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Does anxiety about weight or eating cause people to become overweight?

Does anxiety about weight or eating cause people to become overweight?



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A while ago I saw this TED talk about the futility of dieting. The speaker suggests that a body maintains a homeostatic weight point and returns to that weight after dieting has stopped:

Turns out the brain is an incredibly efficient regulator of body weight. Isn't weight loss about how much you eat versus how much energy you burn? Nope, it's not that simple an equation: it turns out that hunger and energy use are controlled by the brain, mostly behind the scenes, and this unconscious force is stronger than mere willpower. The brain has its own sense of what your body should weigh - no matter what you believe - called the set point, which has a range of about 15 pounds. While lifestyle changes can shift your weight within this range, it's much harder to move outside of it.

The speaker suggests that once she gave up dieting, she actually lost weight. Since then I've seen a number of other anecdotal reports of people losing weight once they let go of the need to diet and started to "eat anything they wanted".

This makes me ask - does anxiety about weight and attempts to control one's eating cause people to put on weight? In other words, if there's some unresolved anxiety issue in one's life, does it cause the human body to start preparing for hard times by storing extra fat?


People gain weight when they eat more calories than they burn through activity. This imbalance is the greatest contributor to weight gain.

The world around us influences our ability to maintain a healthy weight. For example:

  • Not having area parks, sidewalks, and affordable gyms makes it hard for people to be physically active.
  • Oversized food portions increase Americans’ calorie intake, making even more physical activity necessary to maintain a healthy weight.
  • Some people don’t have access to supermarkets that sell affordable healthy foods, such as fresh fruits and vegetables.
  • Food advertising encourages people to buy unhealthy foods, such as high-fat snacks and sugary drinks. 1

Obesity and Depression

The study included 4,363 government workers between the ages of 35 and 55 when enrolled in the mid- to late-1980s.

Mental health and physical examinations were conducted at study entry and at three other time points over an average follow- up of 19 years. The physical exams included measurements of weight, height, and body mass index (BMI).

After adjusting for known risk factors for obesity, such as the use of psychiatric drugs associated with weight gain, people who had symptoms of depression, anxiety, or other mental health problems at the start of the study were more likely than those who did not to become obese over time.

But obesity did not significantly increase the risk for depression, anxiety, or other mental health disorders, as other studies have shown.

The study appears in the journal BMJ Online First.

“When we looked at it the other way around and asked if weight gain leads to mental illness, the association was not clear,” Kivimaki says. “That doesn’t mean there is no association, but it appeared to be much weaker in our study.”


Why stress causes people to overeat

There is much truth behind the phrase "stress eating." Stress, the hormones it unleashes, and the effects of high-fat, sugary "comfort foods" push people toward overeating. Researchers have linked weight gain to stress, and according to an American Psychological Association survey, about one-fourth of Americans rate their stress level as 8 or more on a 10-point scale.

In the short term, stress can shut down appetite. The nervous system sends messages to the adrenal glands atop the kidneys to pump out the hormone epinephrine (also known as adrenaline). Epinephrine helps trigger the body's fight-or-flight response, a revved-up physiological state that temporarily puts eating on hold.

But if stress persists, it's a different story. The adrenal glands release another hormone called cortisol, and cortisol increases appetite and may also ramp up motivation in general, including the motivation to eat. Once a stressful episode is over, cortisol levels should fall, but if the stress doesn't go away — or if a person's stress response gets stuck in the "on" position — cortisol may stay elevated.

Stress eating, hormones and hunger

Stress also seems to affect food preferences. Numerous studies — granted, many of them in animals — have shown that physical or emotional distress increases the intake of food high in fat, sugar, or both. High cortisol levels, in combination with high insulin levels, may be responsible. Other research suggests that ghrelin, a "hunger hormone," may have a role.

Once ingested, fat- and sugar-filled foods seem to have a feedback effect that dampens stress related responses and emotions. These foods really are "comfort" foods in that they seem to counteract stress — and this may contribute to people's stress-induced craving for those foods.

Of course, overeating isn't the only stress-related behavior that can add pounds. Stressed people also lose sleep, exercise less, and drink more alcohol, all of which can contribute to excess weight.

Why do people stress eat?

Some research suggests a gender difference in stress-coping behavior, with women being more likely to turn to food and men to alcohol or smoking. And a Finnish study that included over 5,000 men and women showed that obesity was associated with stress-related eating in women but not in men.

Harvard researchers have reported that stress from work and other sorts of problems correlates with weight gain, but only in those who were overweight at the beginning of the study period. One theory is that overweight people have elevated insulin levels, and stress-related weight gain is more likely to occur in the presence of high insulin.

How much cortisol people produce in response to stress may also factor into the stress–weight gain equation. In 2007, British researchers designed an ingenious study that showed that people who responded to stress with high cortisol levels in an experimental setting were more likely to snack in response to daily hassles in their regular lives than low-cortisol responders.

How to relieve stress without overeating

When stress affects someone's appetite and waistline, the individual can forestall further weight gain by ridding the refrigerator and cupboards of high-fat, sugary foods. Keeping those "comfort foods" handy is just inviting trouble.

Here are some other suggestions for countering stress:

Meditation. Countless studies show that meditation reduces stress, although much of the research has focused on high blood pressure and heart disease. Meditation may also help people become more mindful of food choices. With practice, a person may be able to pay better attention to the impulse to grab a fat- and sugar-loaded comfort food and inhibit the impulse.

Exercise. While cortisol levels vary depending on the intensity and duration of exercise, overall exercise can blunt some of the negative effects of stress. Some activities, such as yoga and tai chi, have elements of both exercise and meditation.

Social support. Friends, family, and other sources of social support seem to have a buffering effect on the stress that people experience. For example, research suggests that people working in stressful situations, like hospital emergency departments, have better mental health if they have adequate social support. But even people who live and work in situations where the stakes aren't as high need help from time to time from friends and family.


The Second Assault

Victims of childhood sexual abuse are far more likely to become obese adults. New research shows that early trauma is so damaging that it can disrupt a person’s entire psychology and metabolism.

Christine White was a preteen when she went on her first diet. At school, she was bubbly and outgoing, an honors student immersed in social causes. But at home, she would carefully ration her food.

By the time she was 14, she had developed bulimia. It was easier to hide the purging from her family than it was to explain why she wasn’t eating. In her darkest moments, she would scribble her anxieties into a blue-lined journal.

When I eat food now I feel guilty,” she wrote in rounded, 14-year-old script. “I don’t like to eat in front of other people.”

As a college student, she stopped throwing up but kept overeating. Carbs were her crutch. “If I'm stressed, let me crawl inside a bag of Tostitos,” said White, who goes by her nickname, Cissy. She would shovel handfuls of cereal in her mouth, or boil and eat enormous amounts of pasta.

She didn’t fully understand what drove her binges, but she had one idea—an experience she referred to as “my hell” and “my secret” in later journals.

When White was an infant, her mother began dating a man 26 years her senior, and he lived with the family until White was 10. Though to outsiders he seemed affable, the stepfather was largely unemployed, according to White, and he had a boorish streak. “He was the kind of guy who would beep at pretty women walking down the street,” she said, “even with his kids in the car.”

At home, his immaturity had a sinister element, White said. A number of times, after White showered, he’d make her parade in front of him naked so he could “inspect” her. During games of Yahtzee, he would force her to sit on his lap for longer than was comfortable. He’d grab her behind and make flirtatious comments. Occasionally, he’d put a treat in his pocket and cajole her into fishing around for it.

“I knew that I didn’t like what was happening,” she said, “but I didn’t know what was appropriate.”

To her teen self, White’s body was criminal. “I felt like I was always in a battle with food,” she said. “I just thought, this body needs to be tamed. It makes terrible things happen.”

As horrifying as White’s story is, it’s a common one among people who have been abused as children. Researchers are increasingly finding that, in addition to leaving deep emotional scars, childhood sexual abuse often turns food into an obsession for its victims. Many, like White, become prone to binge-eating. Others willfully put on weight to desexualize, in the hope that what happened to them as children will never happen again.

In White’s case, overeating did not lead to obesity—her weight only ever ranged from roughly 118 pounds to 175. But research shows that in general, childhood sexual abuse might be a key predictor of obesity and overweight in adulthood. More importantly, experts say, this disturbing connection suggests it’s fruitless to treat eating-disordered patients without investigating and addressing potential childhood trauma first.

In 1985, a 28-year-old woman named Patty arrived at a weight-loss clinic in San Diego operated by Kaiser Permanente. The clinic was designed for people who were between 60 and 600 pounds overweight. Patty asked the doctor running the program, Vincent Felitti, for help. Patty weighed 408 pounds. In less than a year, she had shed 276 of them on a near-fasting diet.

“We thought, ‘Well, we’ve obviously got this problem licked,’” Felitti told me recently. “We’re going to be a world-famous department of preventive medicine here.”

Patty stayed at her svelte new weight for a few weeks. Then, in less than a month, she gained back 37 pounds—a feat that would require eating more than 4,000 excess calories daily. Patty blamed it on sleepwalking, saying that though she lived alone, she had been waking up in the mornings to a kitchen covered in opened boxes and cans.

Felitti believed her sleep-eating story, but he asked her, “Why did that start now? Why not five years ago? Why not 10 years from now?”

Patty said she didn’t know. When Felitti pressed her, she said there was a man at work who was much older and married. After she lost weight, he complimented and propositioned her.

Felitti countered that, though the sexual advances were understandably unpleasant, extreme weight-gain seemed like a strange response.

That’s when Patty revealed that her grandfather began raping her when she was 10.

In short order, Patty regained all of the weight and then some.

Patty’s story offered a clue into why nearly half of Felitti’s obesity patients dropped out of the weight-loss program. He interviewed more of these patients and found that 55 percent acknowledged some form of childhood sexual abuse. Like Patty, many would enter his program, slim down, then promptly bulk up again.

Together with Robert Anda at the Centers for Disease Control and Prevention, Felitti would go on to run the Adverse Childhood Experiences Study, which hunted for lingering impacts of difficult upbringings in the general population. The study generated a framework called the ACE Score, or the sum of all the types of trauma a person might have experienced in childhood—everything from their parents’ divorce, to poverty, to physical and sexual abuse.

The more ACEs a person has, the greater their risk of all sorts of maladies. Six ACEs increases the risk of injecting-drug abuse by 4600 percent, for example. Though some people develop resilience to early adversity, Felitti and Anda found that abuse victims’ ability to “bounce back” without treatment is markedly overstated.

“The things that don’t kill you can make you stronger,” Felitti said. But if they go unaddressed, they can also “get to a point where they become overwhelming and will destroy you.”

White’s stepfather moved out eventually, but he still made her wary whenever they interacted. His overtures ramped up as White lost weight in adolescence. He’d send her cards and tell her she should be a model. “That was just disgusting to me,” she said.

White’s stepfather has since passed away, but the distress he inflicted loomed over her early adult life. In 1985, when she was 18, she confessed to her journal that she was having trouble having intercourse with her boyfriend. “I’m so frigid,” she wrote.

She wouldn’t have a normal sex life until her early 40s. In college, she’d cry nearly every day and wake up with nightmares and flashbacks.

Experts say sexual abuse is one of the worst adverse experiences, and also one of the most likely to compound other life stressors.

“It’s bad to have a substance-abusing parent, or a mentally ill parent who's untreated,” said Frank Putnam, a professor of psychiatry at the University of North Carolina at Chapel Hill and another prominent childhood-adversity researcher. “Of all those [ACEs], sexual abuse seems to be the most pernicious. This is particularly true for women.”

“Sexual abuse is about betrayal,” he added. “It’s occurring at the hands of trusted family members and caregivers.”

Studies by Putnam and others have found that sexually abused women are more likely to suffer from an array of seemingly unrelated mental and physical ailments, including premature puberty and problems in school.

One 75-year-old former patient of Felitti’s, who saw him when she was in her 20s and weighed 270 pounds, said she began eating compulsively after a childhood of horrific sexual and emotional violence. (She and several other sources requested anonymity to protect family members and friends.) She now has a host of health problems, like bone problems and tumors in her brain and sciatic nerve, that she believes are related to her weight and mental anguish.

“It bothers you all your life,” the woman told me. “It decimates you as a human being.”

The trauma of sexual abuse often manifests through a preoccupation with food, dieting, and a drive to feel uncomfortably full. One analysis of 57,000 women in 2013 found that those who experienced physical or sexual abuse as children were twice as likely to be addicted to food than those who did not.

One Maryland woman who was a victim of incest at the hands of her father, uncle, and cousin would sometimes go for days without eating as a teen. Now that she’s in her 50s, the pattern has reversed, and she finds herself prone to binges. When at the airport, for example, she beelines for snack shops, buys two to three bags of M&Ms and a pack of Cheez-Its, and downs it all.

“I’m telling myself the whole time, ‘Why am I doing this?’” she said. “We still always carry this guilt around.”

Trauma that occurs during critical periods in the brain’s development can change its neurobiology, making it less responsive to rewards. This anhedonia—a deficit of positive emotions—more than doubles the likelihood that abused children will become clinically depressed adults. It also increases their risk of addiction. With their brains unable to produce a natural high, many adult victims of child abuse chase happiness in food. It’s this tendency, when combined with what many described as a desire to become less noticeable, that makes this group especially vulnerable to obesity.

Constance, a 53-year-old Virginia woman who also asked that I use a pseudonym, was fondled as a young girl by both an older cousin and her grandfather. A few years after the molestation ended, she was at a family function when she became so uncomfortable that she snuck off to a pantry and ate cookies until she felt sick.

In middle school, three neighborhood boys tricked her into coming over to their house. When she arrived, she said, they held her down and gang-raped her. For years, Constance didn’t tell anyone about the rape. Her weight spiked. When people weren’t looking, she would gorge on cookies, cakes, and chips. By the time she was a teenager, she weighed 180 pounds.

In high school, she turned to drinking and prescription pills, and later, she went to jail and rehab for a cocaine addiction. “When I was under the influence, I was able to come outside of myself,” she said. “I would talk and laugh.” Even after rehab, she struggled with a compulsive-shopping habit that ran up her credit cards.

Today, Constance is still overweight and lives alone. She’d like to find a partner, but she has doubts. “I'm never really quite comfortable or feel safe with men,” she said. “I’m a little afraid of them because I know what they can do.”

Compulsive overeating doesn’t always lead to obesity, but studies show that sexual-abuse victims are far more likely to be obese in adulthood. Research suggests childhood sexual abuse increases the odds of adult obesity by between 31 and 100 percent. One study found that about 8 percent of all cases of obesity, and 17 percent of “class three” severe obesity, can be attributed to some form of child abuse.

The reasons are both metabolic and psychological, both willful and subconscious. For many victims, the drivers of their obesity act in synergy, compounding each other, and they might change over time. One such pathway is inflammation: The major, unrelieved stress of abuse triggers the adrenal glands to pump out steroid-like hormones. One of these hormones, cortisol, not only affects the brain’s ability to plan things like diets, it also affects appetite, satiety, and metabolism.

And there’s some evidence that stress induces the body to squirrel away fat—a vestige of a time in human evolution when this would have been useful. Chronic stress also sparks the release of chemicals called pro-inflammatory cytokines, which prevent insulin from being taken up by the muscle cells. This is called insulin resistance, and it’s strongly correlated with obesity. “If you think of the body as a clever organism, if it’s exposed to something that’s threatening, it protects itself by making sure there are plenty of calories on board,” said Erik Hemmingsson, an associate professor of medicine at Karolinska University in Sweden.

Abuse victims might therefore become heavy even if they eat normal amounts. One 93-year-old woman, Helen McClure, has been obese for years, but she’s not quite sure why. She doesn’t have a problem with overeating, she says.

As a child, she thought the fact that her father occasionally massaged her genitals was “just a part of growing up.”

“I first realized how bad it was was when I was in junior high and we learned about how babies are born,” she said. “It shocked me.” By then, she weighed 200 pounds.

Many survivors, meanwhile, put on weight in order to protect against future abuse. Women I interviewed said they felt more physically imposing when they were bigger. They felt their size, rightly or wrongly, helped ward off sexual advances from men.

Patricia Borad, another of Felitti’s patients, said physical abuse was a daily part of her childhood. Her mother called her “jezebel” her father would paddle her and her other siblings if only one of them did something wrong. When she was in her teens, her father refused her permission to go on a camping trip with her boyfriend’s family. When she asked him why, he backhanded her so hard she flew across the room.

“For that reason, I just grew up not being able to say ‘no’ to a man,” she said.

In adulthood, she was fine with the attention she drew from romantic prospects—whenever she was single. But if she was in a relationship, she’d put on weight so that other men would be less likely to flirt with her and try to lure her away from her partner. “If I didn’t want that extra attention from men,” she said, “it was much easier not to get it if I was overweight.”

Another survivor echoed her perspective: “Eating and getting big, I felt like nobody would notice me.”

People who have unexamined childhood trauma often fail when they attempt weight-loss treatments. Some studies show that patients with histories of abuse tend to lose less weight after bariatric surgery or during clinical weight-loss treatment. Among women who were hospitalized for psychiatric treatment after bariatric surgery, one study found that 73 percent had a history of childhood sexual abuse. Gastric bypass prevents them from eating large quantities—thereby removing an essential coping mechanism.

In Felitti’s weight-loss group, there was one woman, also a victim of abuse, who would come every week and sit silently with a smile on her face. One week, she announced that her family had finally scraped together the $20,000 necessary for her to have bariatric surgery.

Well, this is going to be a disaster,” Felitti thought.

She lost 94 pounds, became suicidal, and was psychiatrically hospitalized five times the following year.

“The [weight] came off too quick,” she told him later. “I felt like I was losing my protective wall.

These women’s stories suggest that obesity is not what it seems. Given how it increases obesity risk, preventing child abuse could be considered a public-health measure on par with mandatory calorie labels. Doctors may tell overweight patients to diet and hit the gym, but if they’ve suffered childhood trauma, their bodies might be actively working against them. Worse still, the patient might—consciously or otherwise—have a dark reason for remaining heavy.

Felitti eventually incorporated a questionnaire that asks patients about sexual abuse and other childhood trauma into Kaiser Permanente’s Obesity Program. Several obesity-treatment specialists contacted for this story also said they routinely ask their patients about sexual abuse—most won’t mention it unless prompted.

Wendy Scinta, an obesity-medicine specialist in central New York, says the first question she asks patients who seek weight-loss treatment is, “Did you have a happy childhood?”

People who did will say so right away. Among those who didn’t, there’s usually a pause. A “hmmm.” A vague explanation. If the patient recalls abuse, Scinta might refer them to the psychologist she has on staff.

Some doctors say they struggle to secure insurance-plan payouts for the extensive psychological or psychiatric treatment that abuse survivors require. About half of psychiatrists don’t take insurance, and half of U.S. counties have no mental-health professionals. The Centers for Medicare and Medicaid Services covers 16 to 22 visits per year for obesity-related medical counseling, but psychological therapy is not included.

“With people who are abused, you have to uncover their awful wounds before they get better,” said Marijane Hynes, an internist at the George Washington University Medical School in Washington who focuses on obesity. At her hospital, psychiatry residents see many of her patients for free, and she’s not sure how she would provide mental-health treatment without their help.

Some survivors find unorthodox routes to restoring mental and physical health. Later in her life, McClure, the 93-year-old abuse victim, began speaking regularly on abuse issues to groups of doctors, social workers, and police departments. The advocacy “has certainly dulled the pain and given me a sense of pride in the fact that I have been able to turn my disgusting story into a tool to help others,” she said.

White, the woman who documented her teenage dieting and bulimia in journals, was diagnosed with post-traumatic stress disorder in her 20s. After suffering an anxiety attack, she called the health center at her college, which referred her to therapy. She would ride the bus to the therapist’s lily-white, immaculate office twice each week. “I used to refer to it as paid-for parenting,” said White, who is now 49 and living in Weymouth, Massachusetts.

The therapist was warm and welcoming. Eventually, though, White felt it wasn’t enough to simply talk about her emotions. Her abuse had left her feeling like an amputee, she said. Talk therapy was like retracing the question, “How do you feel about the fact that you can't get up the stairs?” she said—when all she really wanted was a ramp.

In her 30s, she enrolled in a writing workshop. She and dozens of other people, many of them survivors of trauma, would sit in a room, compose essays about their pasts, and share their work with the group. At first, being open about her childhood felt awkward. But after each of the four sessions, White found herself feeling better for months.

It was around that same time that she began regularly practicing yoga. That, too, was fraught initially. For a survivor of sexual abuse, lying down in a dark room with strangers, as most yogis do at the end of a class, was scary. Gradually, though, the practice helped her once again feel safe in her skin.

Decades later, the days of seeing her body as tainted are finally over for White. She still believes she’ll be keenly sensitive to stress for the rest of her life. But now, when something triggers her—like her home flooding a few years ago—she turns to a relaxation technique called guided imagery to manage her symptoms. She’s become an advocate for abuse victims, and in 2014 she opened her own writing workshop.

She says the abuse will always tug at her, but today its power is diminished. “That's just stuff that happened to you,” she said. “It isn't you.”

Olga’s reporting on parenting and childhood was undertaken as a project for the Fund for Journalism on Child Well-Being and the National Health Journalism Fellowship, programs of the USC Annenberg Center for Health Journalism.


Why people become overweight

Everyone knows some people who can eat ice cream, cake, and whatever else they want and still not gain weight. At the other extreme are people who seem to gain weight no matter how little they eat. Why? What are the causes of obesity? What allows one person to remain thin without effort but demands that another struggle to avoid gaining weight or regaining the pounds he or she has lost previously?

On a very simple level, your weight depends on the number of calories you consume, how many of those calories you store, and how many you burn up. But each of these factors is influenced by a combination of genes and environment. Both can affect your physiology (such as how fast you burn calories) as well as your behavior (the types of foods you choose to eat, for instance). The interplay between all these factors begins at the moment of your conception and continues throughout your life.

The calorie equation

The balance of calories stored and burned depends on your genetic makeup, your level of physical activity, and your resting energy expenditure (the number of calories your body burns while at rest). If you consistently burn all of the calories that you consume in the course of a day, you will maintain your weight. If you consume more energy (calories) than you expend, you will gain weight.

Excess calories are stored throughout your body as fat. Your body stores this fat within specialized fat cells (adipose tissue) — either by enlarging fat cells, which are always present in the body, or by creating more of them. If you decrease your food intake and consume fewer calories than you burn up, or if you exercise more and burn up more calories, your body will reduce some of your fat stores. When this happens, fat cells shrink, along with your waistline.

Genetic influences

To date, more than 400 different genes have been implicated in the causes of overweight or obesity, although only a handful appear to be major players. Genes contribute to the causes of obesity in many ways, by affecting appetite, satiety (the sense of fullness), metabolism, food cravings, body-fat distribution, and the tendency to use eating as a way to cope with stress.

The strength of the genetic influence on weight disorders varies quite a bit from person to person. Research suggests that for some people, genes account for just 25% of the predisposition to be overweight, while for others the genetic influence is as high as 70% to 80%. Having a rough idea of how large a role genes play in your weight may be helpful in terms of treating your weight problems.

How much of your weight depends on your genes?

Genes are probably a significant contributor to your obesity if you have most or all of the following characteristics:

  • You have been overweight for much of your life.
  • One or both of your parents or several other blood relatives are significantly overweight. If both of your parents have obesity, your likelihood of developing obesity is as high as 80%.
  • You can't lose weight even when you increase your physical activity and stick to a low-calorie diet for many months.

Genes are probably a lower contributor for you if you have most or all of the following characteristics:

  • You are strongly influenced by the availability of food.
  • You are moderately overweight, but you can lose weight when you follow a reasonable diet and exercise program.
  • You regain lost weight during the holiday season, after changing your eating or exercise habits, or at times when you experience psychological or social problems.

These circumstances suggest that you have a genetic predisposition to be heavy, but it's not so great that you can't overcome it with some effort.

At the other end of the spectrum, you can assume that your genetic predisposition to obesity is modest if your weight is normal and doesn't increase even when you regularly indulge in high-calorie foods and rarely exercise.

People with only a moderate genetic predisposition to be overweight have a good chance of losing weight on their own by eating fewer calories and getting more vigorous exercise more often. These people are more likely to be able to maintain this lower weight.

What are thrifty genes?

When the prey escaped or the crops failed, how did our ancestors survive? Those who could store body fat to live off during the lean times lived, and those who couldn't, perished. This evolutionary adaptation explains why most modern humans — about 85% of us — carry so-called thrifty genes, which help us conserve energy and store fat. Today, of course, these thrifty genes are a curse rather than a blessing. Not only is food readily available to us nearly around the clock, we don't even have to hunt or harvest it!

In contrast, people with a strong genetic predisposition to obesity may not be able to lose weight with the usual forms of diet and exercise therapy. Even if they lose weight, they are less likely to maintain the weight loss. For people with a very strong genetic predisposition, sheer willpower is ineffective in counteracting their tendency to be overweight. Typically, these people can maintain weight loss only under a doctor's guidance. They are also the most likely to require weight-loss drugs or surgery.

The prevalence of obesity among adults in the United States has been rising since the 1970s. Genes alone cannot possibly explain such a rapid rise. Although the genetic predisposition to be overweight varies widely from person to person, the rise in body mass index appears to be nearly universal, cutting across all demographic groups. These findings underscore the importance of changes in our environment that contribute to the epidemic of overweight and obesity.

Environmental causes of obesity

Genetic factors are the forces inside you that help you gain weight and stay overweight environmental factors are the outside forces that contribute to these problems. They encompass anything in our environment that makes us more likely to eat too much or exercise too little. Taken together, experts think that environmental factors are the driving force for the causes of obesity and its dramatic rise.

Environmental influences come into play very early, even before you're born. Researchers sometimes call these in-utero exposures "fetal programming." Babies of mothers who smoked during pregnancy are more likely to become overweight than those whose mothers didn't smoke. The same is true for babies born to mothers who had diabetes. Researchers believe these conditions may somehow alter the growing baby's metabolism in ways that show up later in life.

After birth, babies who are breast-fed for more than three months are less likely to have obesity as adolescents compared with infants who are breast-fed for less than three months.

Childhood habits often stick with people for the rest of their lives. Kids who drink sugary sodas and eat high-calorie, processed foods develop a taste for these products and continue eating them as adults, which tends to promote weight gain. Likewise, kids who watch television and play video games instead of being active may be programming themselves for a sedentary future.

Many features of modern life promote weight gain. In short, today's "obesogenic" environment encourages us to eat more and exercise less. And there's growing evidence that broader aspects of the way we live — such as how much we sleep, our stress levels, and other psychological factors — can affect weight as well.

The food factor as one of the causes of obesity

According to the Centers for Disease Control and Prevention (CDC), Americans are eating more calories on average than they did in the 1970s. Between 1971 and 2000, the average man added 168 calories to his daily fare, while the average woman added 335 calories a day. What's driving this trend? Experts say it's a combination of increased availability, bigger portions, and more high-calorie foods.

Practically everywhere we go — shopping centers, sports stadiums, movie theaters — food is readily available. You can buy snacks or meals at roadside rest stops, 24-hour convenience stores, even gyms and health clubs. Americans are spending far more on foods eaten out of the home: In 1970, we spent 27% of our food budget on away-from-home food by 2006, that percentage had risen to 46%.

In the 1950s, fast-food restaurants offered one portion size. Today, portion sizes have ballooned, a trend that has spilled over into many other foods, from cookies and popcorn to sandwiches and steaks. A typical serving of French fries from McDonald's contains three times more calories than when the franchise began. A single "super-sized" meal may contain 1,500–2,000 calories — all the calories that most people need for an entire day. And research shows that people will often eat what's in front of them, even if they're already full. Not surprisingly, we're also eating more high-calorie foods (especially salty snacks, soft drinks, and pizza), which are much more readily available than lower-calorie choices like salads and whole fruits. Fat isn't necessarily the problem in fact, research shows that the fat content of our diet has actually gone down since the early 1980s. But many low-fat foods are very high in calories because they contain large amounts of sugar to improve their taste and palatability. In fact, many low-fat foods are actually higher in calories than foods that are not low fat.

The exercise equation

The government's current recommendations for exercise call for an hour of moderate to vigorous exercise a day. But fewer than 25% of Americans meet that goal.

Our daily lives don't offer many opportunities for activity. Children don't exercise as much in school, often because of cutbacks in physical education classes. Many people drive to work and spend much of the day sitting at a computer terminal. Because we work long hours, we have trouble finding the time to go to the gym, play a sport, or exercise in other ways.

Instead of walking to local shops and toting shopping bags, we drive to one-stop megastores, where we park close to the entrance, wheel our purchases in a shopping cart, and drive home. The widespread use of vacuum cleaners, dishwashers, leaf blowers, and a host of other appliances takes nearly all the physical effort out of daily chores and can contribute as one of the causes of obesity.

The trouble with TV: Sedentary snacking

The average American watches about four hours of television per day, a habit that's been linked to overweight or obesity in a number of studies. Data from the National Health and Nutrition Examination Survey, a long-term study monitoring the health of American adults, revealed that people with overweight and obesity spend more time watching television and playing video games than people of normal weight. Watching television more than two hours a day also raises the risk of overweight in children, even in those as young as three years old.

Part of the problem may be that people are watching television instead of exercising or doing other activities that burn more calories (watching TV burns only slightly more calories than sleeping, and less than other sedentary pursuits such as sewing or reading). But food advertisements also may play a significant role. The average hour-long TV show features about 11 food and beverage commercials, which encourage people to eat. And studies show that eating food in front of the TV stimulates people to eat more calories, and particularly more calories from fat. In fact, a study that limited the amount of TV kids watched demonstrated that this practice helped them lose weight — but not because they became more active when they weren't watching TV. The difference was that the children ate more snacks when they were watching television than when doing other activities, even sedentary ones.

Stress and related issues

Obesity experts now believe that a number of different aspects of American society may conspire to promote weight gain. Stress is a common thread intertwining these factors. For example, these days it's commonplace to work long hours and take shorter or less frequent vacations. In many families, both parents work, which makes it harder to find time for families to shop, prepare, and eat healthy foods together. Round-the-clock TV news means we hear more frequent reports of child abductions and random violent acts. This does more than increase stress levels it also makes parents more reluctant to allow children to ride their bikes to the park to play. Parents end up driving kids to play dates and structured activities, which means less activity for the kids and more stress for parents. Time pressures — whether for school, work, or family obligations — often lead people to eat on the run and to sacrifice sleep, both of which can contribute to weight gain.

Some researchers also think that the very act of eating irregularly and on the run may be another one of the causes of obesity. Neurological evidence indicates that the brain's biological clock — the pacemaker that controls numerous other daily rhythms in our bodies — may also help to regulate hunger and satiety signals. Ideally, these signals should keep our weight steady. They should prompt us to eat when our body fat falls below a certain level or when we need more body fat (during pregnancy, for example), and they should tell us when we feel satiated and should stop eating. Close connections between the brain's pacemaker and the appetite control center in the hypothalamus suggest that hunger and satiety are affected by temporal cues. Irregular eating patterns may disrupt the effectiveness of these cues in a way that promotes obesity.

Similarly, research shows that the less you sleep, the more likely you are to gain weight. Lack of sufficient sleep tends to disrupt hormones that control hunger and appetite and could be another one of the causes of obesity. In a 2004 study of more than 1,000 volunteers, researchers found that people who slept less than eight hours a night had higher levels of body fat than those who slept more, and the people who slept the fewest hours weighed the most.

Stress and lack of sleep are closely connected to psychological well-being, which can also affect diet and appetite, as anyone who's ever gorged on cookies or potato chips when feeling anxious or sad can attest. Studies have demonstrated that some people eat more when affected by depression, anxiety, or other emotional disorders. In turn, overweight and obesity themselves can promote emotional disorders: If you repeatedly try to lose weight and fail, or if you succeed in losing weight only to gain it all back, the struggle can cause tremendous frustration over time, which can cause or worsen anxiety and depression. A cycle develops that leads to greater and greater obesity, associated with increasingly severe emotional difficulties.

To find weight loss solutions that can be tailored to your needs, buy the Harvard Special Health Report Lose Weight and Keep It Off.


Coping in More Effective Ways

There are numerous approaches for lessening the intensity of anxiety and/or coping in a more effective way when anxiety is present:

    , especially Cognitive Behavioral, Dialectical Behavior Therapy, or Acceptance and Commitment Therapy
  • Self-help through books (7,8), apps , or online programs (e.g., www.online-therapy.com www.get.gg/cbtstep1)
  • Courses in mindfulness meditation (search for “MBSR” in your local area)
  • Discuss medication options with your physician or a psychiatrist
  1. Telch, C.F. & Stice, E. (1998). Psychiatric comorbidity in women with binge eating disorder: Prevalence rates from a non-treatment-seeking sample. Journal of Consulting and Clinical Psychology, 66, 768-776.
  2. Masheb, R.M. & Grilo, C.M. (2006). Emotional overeating and its associations with eating disorder psychopathology among overweight patients with binge eating disorder. International Journal of Eating Disorders, 39, 141-146.
  3. Heatherton, T.F., & Baumeister, R.F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86-108.
  4. Safer, D.L., Telch, C.F., & Chen, E.Y. (2009). Dialectical Behavior Therapy for Binge Eating and Bulimia. Guilford Press: NY.
  5. Kenardy, J., Arnow, B., & Agras, W.S. (1996). The aversiveness of specific emotional states associated with binge-eating in obese subjects. Australian and New Zealand Journal of Psychiatry, 30, 839-844.
  6. Hayes, S.C., Wilson, K.G., Gifford, E.V., Follette, V.M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.
  7. Brantley, J. (2007). Calming your anxious mind: How mindfulness and compassion can free you from anxiety, fear, and panic. New Harbinger.
  8. Wilson, K.G. & DuFrene, T. (2010). Things might go terribly horribly wrong: A guide to life liberated from anxiety. New Harbinger.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.


Stress Essential Reads

Dealing With a Stressful Situation When All Alone

Disaster-Related Stress: From the Universal to the Unique

4. Cravings and Fast Food

When we are chronically stressed, we crave “comfort foods,” such as a bag of potato chips or a tub of ice cream. These foods tend to be easy to eat, highly processed, and high in fat, sugar, or salt.

We crave these foods for both biological and psychological reasons. Stress may mess up our brain’s reward system or cortisol may cause us to crave more fat and sugar.

We also may have memories from childhood, such as the smell of freshly baked cookies, that lead us to associate sweet foods with comfort.

When we are stressed, we also may be more likely to drive through the fast food place, rather than taking the time and mental energy to plan and cook a meal. Americans are less likely to cook and eat dinner at home than people from many other countries, and they also work more hours.

Working in urban areas may mean long, jammed commutes, which both increase stress and interfere with willpower because we are hungrier when we get home later. A University of Pennsylvania research study showed, in laboratory mice, that being “stressed” by exposure to the smell of a predator lead the mice to eat more high-fat food pellets, when given the choice of eating these instead of normal feed.

5. Less Sleep

Do you ever lie awake at night worrying about paying the bills or about who will watch your kids when you have to go to work? According to the APA’s “Stress in America” survey, more than 40 percent of us lie awake at night as a result of stress. Research shows that worry is a major cause of insomnia. Our minds are overactive and won’t switch off. We may also lose sleep because of pulling overnights to cram for exams or writing until the early hours.

Stress causes decreased blood sugar, which leads to fatigue. If you drink coffee or caffeinated soft drinks to stay awake, or alcohol to feel better, your sleep cycle will be even more disrupted. Sleep is also a powerful factor influencing weight gain or loss. Lack of sleep may disrupt the functioning of ghrelin and leptin—chemicals that control appetite. We also crave carbs when we are tired or grumpy from lack of sleep.

Finally, not getting our precious zzz's erodes our willpower and ability to resist temptation. In one study, overweight/obese dieters were asked to follow a fixed calorie diet and assigned to get either 5-1/2 or 8-1/2 hours of sleep a night (in a sleep lab). Those with sleep deprivation lost substantially less weight.

How to Minimize Weight Gain When You’re Stressed

1. Exercise

Aerobic exercise has a one-two punch. It can decrease cortisol and trigger the release of chemicals that relieve pain and improve mood. It can also help speed your metabolism so you burn off the extra indulgences.

2. Eat Mindfully

Mindful Eating programs train you in meditation, which helps you cope with stress, and change your consciousness around eating. You learn to slow down and tune in to your sensory experience of the food, including its sight, texture or smell. You also learn to tune into your subjective feelings of hunger or fullness, rather than eating just because it’s mealtime or because there is food in front of you. A well-designed study of binge-eaters showed that participating in a Mindful Eating program led to fewer binges and reduced depression.

3. Find Rewarding Activities Unrelated to Food

Taking a hike, reading a book, going to a yoga class, getting a massage, patting your dog, or making time for friends and family can help to relieve stress without adding on the pounds. Although you may feel that you don’t have time for leisure activities with looming deadlines, taking time to relieve stress helps you to feel refreshed, lets you think more clearly, and improves your mood, so you are less likely to overeat.

4. Write in a Journal

Writing down your experiences and reactions or your most important goals keeps your hands busy and your mind occupied, so you’re less likely to snack on unhealthy foods. Writing can give you insight into why you’re feeling so stressed and highlight ways of thinking or expectations of yourself that may be increasing the pressure you feel. Writing down your healthy eating and exercise goals may make you more conscious of your desire to live a healthier lifestyle and intensify your commitment. Research studies have also shown that writing expressively or about life goals can improve both mood and health.

Dr. Elissa Eppel, a psychologist and professor at the University of California, San Francisco Medical Center has conducted pioneering research on stress, eating, and weight gain. Click here for a summary of her work and a talk by Dr. Eppel.

Dr. Michelle May, a family physician, author, and recovered yo-yo dieter has developed a Mindful Eating program to help combat emotional and stress-related eating. Click here for more information at her Mindful Eating blog.

Learn about why we crave sugar and its effects on our health: Why Our Brains Love Sugar — and Why Our Bodies Don't.


[4] Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016315(21):2284–2291.

[5] Liu X, Chen Y, Boucher NL, Rothberg AE. Prevalence and change of central obesity among US Asian adults: NHANES 2011–2014. BMC Public Health. 201717(1):678.

[6] St-Onge MP. Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obesity Reviews. 201718(suppl 1):34–39.

[7] Hirshkowitz M, Whiton K, Albert SA, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 20151(4):233–243.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Jamy D. Ard, Wake Forest Baptist Health, Wake Forest School of Medicine


Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

A global study confirms that during the pandemic, many of us ate more junk food, exercised less, were more anxious and got less sleep.

Not long ago, Stephen Loy had a lot of healthy habits. He went to exercise classes three or four times a week, cooked nutritious dinners for his family, and snacked on healthy foods like hummus and bell peppers.

But that all changed when the pandemic struck. During the lockdowns, when he was stuck at home, his anxiety levels went up. He stopped exercising and started stress eating. Gone were the hummus and vegetables instead, he snacked on cookies, sweets and Lay’s potato chips. He ate more fried foods and ordered takeout from local restaurants.

“We were feeding the soul more than feeding the stomach,” said Mr. Loy, 49, who lives in Baton Rouge and is the executive director of a tech incubator. “We were making sure to eat things that made us feel better — not just nutritional items.”

Now a global survey conducted earlier this year confirms what Mr. Loy and many others experienced firsthand: The coronavirus pandemic and resulting lockdowns led to dramatic changes in health behaviors, prompting people around the world to cut back on physical activity and eat more junk foods. It drove anxiety levels higher and disrupted sleep. And those who are obese, who already face increased health risks, may have fared the worst, the researchers found. While they tended to experience improvements in some aspects of their diets, such as cooking at home more and eating out less, they were also the most likely to report struggling with their weight and mental health.

The findings, published in the journal Obesity, offer a cautionary lesson for many of us as coronavirus cases continue to surge and renewed calls for lockdowns and other restrictions again take hold. With months to go before a vaccine becomes widely available and we can safely resume our pre-pandemic routines, now might be a good time to assess the healthy habits we may have let slip and to find new ways to be proactive about our physical and mental health.

The study, carried out by researchers at the Pennington Biomedical Research Center in Louisiana, surveyed almost 8,000 adults across the globe, including people from 50 different countries and every state in America. The researchers found that the decline in healthy behaviors during the pandemic and widespread lockdowns was fairly common regardless of geography.

“Individuals with obesity were impacted the most — and that’s what we were afraid of,” said Emily Flanagan, an author of the study and postdoctoral fellow at the Pennington Biomedical Research Center. “They not only started off with higher anxiety levels before the pandemic, but they also had the largest increase in anxiety levels throughout the pandemic.”

The findings shed light on exactly how people altered their routines and behaviors in response to the lockdowns that were implemented in countries around the world this year to slow the spread of the virus. The pandemic disrupted everyday life, isolated people from friends and family, and spawned an economic crisis, with tens of millions of people losing jobs or finding their incomes sharply reduced.

Dr. Flanagan and her colleagues assumed many people were experiencing enormous levels of stress. But they were not sure how the pandemic and stay-at-home orders were impacting how people slept, how much they exercised and what they ate. So they designed an extensive survey and recruited people on social media to answer questions about how their mental and physical health had been affected.

“This was such a drastic and abrupt change to everyone’s daily life that we needed to see what was going on,” said Dr. Flanagan. “We wanted to put some data to the anecdotal behaviors we were seeing.”

From April through early May, about 7,750 people, most of them from the United States but also from countries such as Canada, Australia and Britain, completed the survey. The average age of the respondents was 51, and a majority were women. Based on their body mass indexes, about a third of the people were overweight, a third were obese, and a third were considered normal weight.

The researchers found that most people became more sedentary, which they said was probably related to less daily commuting and more time spent indoors. But even when people did engage in structured exercise, it tended to be at lower intensity levels compared to before the pandemic. Many people also said they had given in to their food cravings: Consumption of sugar sweetened beverages and other sugary snack foods, for example, went up.

That might explain another finding: About 27 percent of people said they had gained weight after the initial lockdowns went into effect. The figure was even higher among people classified as obese: About 33 percent said that they had gained weight, compared to 24.7 percent of people considered normal weight. People who gained weight also had the largest declines in physical activity.

There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic perhaps not surprisingly, they tended to be people who increased their physical activity levels and improved their diets. And despite snacking on more junk foods, many people showed an increase in their “healthy eating scores,” a measure of their overall diet quality, which includes things like eating more fruits and fewer fried foods. The researchers said that the overall improvements in diet appeared to be driven by the fact that the lockdowns prompted people to cook, bake and prepare more food at home. Other recent surveys have also shown a sharp rise in home cooking and baking this year, with many people saying they are discovering new ingredients and looking for ways to make healthier foods.

But social isolation can take a toll on mental wellness, and that was evident in the findings. On average, people reported significantly higher anxiety levels. About 20 percent said that their symptoms, such as experiencing dread and not being able to control or stop their worrying, were severe enough to interfere with their daily activities. About 44 percent of people said that their sleep had also worsened during the pandemic. People on average reported going to bed about an hour later than usual and waking up roughly an hour later than usual. Only 10 percent of people said that their sleep had improved since the pandemic began.

The greatest spikes in anxiety occurred among people who are obese. It was unclear why exactly, but one reason may have been concerns about the virus. The survey took place at a time when studies were first beginning to show that excess weight puts people at a much higher risk of being hospitalized with Covid-19. “We don’t have data to back this up, but our hypothesis is there was a lot more anxiety about their own health,” Dr. Flanagan said. “A heightened fear of the virus would most certainly increase their anxiety levels.”

Dr. Flanagan said it was perhaps not surprising that people tended to engage in less healthful habits during the pandemic, as so many aspects of health are intertwined. Stress can lead to poor sleep, which can cause people to exercise less, consume more junk foods, and then gain weight, and so on. But she said she hoped that the findings might inspire people to take steps to be more proactive about their health, such as seeking out mental health specialists, prioritizing sleep and finding ways to exercise at home and cook more, in the event of future lockdowns.

“Being aware of how our health behaviors change during these stay-at-home orders could help us combat that if another lockdown is enforced,” she said. “Being aware is really the No. 1 thing here.”