Cortisol and Weight Gain: Understanding the Connection

More than one in three men and more than one in four women are overweight, and more than two in five adults are obese (23). Despite eating a healthy diet and exercising regularly, it's all too common for patients to continue to struggle with weight gain. In a time when stress is at an all-time high, the missing piece to this puzzle may be high cortisol levels.

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What is Cortisol?

Cortisol is a glucocorticoid steroid hormone synthesized in the adrenal glands, which are located on top of the kidneys. Besides its role in stress response, cortisol serves various functions, including increasing blood sugar levels, moderating inflammation, suppressing the immune system, and facilitating energy metabolism. (31)

Cortisol secretion patterns align with the body's circadian rhythm. Levels peak in the morning and then gradually decline throughout the day until they are lowest at night. The brain's hypothalamus and pituitary gland regulate its production and release through the hypothalamic-pituitary-adrenal (HPA) axis.

In moments of heightened stress, cortisol is secreted from the adrenal glands, upregulating processes essential for survival and downregulating those processes that are not. This reflex is necessary for survival and benefits the body in acute scenarios. However, chronic HPA axis activation results in cortisol dysregulation and poor health outcomes, including metabolic dysfunction, inflammation, and neurodegenerative diseases. (14, 27)

The Stress-Weight Connection

Chronic stress and high cortisol levels in the body can contribute to weight gain via several key pathways.

Cortisol's Role in Stress and Metabolism

Cortisol promotes gluconeogenesis, the process by which the liver produces glucose, leading to elevations in blood sugar (hyperglycemia). Hyperglycemia can trigger chronic inflammation. Chronic inflammation increases visceral fat, prompts overeating, and interferes with physical activity by causing joint pain and fatigue – collectively leading to weight gain.

Excess glucose that is not utilized for immediate energy needs is eventually stored as fat, particularly in the abdominal region. This contributes to weight gain and metabolic dysfunction, increasing the risk of developing inflammatory conditions such as obesity, type 2 diabetes, and cardiovascular disease.

Cortisol counteracts the effects of insulin, the hormone responsible for signaling cellular glucose uptake from the bloodstream. This can lead to insulin resistance, perpetuating metabolic dysfunction by impairing glucose uptake into cells for energy production, leading to increased fat storage and weight gain.

Chronic stress and elevated cortisol levels can dysregulate appetite-regulating hormones. Leptin, known as the "satiety hormone," signals feelings of fullness to the brain, while ghrelin stimulates hunger. Dysregulation of these hormones can increase appetite, especially for foods high in sugar, fat, and salt.

Fat Distribution and Visceral Fat

Excessive circulating cortisol and insulin levels trigger the storage of more visceral fat. Visceral fat is particularly harmful as it is metabolically active and releases inflammatory cytokines and adipokines that contribute to systemic inflammation and an increased risk of developing metabolic syndrome, insulin resistance, type 2 diabetes, and cardiovascular disease. (29, 35)

Symptoms and Indicators of Cortisol-Induced Weight Gain

There are many potential causes of weight gain. Signs and symptoms that point to cortisol-induced weight gain include:

Central obesity, measured by an increased waist-to-hip ratio
Cravings for high-calorie, high-sugar foods
The development of insulin resistance or metabolic syndrome, which is the co-existence of high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat
Changes in mood, such as depression and anxiety
Sleep disturbances
Fatigue, often described as a "tired but wired" sensation.

4 Strategies to Manage Cortisol Levels and Prevent Weight Gain

By implementing these strategies to manage cortisol levels effectively, individuals can minimize the risk of weight gain and promote optimal health.

1. Reduce and Manage Stress

Effective stress reduction practices, such as mindfulness meditation, yoga, deep breathing exercises, and exercise, regulate cortisol levels. According to a 2018 review, these techniques improve eating behaviors and support weight loss efforts.

2. Switch to an Anti-Inflammatory Diet

Dietary adjustments can help manage cortisol levels and prevent weight gain. The Mediterranean diet is a well-studied plan that emphasizes fruits, vegetables, lean proteins, and healthy fats. Research shows that it is positively associated with weight loss and reductions in cortisol, blood sugar, and inflammation.

3. Improve Sleep and, Therefore, Cortisol Regulation

High cortisol levels can disrupt sleep. Poor sleep and inadequate sleep disruption can further disrupt the body's circadian rhythm and perpetuate the dysregulation of cortisol secretion. Sleep deprivation is linked to insulin resistance, overeating, and increased body mass index.

Improving sleep hygiene by establishing a consistent sleep schedule, creating a relaxing bedtime routine, and minimizing exposure to screens before bed can help optimize cortisol regulation and support weight management.

4. Engage in Regular Physical Activity

Regular physical activity is another effective strategy for managing cortisol levels and preventing weight gain. Exercise helps reduce stress, improve mood, promote healthy cortisol secretion, and enhance insulin sensitivity. (13, 43)

Incorporating a variety of activities, including aerobic exercise, strength training, and flexibility exercises, into a balanced fitness routine can help regulate cortisol levels and support overall metabolic health.

The Role of Professional Help

Seeking professional assistance can be instrumental in effectively managing cortisol levels and preventing weight gain. Healthcare professionals can offer personalized guidance, support, and interventions to address cortisol-related issues.

When to See a Doctor

It is advisable to consult a healthcare provider when experiencing persistent symptoms of stress, weight gain, or metabolic dysfunction. Medical consultation is particularly recommended to assess cortisol levels and rule out underlying health conditions such as Cushing's syndrome, a hormonal disorder characterized by excessive cortisol production and symptoms like:

Abdominal weight gain
Muscle wasting in the arms and legs
A round face
Increased fat around the base of the neck and between the shoulders
Easy bruising and purple stretch marks

Seeking Nutritional and Psychological Support

Dietitians, nutritionists, and therapists can provide nutritional and psychological support for managing cortisol-related weight gain.

Dietitians and nutritionists can offer personalized dietary recommendations tailored to individual needs, focusing on nutrient-dense foods, portion control, and stress-reducing eating patterns (30).

Therapists can provide counseling and behavioral interventions to address underlying stressors contributing to elevated cortisol and develop appropriate and healthy coping strategies. Additionally, psychotherapy can help in addressing the emotional hardships that often accompany weight gain and difficult weight loss; overweight adults have a 55% higher risk of depression.

Medical Interventions

Patients with Cushing's disease caused by a hormone-secreting tumor require surgical removal of the tumor (41).

Other hormonal imbalances, in addition to cortisol and insulin, can significantly impact weight management. These may include estrogen and thyroid hormones. In certain cases, hormone replacement therapy under the guidance of a doctor can be beneficial to restore hormonal balance.