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Laurel Green isn't really sure how she managed to put on more than 30 pounds between her 40th and 45th birthdays. "Sure, I overate occasionally, but I certainly didn't gorge all the time on lots of junk or fast food," says the mother of three from Shawnee Mission, Kansas.
And it's not as though Green were sedentary either -- far from it. Her job as a physical therapist and director of a hospital center for women's health kept her on her feet much of the day. That's why formal exercise often took a backseat. That and the fact that she was also dealing with her younger son's ADHD diagnosis; caring for her aging mother, who had suffered a stroke and gotten hip-replacement surgery; and locking horns with her teenage son over his grades.
As it turns out, these personal struggles in and of themselves likely explain some of Green's added pounds. According to a large, not-yet-published study, the stresses of midlife may be a direct contributor to weight gain. "Women in midlife have a lot going on, and these pressures appear to cause some women's bodies to conserve more fat," says lead investigator Tene T. Lewis, PhD, a health psychologist at Rush University Medical Center, in Chicago.
Dr. Lewis and her colleagues asked more than 2,000 women in their 40s and 50s, all participants in a long-term project called the Study of Women's Health Across the Nation, about negative or stressful life events they had experienced in the past year. The list of "bad things" women were asked about included being fired or laid off, experiencing major money worries, losing a loved one, or going through a divorce. Researchers discovered that the more stressors a woman reported, the more weight she had gained over four years, even after taking into account variables that influence weight, such as diet, exercise, smoking, and age.
So how and why would strain and anxiety trigger some of us to pile on extra weight? Stress activates the flight-or-fight response, a physiological reaction designed to get your body moving quickly in a physical emergency. When your brain perceives a threat, it sounds the alarm to your adrenal glands (located on your kidneys) to pump out the stress hormone cortisol. The hormone then signals fat cells to quickly release energy, which your muscles can use for a surge of power to "flee" or "fight." When the danger passes, cortisol briefly stays elevated to encourage your body to replenish its fat stores, then returns to normal.
"The system works beautifully if you're running for the last bus home after work. It gives you a burst of energy, which you recover from quickly once you take your seat," says Pamela Peeke, MD, clinical assistant professor of medicine at the University of Maryland School of Medicine, in Baltimore, and author of Body for Life for Women. But when you turn on the stress response for months on end -- worrying about your marriage or mortgage payments -- you do damage. "Then, cortisol levels remain persistently elevated, persistently signaling your body to store fat," says Dr. Peeke.
This mechanism may also affect where flab builds up on your body. Under stress, women who carry excess weight in their abdominal area secreted significantly more cortisol than women who didn't have extra belly fat, according to a study from the University of California at San Francisco. And since deep abdominal fat tissue has up to four times the number of receptors for cortisol as does superficial fat elsewhere in the body, the cells in this area are the most likely to respond and store fat when exposed to extra stress-induced cortisol. Unfortunately, this extra abdominal flab isn't just a cosmetic concern; it is strongly linked to a greater risk of heart disease and stroke, two top killers of women over 50.
The stress-fat connection plays out in our bodies in three other subtle ways, the cumulative effects of which can be hefty.
Stress stimulates your appetite. A persistently high-level release of cortisol relentlessly sends your body the message that you need to refuel your energy stores and also spurs a spike in insulin, the hormone that controls blood sugar levels. Insulin plays a key role in feelings of hunger and satiety.
It awakens high-calorie cravings. "We all know we don't yearn for celery sticks when under pressure," says Elissa S. Epel, PhD, assistant professor of psychiatry at the University of California at San Francisco. Her research shows that women tend to reach for comfort foods -- high-fat, sweet treats like ice cream, candy, or cake -- when anxious. That's because these rich foods stimulate the release of opioids, brain chemicals that produce pleasurable feelings and help ease anxiety, at least temporarily.
It disrupts your sleep. Stress and the associated worrying that keeps you up at night can trigger hormonal changes that encourage weight gain. When researchers tested 1,024 volunteers involved in the long-term Wisconsin Sleep Cohort Study, they found that compared with men and women who routinely slept eight hours nightly, those who logged only five hours had about a 15 percent higher level of ghrelin, a hormone that stimulates hunger, and a 16 percent lower level of leptin, a hormone that signals fullness.
Another study of 924 adults found that normal-weight individuals slept an average of 16 minutes more per day than those who were heavier. This may surprise women who are mistakenly consoling themselves that at least they are burning up energy tossing and turning. "The full story on how a sleep deficit may be linked to weight gain is far from in," says Robert D. Vorona, MD, assistant professor of internal medicine in the division of sleep medicine at Eastern Virginia Medical School, in Norfolk. "But it's safe to say that if stress is preventing you from getting adequate sleep, it's an area of self-care you should pay attention to."
Although you can't control many of the things that cause you stress, such as a parent's illness or losing your job, you can take steps to curb the negative effect these stressors have on your body. "Support is essential. Reach out to family and friends," says Alice Domar, PhD, director of the Mind/Body Center for Women's Health at Boston IVF. Her research has shown that mind/body support groups not only improve women's ability to emotionally cope with such hardships as infertility, endometriosis, and gynecological cancer, but also may improve physical outcomes (resulting in higher pregnancy rates among infertile women, for example).
A support group doesn't have to be formal. It can simply be a network of friends who are willing to lend a sympathetic ear when you need one. Dr. Domar notes that sharing your worries can lead to meeting others in a situation similar to yours: "You learn of a friend of a friend who also lost a child, and before you know it, you're in touch with someone who really understands what you're going through -- and vice versa. As a result you feel less isolated."
Another outlet for pent-up tension is keeping a "stress diary," which can help you pinpoint what issues really push your buttons and so negotiate them better in the future. After a big fight with your husband, for instance, jot down why you feel agitated, frustrated, or angry. Later, once you've cooled off, reread what you wrote and try to analyze it in a nonjudgmental way, then brainstorm things you could do next time to respond differently.
Include in your diary a laundry list of "stress-reaction alternatives" that you can tap into when you feel sad, hopeless, edgy, or overwhelmed, advises Dr. Domar, "so you don't do something like spoon peanut butter straight from the jar to make yourself feel better." Try some of these de-stressing tactics, all of which can quell the surge of cortisol in your body:
Visualize yourself less tense. Mental imagery has been shown to help people cope with pain, both physical and psychological. Imagine your stress as a palpable entity that you can grab and fling away from yourself. Or close your eyes and picture yourself at the beach. A moment in such peaceful surroundings can leave you feeling refreshed when you "return."
Breathe deeply. Taking slow, full breaths is the key element of the much-studied relaxation response, serving to reduce blood pressure, heart rate, and muscle and mental tension. Whenever you feel tension rising and your body's flight-or-fight response kicking in, exhale slowly as if you have just been relieved of a great burden. Let the air push out of your lungs. Silently repeat a comforting word or sound as you inhale to the count of four and exhale to the count of six. Repeat at least two or three times.
Practice mindful meditation. This tactic can help put the brakes on a tendency to catastrophize, that is, letting your mind run wild with horrible scenarios and what-ifs. Snap yourself back into the here and now by focusing on how your body feels at this very moment -- what kind of breaths you are taking, whether the skin on your hands is cool or hot, or what the inside of your mouth tastes like. Sustaining this concentration for even 30 seconds can help clear your mind.
Remind yourself that you have choices. Stressful situations can make you feel like a victim; after all, none of us chooses to have sad or bad things happen in our lives. But you can establish boundaries so that the stressor doesn't spill over into every aspect of your life. It's in your power to stop complaining about how unreasonable your boss is, for instance, and to turn your attention to playing catch with your kids once you get home from work. Simply deciding to get outside yourself and stop dwelling on the problem can bolster your sense of power and lift some of your anxiety.
Learning how to better manage her stress helped Laurel Green change her life -- and weight. "On my 45th birthday I realized I had allowed my entire identity to be consumed by my different commitments and worries. I was living on automatic pilot and had become a pathological nurturer of everyone but myself," she says. "I felt sluggish and disconnected -- certainly not how I wanted to be."
At that turning point, Green made a promise to take better care of herself and became disciplined about carving time out every day to do it. She started by power-walking with a close friend and was surprised to find that the hard work and sweat boosted her spirits. From there, Green added to the mix biking, weight lifting, using the elliptical trainer at her gym, and playing in a women's indoor soccer league, doing at least one workout every day of the week. Green also quit being a member of what she calls "the clean plate club" and began paying closer attention to whether she was really hungry, choosing smaller portions as well as healthier foods.
Interestingly, Green was strictly focused on fitness and de-stressing; she never set a weight-loss goal. Still, she has dropped 50 pounds over the past four years. Is it partly because her life is less stressful? "Absolutely not!" says Green, who during this period also coped with her teenage son's announcement that his girlfriend was pregnant, supporting them in their decision to place the baby up for adoption. "Now, no matter how bad things get, I've learned I can cope with stress without sacrificing my own health in the process," says Green. "And I feel more positive even when things get tough."
It takes willpower and a plan to overcome a stress-fueled appetite. "Eat every three to four hours, so you head off hunger before it gets out of control," says Pamela Peeke, MD, of the University of Maryland School of Medicine and author of Body for Life for Women. And if the urge to "stress-eat" still strikes, try these appetite tamers:
Incorporating exercise into your daily life is one of the most effective ways to combat stress. Physical activity helps regulate levels of the stress hormones cortisol and insulin, so they're less likely to contribute to your weight and waistline. Workouts also bolster your ability to deal with stress by helping you get a better night's sleep. (Just be sure to finish exercising at least three hours prior to your bedtime, or else you may be too revved up to settle down.) What's more, studies show that exercise may fight mild to moderate depression, a common side effect of stress. And it helps you shed pounds, of course, giving you one less thing -- your weight -- to fret and worry about.
The trick to staying on a fitness program? First, set a realistic goal. Even a little bit is beneficial, so don't be afraid to start with as small a commitment as five or 10 minutes of walking a day. Then jot down in your datebook or on your calendar how much exercise you do daily. A diabetes-prevention study involving more than 1,000 participants found that those who kept notes of how much fat they ate and how many minutes they exercised were far more likely to achieve their activity and weight-loss goals than those who failed to keep records. "Keeping track helps you notice if you're starting to slip, so you can quickly get back on course," says study researcher Rena Wing, PhD, professor of psychiatry and human behavior at Brown Medical School, in Providence, Rhode Island. "It also provides positive feedback that can inspire you to keep going."
Originally published in Ladies' Home Journal magazine, July 2005.