including sampling variance of all extracted effect sizes (Level 1), variance between effect sizes within studies (Level 2), and variance between effect sizes among studies (Level 3). Omnibus testing was used to explore moderating effects. Publications were assessed for bias. RESULTS: Of 2,488 studies screened, 10 studies met criteria for the systematic review and meta-analysis. Three studies assessed sleep as primary outcome; the remaining 7 studies assessed body mass index (BMI) percentile or z-score as the primary health outcome. Broadly, qualitative findings indicated that stress responses have variable impacts on sleep and obesity outcomes. These outcomes indicated both over- and under-functioning hypothalamic pituitary axis functioning are associated with higher weight status and poorer sleep outcomes. The overall meta-analysis did not indicate a significant effect of stress responses on health behaviors. A significant small effect was found among sleep-related studies. No significant moderators were found.

CONCLUSIONS: Qualitative literature indicates relationships among stress responses and health behaviors in children and adolescents; quantitative outcomes did not find a significant relationship between stress responses and health behaviors. There was a small significant effect between stress responses and sleep-related studies, and no significant effect among BMI/Obesity related studies. However, more research is needed to better understand directionality and mechanisms associated with these relationships to further strengthen intervention and prevention strategies. Additional research in this area of study may better optimize stress responses in children to improve health outcomes.

SLP Collection


Included in

Psychology Commons