Motivation and emotion/Book/2015/Anxiety and weight

Overview
Anxiety is a debilitating psychological disorder that affects 1 in 4 Australian adults and is the most common mental health problem experienced in young Australians (Beyond Blue, 2015). Every individual at some stage of their life will experience moments of high stress or fear of what is yet to come, such as job interviews or presentations, however it is the constant worry of future events, fear of the "what if's" and uneasiness toward situations that separates those with anxiety from those without. Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances (American Psychiatric Association, 2013). Every person has different levels of stress and mechanisms that channel or reduce these, however a person suffering from anxiety is unable to control this.

Theories such as the James-Lange theory, and the Cannon-Bard theory explain how an individual interprets certain events and stimuli and provides insight to how a person suffering from anxiety processes situations differently (Cannon, 1927). Whilst anxiety predominantly effects a person emotionally, the disorder can also effect a person physically and behaviourally. High stress is one of the main precursors for anxiety, with symptoms such as weight gain and loss being some of the undesirable effects (Calm Clinic, 2015). Living a life that is effected by anxiety can lead a person to overeat during periods of stress, favouring unhealthy foods, such as chocolate, and bingeing on these. On the opposite end, some people who experience anxiety are so preoccupied with the intrusive thoughts and worry that they simply forget to eat, or avoid eating all together. In the long term, these unhealthy symptoms of anxiety can lead to severe health problems. Some of these health problems include stroke, cardiovascular disease, diabetes, and disorders such as anorexia, bulimia and binge eating can begin to effect the person (National Heart Foundation, 2015). A persons reaction to stressful situations can take one of two pathways to dealing with the situation, fight or flight. Both these pathways follow and result in different outcomes, however they both involve the release of specific hormones relative to their response (Martin, Ressler, Binder & Nemeroff, 2013). The hormone cortisol, also referred to as the stress hormone, plays a significant role in anxiety disorders and provides a physiological explanation for why a person with anxiety may see weight changes (Kurina, Schneider & Waite, 2004). Anxiety can influence weight, and likewise weight loss and gain can have an impact on anxiety, however through mechanisms to reduce, manage and channel symptoms of anxiety the influence on body weight can be reduced and health risks potentially avoided. {| cellspacing="0" cellpadding="0" style="margin:0em 0em 1em 0em; width:100%"
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Anxiety
Anxiety is a general term for psychological disorders that cause fear, apprehension, worry and nervousness to a person that are unable to be brought under control (American Psychiatric Association, 2013). Anxiety is a negative emotional state, characterised by nervous behaviour and unpleasant inner agitation, with feelings of nervousness, worry and apprehension based on the uncertainty of the outcome of an event or even following a stressful event (American Psychiatric Association, 2013). To further understand anxiety, it can be divided into either State or Trait anxiety, which provides insight as to whether the anxiety being experienced is a temporary emotional state or a consistent personality attribute (Dewey, 1894). State anxiety is a temporary condition in response to a perceived threat, and trait anxiety, like state, is a response to a perceived threat, however it is the intensity and duration that differs and how it can effect more situations, therefor it is more of a personality characteristic (Dewey, 1894). To be diagnosed with an anxiety disorder, a person will have feelings of anxiousness, fear or worry from a stressful situation that has been prevalent in their lives for at least 6 months, that impacts normal functioning in their day-to-day life (American Psychiatric Association, 2013). A support service for those suffering from depression and anxiety, Beyond Blue, have stated that anxiety can be triggered not only from exposure to stressful situations, but that it can be triggered from substance abuse, heath problems and also family history. Other causes of anxiety include genetics, brain chemistry and personality (Beyond Blue, 2015).

Epidemiology
Anxiety effects approximately 14% of Australians with women having a higher percentage of 18% compared to men with 11% to experience any one of the anxiety disorders (Martin, 2003). Australian youth has a rate of 15.4% percent of persons aged 16 to 24 years old who are currently experiencing an anxiety disorder, which equates to 440,000 young persons (Beyond Blue, 2015). The onset for anxiety disorders can start as early as age 11, however certain anxiety disorders are more likely to be diagnosed later in life, around 30 years of age, and will persist for the majority of the diagnosed persons life (Martin, 2003).

Types
Anxiety disorders can be categorised into six main different types. These include Generalised Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder (OCD), Social Anxiety Disorder, Post-Traumatic Stress Disorder and Specific Phobia (American Psychiatric Association, 2013). Each of these disorders has different symptoms however they all stem from anxious emotions.

Treatment
Anxiety treatment varies based on the severity of the disorder effecting the person but there are three main treatment types that can be used which include lifestyle changes for mild anxiety and psychological and medical treatments for more severe forms. Lifestyle changes include regular physical activity, change in diet and self help methods such as relaxation techniques which include meditation and breathing techniques (Beyond Blue, 2015). Psychological treatments include cognitive behaviour therapy (CBT) and behaviour therapy which are aimed at changing the thinking patterns of the person and are a long term management options (Rapee & Heimberg, 1997). Medical treatments for anxiety are used as a short term measure for severe cases as there are side effects that can result from taking them and certain medications can become addictive (Beyond Blue, 2015). These medications include antidepressants and benzodiazepines. A combination of all three treatment types over a long term period will help a person suffering from anxiety be able to implement changes to be able to reduce and channel the symptoms (Beyond Blue, 2015).
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Body weight
Maintaining a healthy body weight is important no matter what age you are as it is the main way to prevent and control serious health conditions. There are many factors that can help a person maintain a healthy body weight which can be either predetermined such as genetics and family history, and factors that are in the persons control such as behaviours, habits and environment (National Heart Foundation, 2015). There is a fine line between maintaining a healthy weight and becoming obsessed with weight control which can result in an eating disorder, as is there with balancing what is consumed and energy expenditure which if the balance is not maintained can result in becoming overweight or obese.

Eating disorders
Eating disorders are defined as persistent eating behaviours that negatively impact a person's health both physically and emotionally (Eating Disorders Victoria, 2011). The DSM-5 has proposed a list of eating disorders, however there are three main disorders which are anorexia nervosa, bulimia nervosa and binge eating disorder that are the most prevalent with statistics showing that these disorders effect nearly 1 million Australians (American Psychiatric Association, 2013). Anorexia nervosa is a preoccupation with maintaining a low body weight, restricted eating, a fear of gaining weight and an intense desire to be skinny (Eating Disorders Victoria, 2011). Bulimia nervosa is also characterised with an obsessive desire to have a low body weight, however a person who suffers from bulimia will have episodes of binge eating which is followed by compensatory behaviours such as vomiting or fasting (Eating Disorders Victoria, 2011). Binge eating is characterised by eating a large amount of food in a discrete period of time and a lack of control over eating during one of these periods or episodes (Eating Disorders Victoria, 2011). According to Eating Disorders Victoria 64% of person's who have an eating disorder will also experience an anxiety disorder.

Obesity
To be diagnosed as obese, a person will have a body mass index (BMI) of 30 or higher (Heart Foundation, 2014) or a body fat percentage that is higher than 25% for males and 31% for females (About the Body Fat Calculator, 2015). The prevalence of obesity in Australia is on the rise from 56.3% in 1995, 61.2% in 2007–08, and 62.8% in 2011–12 (Australian Bureau of Statistics, 2013). There has been a lot of criticism toward using the BMI system of to measure weight, however it does give a general guideline for understanding ideal weight. Calculating body fat percentage is a more accurate technique as it includes the body's true composition. To calculate your BMI click here, or alternatively click here to calculate your body fat percentage Body Fat Calculator. Obesity drastically increases health risks such as diabetes, cardiovascular disease, stroke, high blood pressure, can lead to some cancers, and can reduce overall life satisfaction resulting in psychological disorders such as depression (The National Eating Disorders Collaboration, 2010). Lifestyle changes such as increasing physical activity and changing eating habits are just some of the ways to reduce the onset of obesity.
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James-Lange theory
This theory suggests that emotions occur as physiological reactions to events and that our emotions toward an external stimulus are governed based on the interpretation of physical reactions to the stimuli (Cannon, 1927). For example, you are walking down a path and you see a snake, your heart begins to race and you immediately begin to retreat. This theory proposes that you will interpret your physical reaction, which is to retreat, and therefore because of your reaction you will conclude that you are scared. The James-Lange theory can be used to explain the development of some anxiety disorders, for example panic disorder and specific phobias. Panic disorders and phobias are highly correlated (Rapee & Heimberg, 1997) as individuals who suffer from panic disorders will avoid situations that they associate with high states of panic, and in turn this can result in the individual developing a phobia toward certain aspects of the situation. A person who suffers from anxiety will think of an event, one that has happened or is yet to happen, and associate their physiological responses, such as an increase in heart rate, hot and cold flushes or tightening of the chest with feelings of anxiousness (Cannon, 1927).

Cannon-Bard theory
The Canon-Bard theory contradicts the James-Lange theory as it suggests that people experience physiological reactions simultaneously with feeling emotions and that one does not cause the other (Weisfeld & Goetz, 2013). It was with the development of this theory that the reaction "fight or flight" was uncovered and applied to emotional responses (Cannon, 1927). The fight or flight response is the physiological reaction that a person will have to a perceived threat or harm that is elicited toward them and how they will react, whether to fight the threatening situation, or to take "flight" and flee away from harm (Calm Clinic, 2015). The response is learned however internal processes that activate glands that secrete hormones are also responsible for the type of response to the situation (Martin, Ressler, Binder & Nemeroff, 2013). The theory is applied to anxiety disorders as research conducted by Cannon (1927) has found that those who suffer from these disorders have a hypersensitive fight or flight response. Sufferers of anxiety more often than not will perceive most situations as dangerous and will automatically have heightened senses as to the response that they could potentially have to take. Once the fight or flight response is activated in a certain situation, for example you become afraid in a crowd of people, a person who suffers from an anxiety disorder will associate being in crowds as a potential danger even if there is no real threat (Martin, 2003).

Influence of anxiety on weight
Anxiety has a negative effect on weight gain and weight loss in person's who suffer from these disorders. Studies have shown that there is a link between anxiety disorders and eating disorders and that whilst anxiety can cause the onset of eating disorders, there are instances where eating disorders can cause anxiety in some people (Tanofsky-Kraff, 2011). Anxiety in some people can cause negative coping mechanisms, such as binge eating, to deal with the stress that the disorders can put a person through. If a person continues to apply these mechanisms to coping with stress and worry it soon becomes a learned response and they will automatically turn to this method whenever faced with similar situations. Binge eating has been found to be one of the most common forms of coping under stressful situations in anxiety disorders (Troisi, Massaroni & Cuzzolaro, 2005). The onset of an eating disorder can go one of three ways, anorexia nervosa, bulimia nervosa or binge eating (Eating Disorders Victoria, 2011). The path of anorexia will see the person suffer from an unhealthy weight loss and the potential for greater health risks such as low blood sugar and kidney and liver failure (Eating Disorders Victoria, 2011). With bulimia a person can also have unhealthy weight loss and health risks such as electrolyte imbalance which if severe enough can lead to heart failure or even death (Eating Disorders Victoria, 2011). On the contrary to weight loss, a person who results to eating to compensate for their feeling of stress and worry and does this often with no repercussions will see a significant increase in weight. This increase in weight is much higher for those who suffer from social anxiety disorder, specific phobias or panic disorder as they could have a fear which stops them from exercising in public areas, or an increase in heart rate, which leaves them to lead a sedentary lifestyle (Rapee, 1997).

Neurobiology
In any situation that the human body experiences, certain hormones and chemicals are secreted in order for an appropriate response (Martin, Ressler, Binder & Nemeroff, 2013). The circuit known as the hypothalamic-pituitary-adrenal axis (HPA) plays a key role in the release of the hormone cortisol which is what is released in response to stress. The hormone cortisol is one of the key responses that is automatically triggered when a person is put into a stressful or potentially threatening sitaution (Martin, Ressler, Binder & Nemeroff, 2013). Under conditions of constant stress, which is typical of anxiety disorders, the HPA goes into overdrive.

Cortisol
Cortisol is an adrenal hormone that is responsible for the regulation of bodily systems and is released during stressful periods (Kurina, Schneider &* Waite, 2004). It is also referred to as the 'stress' hormone. The role that cortisol plays in the body is drawing upon energy stores, fat, protein or carbohydrates, during times when a physiological demand needs to be met (Martin, Ressler, Binder & Nemeroff, 2013). During times of stress or fear the bodies adrenal gland will release cortisol, which allows the body to respond to the perceived threat based on the fight or flight mechanism (Martin, Ressler, Binder & Nemeroff, 2013). For sufferers of anxiety, the release of cortisol in the body becomes a regular thing due to the constant state of perceived threats and ready's the body for fight or flight, however this backfires as the person does not act upon which results in a build up of cortisol that leads to negative physical effects (Martin, Ressler, Binder & Nemeroff, 2013). A build up of cortisol results in the stored fats that are released to be now stored around the abdomen which results in weight gain and a spike in insulin levels due to a rise in blood sugar which leaves the person craving sugary foods are just two of many symptoms that this hormone has on the body due to anxiety (Kurina, Schneider &* Waite, 2004).

What can we do?
There are approaches and mechanisms that can be used to reduce anxiety which can also be implemented to change eating habits. The first step to reduce or avoid weight loss or gain is to become aware of eating habits and to counteract the need to eat when feeling stressed or anxious, and remember to eat during high levels of stress. Depending on whether it is weight loss or gain a person has because of anxiety will determine which steps will need to be taken. For persons who have a tendency to binge eat during highly stressful periods, replacing this urge with exercise or relaxation methods such as yoga will reduce tension and release chemicals such as dopamine that are also released by consuming "feel good" foods, such as chocolate (Kurina, Schneider & Waite, 2004). The key is understanding when these urges occur and counteracting them with the healthier response, which in time will become the learned response during stressful situations. There are particular diet based approaches that can be taken to assist with weight issues that are influenced by anxiety. The approaches include decreasing consumption of processed foods, sugar (particularly fructose) and grains, increase consumption of probiotic foods, increase vitamin B12 and vitamin D, increase animal-based omega-3 fats, get adequate exercise and ensure the right amount of sleep is obtained nightly (Mercola, 2015). To reduce the symptoms of anxiety, and in turn reduce the effect it has on weight, a combination of lifestyle changes, emotional coping mechanisms and influences of different types of treatment will help to reduce the influence of anxiety on weight.