Investigating the Role of Chronic Stress and Camouflaging in Obesity Among Autistic Adolescents and Emerging Adults - PROJECT SUMMARY / ABSTRACT Autistic individuals, who represent 1 in 36 individuals in the United States, are disproportionately likely to experience obesity relative to the general population. Obesity rates among this group increase during adolescence and emerging adulthood (age 15–30). 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 concentration of the stress hormone cortisol that increases food consumption and fat storage. Autistic individuals experience severe chronic stressors in the forms of lifelong stigma, discrimination, victimization, and rejection. Three-fourths engage in camouflaging: utilizing behavioral and cognitive strategies to mask autistic traits to appear more “typical.” Camouflaging—found to coincide with periods of developmental changes and transitions—is a potentially highly impactful chronic stressor for autistic individuals. Camouflaging leads to low well-being, self-esteem, and quality of life; high distress, anxiety, depression, and suicidality; and delayed diagnosis and compromised healthcare, which are linked to obesity in the general population. Despite this, research has yet to investigate camouflaging as a potentially impactful chronic stressor leading to obesity in autistic populations. I will address this gap through my proposed research. In collaboration with my mentorship team of R01-funded investigators and community collaborators, I will collect a multi-modal suite of pilot data—including validated survey data and assessment of cortisol through mail-in hair sampling—from 250 autistic adolescents and emerging adults. I will test associations between chronic stressors—including camouflaging—and obesity; assess whether the association between camouflaging and obesity is strongest for those with chronically elevated cortisol; and test sub-group differences based on autism severity. This research addresses NIDDK's mission to address disproportionate obesity in minority populations by informing efforts to make obesity interventions more effective for a large and at-risk population. The combination of my proposed K01 training and unparalleled access to an expansive recruitment and data collection network makes me uniquely positioned to carry out this research. I will gain knowledge and skills in obesity and biomedical research as well as cultivate leadership skills and develop and submit an R03 application in preparation for an eventual R01. This project supports my long-term goal of becoming an independent investigator in obesity at the intersection of developmental and biomedical health.
