Stress & Body Shape: Stress Affects on Body Weight (cont.)

ELLIN: With insulin levels and cortisol levels increased, the tendency is to eat sugar, fat, and salty, crunchy foods. Unfortunately, the kinds of foods we crave when our cortisol and insulin levels are up, only add to the weight gain.

So often when we feel most like having candy or cookies because our cortisol and insulin levels are elevated, what we most need are foods high in fiber and healthy fats, and lean protein foods. In addition, we may feel like sitting when what we need is to walk the dog or go to the gym.

It's ironic and sad that those of us who are most at risk of high insulin and high cortisol levels and cravings for sugar and fat, are most at risk of that excess weight being deposited in the abdomen, where it can increase our risk of the metabolic syndrome.

EPEL: We are very concerned about metabolic syndrome, more than about excess weight itself. Half of obese people have metabolic syndrome. This is a cluster of risk factors for chronic diseases, such as heart disease.

We think that life stress and environmental stress contribute to the type of obesity that is associated with the metabolic syndrome. So we fear that stress is not only promoting excess weight, but also excess exposure to insulin, which can be pro-aging and disease promoting, and abdominal fat, which we know is contributing to disease.

So at UCSF, we have developed an interdisciplinary center for obesity research and education. We are trying to understand, from genetics up to the social and environmental level, how different stresses contribute to the malignant form of obesity -- abdominal obesity with the metabolic syndrome -- and then, what we can do about it in our clinics and from a public health perspective.

MEMBER QUESTION: So the apple shape is a more "dangerous" shape than the pear shape?

EPEL: Many of us in the field strongly believe that abdominal obesity is a much more specific or causal factor for disease than general obesity.

In fact, there are now several studies showing that peripheral fat, the fat at our hips and thighs, is not only benign, but also possibly protective of health, in terms of relating to better glucose control and lower risk of diabetes.

ELLIN: The new research on stress and metabolic syndrome is so important. It's also key to appreciate that body fat affects many systems, and that a person who, let's say, is a pear rather than an apple, has other consequences of obesity that does not have to do with diabetes or cardiovascular disease. It could relate to pulmonary function, orthopaedic problems, or other medical conditions.

As obese people age, various medical problems are apt to crop up and often they exacerbate the obesity. For example, a person carrying some extra weight may feel fine, they may be healthy in terms of blood sugars or lipids, even though heavy, but then they have knee or foot problems associated with the body size and then have a hard time exercising -- and then being inactive contributes to their stress level and their further weight gain.

MODERATOR: So how do you move from unconsciously reaching for that bag of chips when stressed, to conscious action?

EPEL: That is a great question, one that we would all like a good answer to. There is no simple cure for our impulses, cravings, and drives -- the strong evolutionary-based motivations.

But there are skills that can help. Some programs focus on overeating and some on stress reduction, but several programs marry the two, fostering a mental shift so that someone can be in the moment, tuned into their true needs. Such programs can be more effective than ones that simply promote supplements or relaxation techniques without cognitive skills training.

One such example that has been supported in pilot studies is called mindfulness-based stress reduction (MBSR), for binge eating disorder. Jean Kristeller at Indiana State University has shown that MBSR reduces binge eating for people with binge eating disorder (BED) through attentional skills training. People who have gone through this program learn to control that incredibly strong impulse to overeat when they do not need calories.

For severe anxiety, cognitive behavioral therapy is effective. A program that uses cognitive behavioral techniques is Kelly Brownell's LEARN program (800) LEARN-4-1 Laurel Mellin's program also has pilot data showing long-term weight maintenance, and it's long-term maintenance that matters. Anyone can lose weight -- keeping it off is the challenge.

MODERATOR: And Dr. Brownell is our in-house eating disorders expert. You can post questions for him on WebMD's message boards.

ELLIN: Nonhomeostatic eating, eating when you're below the line, is such an important contributor to obesity that we have to look at its origin -- even though it's diverse and some can be genetic -- much has to do with the feeling brain.

The feeling brain is the clearinghouse of all the information in and out, and when the total stress is more than we have the skills to bring back to balance, stress eating is triggered, therefore whole-body approaches can be more effective than single approaches.

In The Solution participants master developmental skills, knowing how to nurture themselves from the inside and set limits not only with themselves, but also with others and with life.

To live above the line, where the drive to overeat, overdrink, or overspend fades, is to not only to master these tools, but to live what we call a masterful life, taking time to care for your body, to exercise, to engage in meaningful pursuits, and to relax. Decreasing stress and obesity involves taking better care of ourselves, not only mentally, but also in our lives.

MODERATOR: We have only touched the tip of the iceberg on this subject. Do you have places for folks to go who want to pursue this more?

ELLIN: We will be having UCSF's Center for Obesity Research and Education's obesity web site up sometime next month. Visit the Center for Health and Community web site, to be linked to it.

The programs developed at UCSF for obesity are The Solution for adults and The Shapedown Program for children. Find a local Solution program at or call the Institute for Health Solutions: (415) 457-3331. For local Shapedown programs, visit Also, the books by Laurel Mellin, MD, are: The Pathway (HarperCollins 1994) and another book due out next spring, The 3-Day Solution Plan (Ballantine, 2005).

There are also resources available at:

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