By Dr. Melissa Gomez

In my medical practice I have a toolbox full of tools to help my patients manage their diet, blood sugars, blood pressure, sleep, exercise, etc. All of these useful tools help me manage the bigger picture in my patient’s lives: helping patients lose weight and fix their metabolism. However, there is one aspect of weight loss where my tools are sparse and if we don’t figure out a way to treat this it can make weight loss all but impossible:


In this post I will discuss some of the more well understood reasons why stress prevents weight loss. Like most things in medicine, we do not fully understand all of the mechanisms that cause stress to inhibit weight loss, but we understand what I believe to be some of the major reasons why stress prevents weight loss.


The first barrier to weight loss when a human is under chronic stress is the hormone cortisol. Cortisol is the hormone we release from our adrenal glands when we are under stress. While in an acute stressful situation cortisol can actually stimulate energy expenditure and burn calories, once stress becomes chronic, cortisol becomes a hormone that tells our bodies to store fat, reduce energy expenditure and gain weight. It does so by increasing our appetite, decreasing our basal metabolic rate, increasing our release of insulin and sending signals to our body which, overtime, causes weight gain. There is actually a rare disease called Cushing’s disease whereby your pituitary gland sends abnormal signals resulting in the overproduction of cortisol. This disease causes weight gain, severe fatigue and metabolic abnormalities like diabetes, high blood pressure and fatty liver. Humans who are under chronic stress can see similar changes to their weight and metabolism in the absence of Cushing’s disease.


Insulin is also a potent stimulator of weight gain. In appropriate amounts, insulin helps get energy into the parts of our bodies that need it most like our muscles; insulin also helps to regulate our blood sugar levels in order to prevent them from getting too high. However, when our stress levels are chronically high, cortisol stimulated glucose production from your liver increases insulin. When insulin levels are chronically high, insulin starts to be less effective at finding room for energy in our muscles and the body has to find another place to put energy, namely our fat cells. High insulin makes us gain weight and also makes us resistant to losing weight, even with diet and exercise. What we tend to see in our patient population that is chronically stressed is that they are gaining weight, their energy is very low (because the energy is all going to the fat cells instead of the muscle cells), they are always tired and eventually they develop diabetes.


I consider the gut microbiome (bacteria that live our our digestive tract) the new frontier in medicine and metabolism. While we are still figuring out all the ways in which the bacteria that live in our gut interact with our metabolism, it is clear that chronic stress can change the bacteria that live in our gut and influence our weight. These bacteria can influence how we absorb nutrients, how fast we metabolize foods, how strong our hunger signals are and how good our mood is. Unfortunately, when our stress levels are high the bacteria in our gut changes in favor of low energy, low mood, poor utilization of nutrients and weight gain. Decreasing our stress levels can help rebalance our gut bacteria in favor of weight loss and improved mood and energy.

So in the future, if you find that you are doing your best to lose weight but you are having trouble and recognize that you are under a lot of stress it may be time to start working on stress management. It may be important to work with a therapist or other mental health provider, increase your exercise, pray, meditate, or find other options that may help reduce your stress. In future posts I will review some evidence based methods to help reduce stress that can both improve your quality of life and help you get the weight off and keep it off.

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