How stress sabotages weight loss after surgery

Stress is something we all experience and often cannot avoid, particularly due to the uncertainty we face at the moment with COVID-19. But, stress can do more than make your heart pump, your mind race, or adrenaline soar. Long term stress can also slow weight loss and lead to weight gain, especially if we don’t deal with it well. So let’s dig in and unpack why stress contributes to weight gain and what you can do about it.

Stress, cortisol and weight gain

Acute and chronic stress can produce different physiological reactions involving slightly different pathways of hormones, yet both can result in an increase in hunger. Acute stress triggers the flight or fight response – the release of adrenaline to prepare you to deal with whatever danger you are facing. After the danger has subsided the HPA-Axis in the brain is stimulated. The HPA axis is responsible for the body’s response to chronic or prolonged stress and is made up of the hypothalamus, pituitary gland and adrenal gland. Stimulation of the HPA Axis leads to production of Cortisol (and now you know where I’m going with this, don’t you?!).

Now what the damn Cortisol does is increase appetite. This is good if you have just outrun a lion because it drives you to replenish the calories burnt while saving your life. However, if activation of this acute stress response system becomes chronic due to psychological stress for example, your body still secretes Cortisol. And… since an actual fight-or-flight response isn’t needed during chronic stress, the combination of increased hunger and no energy expenditure often leads to overconsumption and therefore weight gain.

Stress and eating for comfort

Our relationship with food and the comfort it brings us also ties into this stress equation. Lots of people report turning to food for comfort when stressed. And you guessed it, you don’t often feel like a carrot or piece of fruit, most studies report people turning to traditional comfort food – high fat, high sugar, high calories but low in nutrients. This makes sense, too – when there are events in your life that seem to be out of your control, finding comfort in something you can control (what you eat) can be comforting. In addition, food (particularly carbohydrate-based food) gives your brain a hit of dopamine and serotonin (the feel good hormones) so there is a physiological reward and you feel better after eating for a moment.

The same comfort response applies to other unhelpful habits such as drinking alcohol or smoking. The problem with using food, alcohol, smoking or other unhelpful habits for coping with stress is that they only provide a temporary fix. After you’ve used them, the guilt, shame and fear of failure then sets in and contributes to the stress you are under in the first place. If not interrupted, a vicious cycle then begins. I really like this image below of the stress bucket, with stressors above contributing to the bucket, stress relievers letting stress out of the bucket, and those unhelpful coping mechanisms letting stress out but pouring it straight back in!

Helpful ways to deal with stress that won’t contribute to weight gain

Finding helpful ways to deal with stress and lower your cortisol levels can be tricky but is essential to success in the long term. Thinking about what you can control is key here. Whilst it’s easy to stress about the world and what might happen, stressing about those things long term isn’t helpful and can set off that cycle we spoke about above. Instead, focus on things that are important but also that you can control.

What works for you as a stress relief may not work for the next person. However, after weight loss surgery a few things are non-negotiable: exercise, eating well and sleeping enough (more on that here). These three are key habits for success long term so focus on these three first! If you want to add icing, here are a few other ideas:

• Taking with friends, family or a therapist
• Taking time out for you
• Finding a hobby to keep your mind (and hands) busy
• Learn something new like a language or to knit!
• Practising mindfulness or meditation
• Keeping a gratitude journal
• Saying ‘no’ – unloading your schedule may help to give you pockets of time out
• Ask for a hug (from a pet works even better…)
• Ask for help
• Distribute some of your load to others if you can (I’m thinking the cleaning, cooking, washing, life admin etc)

References:

• Smith, S.M. & Vale, W.W. (2006). The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine response to stress. Dialogues Clin Neurosci 8(4):383-395.
• Takeda, E., Terao, J., Nakaya, Y. et al. (2004). Stress control and human nutrition. J Med Invest 51(3-4):139-145.
• Ng, D.M. & Jeffery, R.W. (2003). Relationships between perceived stress and health behaviors in a sample of working adults. Health Psychol 22(6):638-642.
• Oliver, G., Wardle, J. & Gibson, E.L. (2000). Stress and food choice: a laboratory study. Psychosom Med. 62(6):853-865.