The overweight and obesity issue is worldwide considered an epidemic and, consequently, a public health problem [1]. A significant portion of the total overweight and obese population can be found in obesogenic cultures and nations, where the condition causes a great total number of malnutrition and deaths. Overweight and obesity results in approximately 2.8 million deaths every year [2].
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Defined as a person whose body mass index (BMI) is >30 kg/m2, the population with overweight and obesity have grown exponentially since 1980, where in 2014 at least 13% worldwide experienced these issues [1]. The conditions are known to be high risk factors for non-communicable diseases such as diabetes, cardiovascular disease, musculoskeletal disorders and even some types of cancers [2].
Although known to be a result of a myriad of genetic and environmental factors [1], the source of overweight and obesity can be—vaguely—summarized in an energetic or caloric imbalance being ingested and used [2]. However this may be, it is also known that psychological and emotional elements influence this matter by modulating metabolic and immunological functions through chronic experience of negative emotions, such as anxiety and stress; evidencing, thus, the influence of stress on overweight and obesity.
What is Stress?
In nueroendocrine terms, stress acts by liberating cortisol, a powerful steroid hormone, from the adrenal cortex into the circulation that follows by the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic suprachiasmatic nucleus (SCN) [3]. Stress may activate itself, for example, during a physical injury or perceived psychological threat. It is a body response additional to its basic homeostatic mechanism that provides a better chance at survival when the body is under treat, mobilizing neural and hormonal networks that optimize cognitive, cardiovascular, immunological and metabolic functions [4].
Exposure to repeated or chronic stress has a detrimental effect on various aspects and processes of a given organism’s physiology, such as in the functioning of the nervous system, growth and development, metabolism and body composition, reproductive function and immune system function [5]. Acute elevations in cortisol levels are beneficial as it encourages survival adaptation—as part of a flight-or-flight mechanism.
Nevertheless, being exposed to chronic high stress will revert such benefits and more se promote maladaptation, such as in developing forms of cancer, mental health disorders, susceptibility to infections, cardiovascular disease, metabolic syndrome and/or obesity [4] depending, of course, on the timing and quantity of cortisol exposure.
Stress is good, since it activates to its optimal function cognitive, cardiovascular, respiratory and metabolic processes. But acute and chronic stress may affect the organism.
Cortisol and Weight Gain
Stress contributes to the development and maintenance of obesity [2, 4]. This relationship can be summarized and described in a bidirectional model that includes the interacting systems of cognition, physiology, behavior and biochemistry influenced by stress [6]. As a result, obesity can develop which in turn, due to sociocultural factors, may provoke weight stigma. Again, the stigma experienced will induce stress and provoke a circuit between stress and obesity.
Each element will be briefly described.
Cognition: Self-regulation is crucial for modulating one’s behavior and decision making. This will directly impact food and physical activity choices, as well as cognitive and emotional processes such as executive functioning and goal-oriented behavior [6].
Behavior: Inadequate self-regulation will more than likely impact one of the following elements that will influence the way in which we eat, exercise and rest. Related to the first, humans, like several species, have been observed to engage in stress-induced eating. It is known that food can soothe stress, which is no worrying issue, but lack of self-control may allow this behavior to reach high and alarming levels (binge eating disorder).
The second of these happens when stress disrupts our physical activity patterns, whether by decreasing physical activity or by increasing sedentary behavior. And lastly, stress is well known to mess with sleeping patterns. Short sleeping periods are related to a higher likelihood of obesity, as with likewise lower muscle mass. Sleeping and resting are essential in weight and stress control [6].
Physiology: Stress is known to activate multiple physiological systems, and in excess, to deter them. Three are commonly mentioned: the HPA, the Reward System and the microbiome. The first of these, as mentioned, secretes cortisol as a stress response, which in turn activates soothing behaviors such as eating, and promotes fat deposition in abdominal regions. The second acts like the HPA, in as much as it refers to a ‘pleasure seeking’ mechanism that when under stress activates food seeking behavior to soothe the negative emotion. And lastly, the microbiome is one that depending on its health can influence the sensation of stress by modulating it or provoking it [6].
Biochemistry: This area refers to the modulation of biochemical substances that are relevant to weight and obesity, such as leptin and ghrelin. Leptin and ghrelin are both, generally speaking, satiation and hunger hormones. The more leptin we secrete, the more satiated we will be, which will bring about a soothing and calm sensation after eating. Ghrelin on the other hand, in high concentrations can cause hunger and stress in order to activate food searching behavior [6].
Managing Stress Manages Weight
Interestingly enough, some of the non-pharmacological interventions for stress are likewise employed in obesity. In the following paragraph, some suggestions are outlined that will both help with stress and with weight gain or obesity.
- Diet: Stress creates greater physiologic demands than basal states. More energy, oxygen, circulation and allover metabolic cofactors are needed when under stress (eg. vitamins and minerals). Eating a nutritionally rich diet can help modulate and soothe stress [7].
- Behavioral Interventions: Several cognitive behavioral therapies have been suggested and proved beneficial in the management of stress. In hand with a therapist, whether it is mindfulness training, relaxation strategies, personal and interpersonal skill training, acceptance and commitment therapy, resilience and coping training, these can improve and diminish acute stress which in turn will help with obesity [8].
- Physical Activity: The benefits of physical activity on health issues, both physiological and psychological, are widely known in the scientific community. Different levels of physical activity imply different effects on stress-related neurophysiological response to psychosocial stress. Those who constantly exercise are less likely to develop depressive illness and more likely to mitigate stress [9].
- Bariatric Surgery: Besides reducing weight in excellent manner, it has been shown that the use of bariatric surgery compared to non-surgical interventions for obesity have measurable benefits in the reduction of psychiatric symptoms such as depression, anxiety and stress—besides, of course, of reduction in body weight [10].
Weight Loss Surgery in Tijuana, Mexico
At LIMARP, International Center of Excellence for Obesity, we offer an integrative bariatric program, with a multidisciplinary approach, for the treatment of obesity. Our program includes a surgical intervention —like a gastric sleeve, a gastric bypass or a duodenal switch—, or a non-surgical intervention —like an intragastric balloon—, along with psychological counselling, nutritional guidance, personalized fitness routines, and long-term follow-up.
For our patients traveling from abroad, we also offer accommodation in our next-door hotel, the luxurious Grand Hotel Tijuana, and transportation to and fro the airport and the hotel.
Our clinic is one of the only centers in Mexico that have been certified as a Center of Excellence by the Surgical Review Corporation. Our lead surgeon, Dr. Liza María Pompa González is certified as a Master Surgeon and Surgeon of Excellence by the same organization, and she is the first female surgeon to be awarded with this recognition.
Contact Us Today
Our team is ready to help you. At LIMARP, patients will always receive warm, sincere and professional answers. For a free evaluation please call us at (619) 270 8823, fill out a contact form at www.limarp.com, or message through any of our social media pages.
References
- [1] Brownell, K. D. et al. (1991). The heterogeneity of obesity: Fitting treatments to individuals. Behav Thera, 22, 53-77.
- [2] Sosa-Cordobés, E. et al. (2023). How effective are mindfulness-based interventions for reducing stress and weight? A systematic review and meta-analysis. Int J Environ Tes Public Health, 20, 446.
- [3] Law, R. et al. (2020). Stress, the cortisol awakening response and cognitive function. Int Rev Neurobiol, 15-, 187-217.
- [4] Russell, G. et al. (2019). The human stress response. Nat Rev Endocr, 15, 525-34.
- [5] Vijayan, M. M. et al. (2010). Stress response and the role of cortisol. In Fish Diseases and Disorders Vol. 2: Non-infectious (Eds. J. F. Leatherland and P.T.K. Woo). LUGAR EDITORIAL
- [6] Tomiyama, A. J. (2019). Stress and obesity. Annu Rev Psychol, 70, 703-18.
- [7] Gonzalez, M. J. et al. (2014). Diet and stress. Psych Clin North Ame, 37(4), 579-89.
- [8] Holman, D. et al. (2018). Stress management interventions: Improving subjective psychological well-being in the workplace. In E. Diener, S. Oishi & L. Tay (Eds.), Handbook of well-being. DEF Publishers.
- [9] Wang, F. et al. (2019). The relationship between physical activity, stress, life satisfaction and sleep quality. J Physic Educ Sport, 19(1), 227-34.[10] Paczkowska, A. et al. (2022). Impact of bariatric surgery on depression, anxiety and stress symptoms among patients with morbid obesity: International multicentre study in Poland and Germany. B J Psych Open, 8(1), e32.