Stress is another obstacle in the journey of patients with obesity.
A survey conducted 2017 by the American Psychological Association found that moderate to high levels of stress affect the majority of Americans. Much attention was given to the physiological and genetic mechanisms behind unhealthy weight and less attention to the role of stress in weight gain and weight management of patients with obesity.
Most stressors faced by people today are predominantly psychological like financial worries and interpersonal relationship turmoil rather than physical. Although the body’s reaction to stress is the same, the release of glucose into the bloodstream to fuel muscles for fight or flight, leaves much excess glucose-fueled energy that’s transformed into body fat.
Connection between stress and BMI was clearly established in research showing the relationship between stress and weight gain. For obese people, stress is another obstacle to have healthier weight. Research has found four pathways to stress: cognition, behavior, physiology and biochemistry.
Pathways to Stress: Cognition, Behavior, Physiology and Biochemistry
When one experiences moderate to high levels of stress, cognitive processes such as executive functioning and self-regulation are disrupted. For example, participants were told to choose from a medium-sized portion of candy now or have larger portion later, those who experienced more cumulative stress were less able to delay gratification, and yielded higher BMI compared to counterparts who were able to delay gratification.
Stress has also been found to contribute to unhealthy eating, decreased physical activity, and sleep behaviors. For instance, in a study conducted by the American Psychological Association, 39% of participants reported overeating and choosing unhealthy foods in response to stress. Previous research also found the same pattern choosing food high in saturated fat and sugar during stressful times at work. Stress also has been linked to decreased physical activity and sedentary lifestyle while eating unhealthy leading to weight gain. Stress also disrupts sleep, which suggests a shorter sleep is associated with increased weight gain and poor food choices.
Stress also negatively affects our physiology. When stressed, cortisol level increases leading to creating abdominal fat. It also promotes the desire to eat by reducing sensitivity to leptin, regulating neuropeptide Y stimulation and activating reward pathways. During stress dopamine is triggered to be released and enhances one’s desire to eat foods high in saturated fat and sugar.
In addition, cognition, behavior, physiology and biochemistry are also negatively affected by stress.
Some evidence suggests that hormones leptin and ghrelin are influenced by stress. Ghrelin stimulates food-reward processes that when stress is high it may be elevated. Research also propose obese patients may be leptin resistant though still for further investigation.
Pathways to Stress: Unhealthy Weight
It’s not uncommon for patients with obesity to feel stigmatized because of their weight. In study, participants randomly assigned to the weight stigma group experienced more stress and negative emotions. When one’s experiencing weight stigma, cognitive processes are negatively affected, particularly executive function and self-regulation. It also showed a negative effect on cortisol levels. Stress is part of a vicious cycle of weight gain wherein stress can lead to weight gain and weight gain can lead to stress, an endless feedback loop with perception of no escape.
How can clinicians help patients with obesity? Certainly, attending to the negative effects of unhealthy levels of stress and working on with their patients identify stressors and develop tools for constructively managing stress is all important. Recommending a Very Low Calorie Diet(VLCD) or Low-Calorie Diet(LCD) and lifestyle changes are effective ways toward helping patients with obesity live a healthier life.