When stress disrupts your weight management plans

Gajanan Kamath, who works as a chartered accountant in a Bengaluru-based multinational company, is not new to stress. It’s the work-related deadlines that keep him tensed, he tells Happiest Health. The agonising period, often, lasts for a few hours, at times, for a few days too.

Like Kamath, most of us are living under stress—due to various reasons. In fact, stress has been labelled as the ‘health epidemic of the 21st century’ by the World Health Organisation (WHO). To help people cope with stress during the Covid-19 pandemic, the WHO in 2020, released an illustrated guide known as Doing What Matters in Times of Stress. 

The WHO’s booklet states that one of the various consequences of stress is the change in the appetite of an individual. The changes in appetite caused by stress can significantly disrupt one’s weight management plans.

How stress results in weight gain or loss

The relationship between stress and body weight, according to various studies, is bidirectional. “While stress can lead to weight loss, it can also lead to weight gain in some cases. This bipartite probability could be attributed to the duration of the stress too,” says Dr Bishwaranjan Das, physiotherapist, Kasturba Medical College Hospital, Mangaluru.

The physiology of stress

Various studies indicate that stress could either lead to comfort/emotional eating or aversion towards food. The two extreme reactions towards food are because of two hormones in the body — cortisol and leptin, say experts.

Cortisol is the stress hormone. When you are stressed, the hypothalamic-pituitary-adrenal (HPA) axis is activated. This, in turn, activates the adrenal glands to secrete cortisol hormone. Dr Ananya Sinha, founder and chief clinical psychologist at TherapHeal, an online mental health platform, says, “Cortisol may lead to higher insulin levels, which may reduce the blood sugar levels. This eventually increases the craving for fatty and sugary food. Increased intake of such food often leads to weight gain.”

Leptin is a fullness hormone that tells you when to stop eating. But, when under stress, it is suspected to reverse its role. Professor Eric Jéquier from the Institute of Physiology, University of Lausanne, Switzerland, published his research, ‘Leptin Signaling, Adiposity, and Energy Balance’ (2002) in the Annals of the New York Academy of Sciences. The study infers that cortisol prevents leptin from sending the fullness signal to the brain. This reduced sensitivity is known as ‘leptin resistance.’ Consequently, cortisol promotes binge-eating.

However, this is not universal. There are exceptions to these studies too. For Kamath, his response to the stressor lies in making strategies that would help him finish his task efficiently and at the earliest. He doesn’t feel hungry till he finishes his work. His case could be supported by the ongoing research of Professor Michael Symonds from the School of Medicine, University of Nottingham.

In the Stress episode of the science documentary “The Truth about…”, Professor Symonds suggests that a body under stress will utilise brown fat (also called brown adipose tissue) reserves from the body. This will help burn the calories. His ongoing study is analysing how stress could help obese and diabetic people manage/lose their weight.

Stress and food choice

The 2000 study, ‘Stress and Food Choice: A Laboratory Study,’ published in Psychosomatic Medicine, a journal of biobehavioural medicine, analysed how acute stress alters food choice during a meal.

The study confirms that stressed emotional eaters (who have high levels of cortisol) displayed a larger appetite for sweet fatty foods than non-emotional eaters (those with lower levels of cortisol.) Kamath’s body type probably encompasses lower cortisol levels.

How men and women respond to stress

“There are ample studies to support that stress eating is more prevalent among women than men. Most often, men eat less while under stress. Those who engage in emotional eating largely crave salty and high-calorie foods,” says Dr Shalini Aiyappa, head of the department of Psychology, St Aloysius College (Autonomous), Mangaluru.

Dr Sinha rationalises the difference in the way men and women respond to stress. “Studies suggest that women preferentially engage in a ‘tend-and-befriend’ response to stressors, whereas men are more likely to express a ‘fight or flight’ response. This essentially means that men typically respond to stress by being argumentative or angry (ie, fight response); or through social withdrawal or sleeping (flight response.)

Stress, weight management and social stigma

Prolonged or acute stress can induce significant weight management issues.  Dr Das emphasises, “When a person has stress and is constantly resorting to eating unhealthily, then it is advisable to approach doctors/psychologists for help. However, stigma prevents them from seeking professional help.”

Dr Alafia J, clinical psychologist and assistant professor at the Department of Psychology, Christ University, Bengaluru, points out the gender difference in this regard. “Women might reach out for help during stress, whereas men might try and ‘solve’ their problems on their own. The role of stigma should not be overlooked as this can be a major reason for not seeking help.”

Higher and lower levels of cortisol: a matter of concern?

Dr Aiyappa suggests that stress eating and anxiety, depression or mood fluctuation are correlated. Dr Das opines that a person’s coping mechanism with stress is not healthy if he/she is repeatedly resorting to:

• Emotional eating
• Eating fast food
• No or little physical activity and/or sleeping less

Dr Alafia suggests that for people with higher cortisol reactors it’s a vicious cycle. “The brain automatically signals to food because it remembers that it led to immediate relief earlier.” Higher cortisol reactors can also generate a condition called Cushing’s syndrome. This condition is marked by extremely high levels of cortisol which can cause abdominal obesity.

Lower cortisol level is also bad say experts. If the cortisol level of a person is too low and he/she is constantly stressed due to work/personal issues, then managing weight becomes a challenge. The person is likely to become underweight and develop gastrointestinal issues or anorexia nervosa.