Motivation and emotion/Book/2014/Stress and weight control

Overview
What is stress? And how does stress affect peoples ability to control their weight? Stress can be defined as that uncomfortable feeling that people get when they are facing a situation they are struggling to cope with. Stress can cause feelings of anxiety, irritability, and frustration and can cause people to feel a sense of helplessness; as well as cause physiological symptoms such as stomach pain, headaches, muscle aches and digestive upset.

So does feelings of stress effect weight control? Can stress cause people to have sudden binge eating episodes, or to stop eating all together? Innately, one could expect that intense periods of stress would naturally cause people to put on or lose weight, based on the premise that people have a tendency to increase or decrease amounts of food as a form of personal comfort.

The purpose of this book chapter is to look at the relationship between the emotional response of stress and the physical act of weight control; it will look at what is stress and how it relates to weight control, the biochemical theory of how stress can impact a persons ability to control their weight, and emotional eating. It will also discuss stress and weight loss with an accompanying case study, the positives and negatives of the effect stress has on weight control, effective forms of stress management to facilitate healthy weight control, and a case study of the effect childhood stress has on adult weight control.

What is stress?
Stress has been described as a process of emotions and feelings that are produced when an individual feels that they cannot sufficiently cope with the requests and demands that are being made of them (Lazarus, 1966). Stress can effect the human body in several different ways, such as; emotionally, feelings of anger, depression, anxiety; physically, symptoms of nausea, diarrhea, fainting, poor concentration; behaviourally; struggling with weight control, insomnia, obsessive-compulsive behaviour (Victorian Government, 2012). While stress is often associated as a negative emotive process, often causing people to have feelings of anxiety and hopelessness, not all stress can be considered negative, as stress often motivates people to complete their tasks and to ‘keep going’ (Lazarus, 1966).



For some time, symptoms of stress have been associated with extreme fluctuations in weight, causing people to both lose and gain weight. According to Creagan (2014), stress is often associated with periods of unhealthy eating; wherein people may choose to eat when they are not hungry, eat foods with a particularly high calorie content or may choose to reduce or completely stop eating food altogether. The combination of stress, as well as unhealthy food choices, often leads to an unhealthy change in a persons weight (Creagan, 2014). These fluctuating eating patterns caused by stress are often linked to emotional eating, which may be seen as an attempt to calm anxiety and other negative emotions caused by stress, as well as fulfill emotional needs (Creagan, 2014).

Types of stress
There are several different degrees of stress. Most people suffer some form of stress in everyday living, for example, a person is stressed getting to work on time, another person is stressed about what present they will get their friend for their birthday etc. These mild forms of stress are considered normal and healthy. Acute stress is extreme stress, causing high levels of anxiety and hopelessness (Victorian Government, 2012). Extreme stress is also associated with several different psychological disorders such as Post Traumatic Stress Disorder, Acute Stress Disorder, Phobias etc (Victorian Government, 2012).

Example of how stress affects weight control
A good example of the effects of stress and weight control can be seen in the change of weight that is often seen in students during stressful university assessments. Research into the weight control and eating habits of university students found a strong correlation between stress and weight gain, suggesting that first year university students gain an average of 10kgs due to the stressful nature of assessments and university life (Walden Behavioural Care, 2014).

The biochemical theory of stress and weight control
Stress has been found to have significant physiological effects on the human body, suggesting there are biochemical processes that may cause shifts in weight control during periods of high stress (Tomiyama et al., 2014).

According to Bouchez (2014), weight control during stress is often influenced by the endocrine system. During periods of stress the body releases a range of hormones including adrenaline, corticotrophin releasing hormone (CRH) and cortisol (Tomiyama et al., 2014). This gives the body instant energy and sends the body into ‘fight or flight’ mode, which is telling the body to fight the danger or run from the danger, then eat and replenish energy even though there is no real danger (Bouchez, 2014). However, since stress is not usually in the form of physical danger, the hormones that have been released are not properly used, which causes them to remain in the body much longer than they are supposed to, causing increased hunger and driving people to eat much more than they may usually eat (Bouchez, 2014).

In addition, the energy food the body needs when it is in ‘fight or flight’ mode is sugar, to fuel the muscles quickly and effectively (Bouchez, 2014). This leads people to not only eat more when they are stressed, but also to choose carbohydrate and sugary food (generally considered poorer health choices). Further research on the biochemical effects of stress on weight control have shown that the stress of feeling uncomfortable with your weight can lead to weight control issues (Schvey, Puhl & Brownell, 2014).

A study conducted by Schvey, Puhl and Brownell (2014) showed that women who were exposed to weight stigma and felt stressed over their current weight, were more likely to produce higher levels of cortisol which in turn made them more likely to gain weight. In addition, acute stress can cause the bodies metabolism to weaken, leading to digestive issues which can cause further long term weight gain (University of Maryland Medical Centre, 2014).

Emotional eating
When considering the relationship between stress and weight control, often people associate the changes in weight due to emotional eating. According to The Mayo Clinic (2014), emotional eating is when people turn to food (often unhealthy choices), either consciously or unconsciously, in order to comfort themselves and attempt to reduce negative feelings, such as stress. An example of emotional eating could be that a person is stressed over a particular work deadline, while they are finishing their work they eat a whole 250g block of chocolate in 10 minutes to make them ‘feel better’. According to Tan and Chow (2014), emotional eating may be due to eating dysregulation. They suggest that when people are stressed, they are less responsive to hunger signals and satiety, which leads them to emotional eat to comfort and satisfy food cravings (Tan & Chow, 2014). Thus, it has long been thought that stress is the major trigger for emotional eating (Tan & Chow, 2014).



A study conducted by Yoshikawa, Tanaka, Ishii & Watanabe (2014) investigated the emotional eating behaviours of young adults. They found that fatigue is a significant problem for this age group and that fatigue caused mental stress (Yoshikawa, Tanaka, Ishii & Watanabe, 2014). Their study suggests that the mental stress associated with fatigue is a significant trigger for young adults emotional eating (Yoshikawa, Tanaka, Ishii & Watanabe, 2014). Similarly, research conducted by Roberts, Campbell & Troop (2013) found that during times of stress the body produces cortisol, which makes the body crave carbohydrate, sugary and fatty foods. Because of this, during times of stress people are more likely to emotionally eat unhealthy foods to attempt to reduce stress (Roberts, Campbell & Troop, 2013). Hence, research suggests that stress is a significant trigger, causing people to eat abnormally in order to attempt to regulate their emotions and comfort themselves.

Stress and weight loss
While stress is commonly associated with emotional eating and associated weight gain, stress has also been found to have the opposite effect and cause people to stop eating. According to Hirth, Rahman & Berenson (2011) acute stress, such as PTSD, can cause unhealthy eating behaviours, as well as weight loss. Their study showed that young women who were exposed to serious stressors were found to have adopted unhealthy eating behaviours such as binge-eating, consistently eating unhealthy foods such as fast food and sugary soft drinks, as well as unhealthy dieting behaviours leading them to lose unhealthy amounts of weight (Hirth, Rahman & Berenson, 2011). According to Kroon Van Diest, Tartakovsky, Stachon, Pettit & Perez (2014), stress can lead to severe weight control problems such as Anorexia, Bulimia and other eating disorders. Similarly, Degortes et al. (2014) report that stress can cause people to stop eating, which can later lead to binge-eating behaviours and eventually to extreme eating disorders. Research demonstrates that while stress is commonly associated with weight gain, it can also cause extreme weight loss amongst individuals.

Case study on stress and weight loss
Priory (2013), a mental health specialist group, report a significant case which demonstrates the link between weight loss and stress.

There was one particular 16-year-old female patient whose parents had been worried for sometime over her increasing weight loss (Priory Group, 2013). She had been on a continuous diet for over a year, even though she had never been overweight (Priory Group, 2013).

She refused to talk about her weight loss and her emotions started become increasingly erratic (Priory Group, 2013). Eventually, she fainted while at school and her parents took her to hospital (Priory Group, 2013).

At the hospital she was found to be severely underweight, with a dangerously low pulse and body temperature (34.5 degrees) (Priory Group, 2013). To help her get in control over her weight, she was referred to several eating disorder specialists, as well as a therapist (Priory Group, 2013).

During sessions with her therapist it was revealed that when she started her unhealthy weight loss she was under significant stress (Priory Group, 2013). It was then believed that her eating problems had not begun due to poor body image (as is the usual eating disorder suspect) but was due to life stressors (Priory Group, 2013).

After 16 weeks in the hospital, she was later discharged after getting control over her weight and learning how to manage stress (Priory Group, 2013).

Positives
While stress is often portrayed as a negative stimulus for weight control, stress can be useful in facilitating healthy eating habits. A study conducted by Gallant, Pérusse-Lachance, Provencher, Bégin & Drapeau (2013) found that some individuals who were within a healthy weight range and had healthy eating habits used (mild) stress as a motivation to stay healthy. In addition, the stress of trying to stay healthy motivated them to continue healthy lifestyle choices (Gallant et al., 2013). According to Boulos, Tufts & Friedman (2014), it is quite healthy for people to experience different levels of stress throughout people’s lives, especially during periods of transition. The University of Maryland Medical Centre (2014) suggests that individuals with the skills to properly manage stress in their lives are then able to control and manipulate stress levels in order to use mild levels of stress to motivate them to lead a healthy lifestyle.



Negatives
Stress is most often associated as having a negative effect on weight control, either producing weight gain or unhealthy weight loss. According to a longitudinal study conducted by Kim, Bursac, DiLillo, White & West (2014) women with less stress showed much greater weight loss compared to those who reported higher stress who did not lose much weight. Their study suggests that people who are trying to control weight and live a healthier lifestyle should try to significantly reduce their stress (Kim, Bursac, DiLillo, White & West, 2014).

Research by Johannessen & Berntsen (2013) into the effects of Post Traumatic Stress Disorder (PTSD) and how it affects weight control, found that as PTSD sufferers underwent counselling and reduced the stress in their lives, they very easily fell into healthy eating patterns and lost weight with ease. A similar study conducted by Kubzansky et al. (2014) also found that as PTSD sufferers reduced their stress they lost weight. They also found, that when participants first started suffering from PTSD and other forms of chronic stress they put on weight. Garcia et al. (2013) found that women in the USA who had reported suffering some form of chronic stress, such as domestic violence, had a much higher likelihood of suffering weight control issues. Hence, there are vast amounts of research supporting the notion that stress has a negative correlation with weight control and that by reducing stress people live healthier lifestyles

Case study on weight gain and stress
In 1985, Dr Vincent Felitti, the chief of Kaiser Permanente’s Department of Preventative Medicine in San Diego, ran a weight loss clinic every year (Stevens, 2012). However, Felitti found that 55% of the participants in his weight loss group left every year before actually finishing the program (Stevens, 2012). With waist lines getting bigger, Felitti found it very distressing that so few patients successfully lost weight (Stevens, 2012). To try and discover why so many people were dropping out of the weight loss program, Felitti contacted several patients (293 participants in total) who dropped out of the program to ask if he could interview them (Stevens, 2012).

Upon interviewing the patients, Felitti found two main aspects of their weight gain journey. Firstly, none were born overweight, but were of a normal or below healthy birth weight (Stevens, 2012). Secondly, that patients would gain weight quickly, then stabilize (not just constant weight gain). They also discovered that if they lost weight they would generally regain it very quickly (Stevens, 2012).

The breakthrough in Felitti’s interviewing came the day he discovered, that for many patients, weight gain was due to chronic stress they experienced in their childhood (Stevens, 2012).

During interviews, Felitti asked questions such as ‘How much did you weigh when you were born’ and ‘When was your first sexual experience and how much did you weigh’ (Stevens, 2012). These questions led to one woman break down as she admitted to having chronic stress as a child, including being sexually abused by her father (she was only a child when she had her first sexual experience) (Stevens, 2012).

From there, Felitti’s research led him to find startling correlations between chronic stressors that patients experienced as children, which would cause them to continue to have weight gain problems as adults (Stevens, 2012). Felitti continued his research to establish the Adverse Childhood Experience Study (ACE Study), which continues to show evidence that stress is a major determinate for weight control (Stevens, 2012).

How to cope with stress and encourage healthy weight control choices


Stress is an uncomfortable feeling, which can lead people to having difficulty controlling their weight. However, there are several different coping mechanisms that can be used to reduce stress and encourage better weight control. They are:


 * Exercise regularly (20 minutes of exercise 3 times a week): exercise not only helps reduce stress as it produces endorphins which produce happiness, but also supports healthy weight control (Victorian Government, 2013)
 * Sleep: a healthy sleep routine can help manage mental stress, as well as discourage emotional eating and abnormal eating patterns (Yoshikawa, Tanaka, Ishii & Watanabe, 2014).
 * Eat healthy: eating a healthy, balanced diet has been shown to reduce stress and automatically helps a person control their weight.
 * Know stress triggers: if a person is aware about what triggers them to feel stressed, they can aim to avoid or reduce contact with whatever is triggering stress (Victorian Government, 2012).
 * Meditation: meditation exercises have been found to relax people and significantly reduce stress, and have been shown to encourage weight control by reducing people’s stress (Van Dam, Hobkirk, Sheppard, Aviles-Andrews & Earleywine, 2013).

Quiz
{Q1. When under stress, what hormonal response does the body enter into?: - (a) hyperactivity response +(b) fight or flight response - (c) adrenaline response - (d) all of the above
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{Q2. Which eating theory has emotional eating been linked to?: - (a) eating dysfunction - (b) anxious eating + (c) eating dysregulation - (d) eating disorder
 * type=""}

{Q3. Which of the following have been found to help effectively manage stress?: - (a) regular exercise - (b) meditation - (c) sleep + (d) all of the above
 * type=""}

{Q4. How can stress benefit weight control?: + (a) stress can motivate people to live a healthy lifestyle - (b) stress can cause extreme weight loss - (c) stress can cause extreme weight gain - (d) stress can cause people to binge-eat
 * type=""}

Conclusion
Stress is a feeling people get when they feel a situation is too much for them to cope with. Stress has largely been associated with weight control, as when people are stressed they often use food as a way of coping with their stress. This is often done in one of two ways, either people eat too much food in order to help reduce stress, or people stop eating to try and cope with stress. There are several biochemical processes between weight control and stress. Basically, stress causes the body to produce several different hormones that it does not normally produce, and these hormones cause people to feel hungry and eat more than they usually would. In addition, ‘emotional eating’ is largely related to stress, as people often attempt to use food to reduce their feelings of stress. There are both positive and negative aspects to how stress relates to weight control. Some use stress to help motivate themselves to manage their weight, while others eat unhealthy types and amounts of food when they are stressed in order to try and reduce their stress. Overall, it can be seen that weight control and stress are correlated together, and whether stress is used positively or negatively to effect weight control seems to be based on each individual.