Introduction to stress and weight

For this Doctor Talks, we are going to be talking about stress and the relationship with weight. What we can do about it. I have Doctor Tiger with me.

She is a double board certified physician in diagnostic radiology and lifestyle medicine, and is the founder of the Wellness Practice Stress Free M. D.

and she combines her training with yoga, medicine, meditation and life coaching, to really help with comprehensive care. So thank you so much for joining us, Doctor Robin.

Tiger, thanks for having me. I'm excited to be here. So let's start off just talking about what stress is. I think sometimes people use that in lots of different contexts.

So when we say stress, what are we talking about? Yeah. So first of all, not all stress is bad okay. And there actually are three different types of stress.

The first type is called use stress EU stress use stress. And that's actually a good stress. It's the falling in love stress that feeling. It's the excited to come and talk with you today.

Feeling right. So that's you stress. And then there's new stress. New new stress like from the word neutral.

Types of stress explained

And that type of stress is type of stress where you know something is happening, for example far away from you and you're aware that it's not really okay, but it doesn't really affect you.

It's kind of neutral for you. And then the third type and the type that we most commonly referred to when talking about stress is distress. This stress.

And that's the stress. That's the problematic stress. That's the stress that chronically which means over time causes us dis ease, which leads to disease.

And there are many, many things that cause chronic stress, most commonly it's psychological stress that is the stress that we are most dealing with, which is the stress from our thoughts about whatever it is that's going on in our life.

And most commonly, they're it's related to work. Well, thank you for breaking that all down. I think probably people don't think about stress as being neutral or even good.

But those are really good explanations. I see that with my little my five year old, she'll sometimes say she's nervous, but she's just excited. Right? It's that sort of good stress.

Yeah. That's the that's the you stress. Can you explain the relationship between stress and weight? Yeah, absolutely. So think about it. When you're feeling the stress and you open up the refrigerator, do you reach for a piece of celery?

Said no one ever. Right. Yeah. So what happens when you're stressed is that your brain can't tell the difference between a real emergency and an emergency.

That's not real. Meaning something that your brain is thinking about. And so it treats you the same way. And what it wants to do is to get you immediate energy to deal with whatever that emergency is that it thinks you're trying to deal with.

So it sees you as running from a wild animal equivalent to concerned about a conversation you had with someone didn't go so well, for example. Right? And so when you need that immediate energy, your body does a few things.

First of all, it craves sugar and fat, which are like immediate energy, right? And you don't have time in an emergency to go to the refrigerator and take off stuff and start making a whole meal or go grocery shopping.

You need energy right away. So your body's going to start mobilizing or releasing those sugars and fats into your body, and it's going to have you crave it so that you want to eat those things.

How stress drives weight gain

So going back to the question, when you're feeling stressed, what do you eat? You reach for things that are full of sugar, full of fats. Right. You want cupcakes and ice cream and cookies and, you know, French fries and lots of salt, right.

And things like that. So when you are stressed, you are craving and eating foods that are unhealthful for you, that cause weight gain. Another thing that happens is you have increased cortisol.

That's a stress hormone. And I think of it as the big bad wolf when we have too much of it. And cortisol is also responsible for waking because cortisol is helping to mobilize these sugars and fats, but it also suppresses or makes your insulin not work properly.

We call that insulin resistance. And insulin is a very important hormone that causes the sugar to get into your cells. So when the insulin isn't working well, we have too much sugar or glucose in our bloodstream.

So that's like a double sugar overload right. So we have sugar that's elevated because our insulin isn't working well. And we have sugar that's elevated because we're mobilizing it and we're eating it.

Right. And so we're eating too much of the bad foods or the foods that cause us to gain weight than we really need. And chemically, hormonally, our body is also working in that fashion.

So two main ways that we gain weight when we're stressed. Another we're breaking that down. Yeah yeah yeah. But a couple other things to think about right.

So as a lifestyle medicine physician, we see all of these different areas of behaviors affecting you. And it affects your weight. So when you're stressed who's here sleeps well again said no one. Right.

And so a lot of these things that were already talked about when you don't sleep well happen your cortisol levels go up. Your insulin resistance goes up.

And another thing that happens is your leptin, which is a really important hormone that determines when you've had enough to eat. We call that satiety.

That hormone level goes down. And so the next day when you're tired and you haven't gotten enough rest, you can eat as much 300 calories more than you normally would.

So again, another way that you're eating more overeating from not sleeping. So stress causes you not to sleep well, you don't sleep well, and therefore you can tend to eat more and more of the wrong foods.

Another example we can keep going, right? Yeah. And sometimes I'll talk like sleep goes both ways. Right? So when we're stressed, we don't sleep well.

But if we also just don't get enough sleep for whatever reason, we have a baby that's keeping us up, or we don't have enough time to sleep, or we have sleep apnea, that also is a stressor to our body.

We also have cortisol that goes up. And so it's like these chicken and the egg situation sometimes two words. Either way that lack of sleep is is having that effect on our body.

You're so right. It's just like a vicious cycle right. This by directionality when you don't sleep, it makes you more anxious and stressed. When you're anxious and stressed, you're not sleeping.

You're exactly right. And then I'll go ahead. So then what do we do about that? Right. So, our stress free mood here. Right. So when we recognize this stress, what do we do about it?

Well, the first thing I like to do is get to the root cause of what's going on. Right? So instead of, you know, oh, I need to exercise more and I need to diet this diet, that diet, and, you know, all these things really taking a step back.

And that's where that life coaching piece comes in. And it's really well, what is the root cause of what's going on here. You know, what is causing the behavior that you're doing that's leading you to feel stressed is are you having a lot of worry?

Are there situations going on at home or at work or in the world?

Sleep, hormones, and the stress cycle

Are you having issues that are causing you not to sleep well, you know, are you having issues around your movement? You know, we didn't get into exercise, but you know, when you're feeling stressed, it can actually go two ways.

But for most people, you just might be like, I'm not doing anything. You know, just you have no motivation, you know, what is it that's driving the behavior that's leading you to gain weight?

So really taking a step back and getting to the root cause of what's going on is the first thing I like to try and figure out. Yeah, that sounds huge, right?

That's all of these, conditions that we've been talking about in the summit is what's the root cause we otherwise we just end up putting Band-Aids on things, right?

And not not solving the thing that's connecting everything together. So talking a little bit more about weight, we've talked about how, stress can contribute to cortisol levels.

Insulin levels are behaviors around eating and taking care of ourselves. Why should we care about weight? You know, like, why does that matter? As a physician, how would you explain the importance of maintaining a healthy weight or losing weight?

Yeah, I mean, most people might think, oh, because I want to look good in bathing suit, right? Most people are concerned about their weight because they care about their physical appearance.

But we know as physicians is that overweight or being overweight is associated with the most common chronic diseases in the world, right? So being overweight is associated with high blood pressure called hypertension, diabetes, type two, cardiovascular disease, which are heart attacks, strokes, cancer.

Right. Being overweight associated with even the way our memory and dementia. And there's been some conversation about stress and which leads to overweight, conditions shortening your lifespan.

Right. Shortening how long you live. And so really understanding that there are multiple reasons why being overweight isn't good for your health, it may not be good for your emotional, psychological health because you don't feel good about yourself, which will cause more stress and cause you to do more of the behaviors that are causing the problem in the first place.

But then we know from the inside out that all of that stress that's causing you to have that extra weight is putting you at risk in increasing your chronic disease.

The chronic diseases in the world. Yeah. So that relationship of weight affecting so many other health risk factors and then stress having such an impact on weight, and again we talked about this by direction where there kind of just this chicken and the egg thing, if we don't address that root cause we're not really able to make a lot of progress forward.

Finding the root cause of stress

So that was why it was so important to me to have you actually as part of this summit, because that's one of the things I see time and time again for my patients is if we don't address that underlying stress, it's really hard to make progress and make a change in terms of of weight and just overall metabolic health, without addressing that underlying cause, the strength.

So, so thank you for for being here and talking about, the importance of, of stress reduction and, and addressing that as an underlying cause. You talked some about how stress impacts hormones, how it impacts, our behavior around food.

What other ways does chronic stress affect lifestyle and the way we behave? Yeah. So we talked a bit about, lifestyle medicine and some of the pillars.

There are six key pillars of lifestyle medicine. We discussed stress. We talked a bit about nutrition and sleep and we mentioned a little bit about exercise.

Right. And so when we're not feeling good, we're more likely to not do things that are really good for us, such as moving our body and moving our body in a way that keeps our bones strong and our muscles strong, and our heart strong and our mind strong.

Right? So lots times exercise sort of falls off the map there. And another thing it happens is that social connection goes out the door. Right. And we know that we have an epidemic of isolation and loneliness in this world, especially since the pandemic.

And our own Surgeon general, Doctor Vivek Murthy, actually brought that to our attention earlier this year when he made this, you know, advisory advisory across the nation for this epidemic of loneliness and this epidemic of isolation.

And so when you are stressed, you are less likely to be connecting with others, right? You're more likely to be alone. You're probably not the nicest person to be around.

So people don't want to be around you either. And that's only, again, this creating this vicious cycle of you being lonely and isolated. And as a radiologist, I can tell you that I geek out on some imaging and it's very interesting that on functional MRI imaging, it is shown that the portion of your brain that is functioning, that is working when you are isolated and alone, is the same part of your brain that is working or letting up on imaging as chronic pain.

So that's why we understand that actually isolation and loneliness is so painful. It it's actually working in the same part of your brain as pain shows up right.

And so when we're stressed and we're not connecting with others, it's just making us feel even more stressed and more alone. And it's so, so very painful and social connection is so important for our health and well-being.

So it directly impacts that. It also causes you to do some things that maybe aren't so healthy for you.

Why healthy weight matters

With respect to other situations beyond food, like risky substances, you're more likely to over drink and use recreational drugs and smoke tobacco, right?

All of these other things come into play because you're trying to mask the emotions and the feelings that you just don't want to feel by escaping, by choosing other things that aren't so good for you.

So really lots of different ways that stress shows up to impact the choices that you make and your overall behavior and health and well-being. That information about the functional MRI on the brain and that loneliness can look the same as pain on the brain is fascinating.

I have not heard that before, but it really makes a lot of sense to me for what I've seen for for patients over my career. You know, you said everyone kind of recognizes that we have this epidemic of loneliness, but I'm actually not sure that everyone is aware that that is going on.

And so if someone is trying to figure out if that's affecting them, and trying to figure out what to do about it, how would you suggest that someone, evaluate for themselves if, if they actually have, have that as part of what's going on for stress for them?

There's this lack of community, this lack of social connection. Yeah. Well, I would just ask, you know, are you involved in relationships with other people, whether it be your friends, your family are getting out of the house?

Are you involved in your community? You know, how what in your life? What situations in your life can you see yourself with other people? Right? And if you're someone that isn't really doing anything with other people, or maybe only a little bit here and there, then it might be time to amp that up.

And if you're someone who is isolated and lonely, you know, most of the time you, you kind of know it, like, wow, you know, I really wish I had some more caring people in my life.

I really wish I had people that I could talk to or or share, you know, things that I love to do with, you know, it's really a very personal thing. So if someone does realize that they've ended up in this place where they have this lack of social connection, which, again, really intensified for so many people in the pandemic, right?

We all changed our behavior. We we were told not to spend time with people, for, for public health reasons. A lot of us started working more from home.

Lots of things changed. Right? And so if someone has recognized like, yeah, I am lonely, like I have that lack of social connection. Do you have any good places to start for people?

Well, first I like to ask, and when I work with clients, I like to ask them, what do you like to do? Like what brings you joy? You know, and if it's something like, I love, you know, fitness, I love yoga.

Okay. You know, instead of doing it remotely in your house, how about getting out to a place where you can do those things?

Stress, lifestyle habits, and isolation

If you're someone that's spiritual and you're religious and, you know, do you want to spend more time in a place where there is community in your religious, you know, whatever your religious belief is, you know, are you just at home again, remote, like so many people were?

Or would it feed your soul to be with individuals in that space? You know, what hobbies do you like to do? You know, what is it you know if you're doing it at home, can you do it in a group?

You know, what can you find in your community? Are you someone that likes to volunteer? Do you like to give of yourself? If so, in what way and where?

How can you get out in your community and do that with other people? So it's really finding what brings you joy because ultimately it isn't something that you just say, you need to go do this over here because it might not be fulfilling.

You need to do it with people that are on the same plane as you, people that have the same hopes and desires and dreams and joy as you in whatever it is you're doing.

That was beautifully said. And I think, you know, looking at like, were there things you used to do in person or, are there things you're doing at home?

Maybe because it is more convenient, but you're losing that social connection with that thing. So for me, fitness is is the thing where I have all the equipment in my house and it's a great back up option so that I can get my workouts in at home.

But there's no community there, right? And so most of the time I do go to a class where there is this shared energy and shared interest and comradery.

And that to me is is where I like to find my community. I could do it at home, but I'm missing a component that we really do know is important to health.

It's so, so good. I love that you said that, because I get up really early every morning and do my meditation, my yoga therapy, and then I head to a 6 a.m.

class at the gym and people are saying, you've got stuff in your house, what are you doing? And going to the gym at 6:00? And I said, I love being around the people in that class.

I love seeing them every morning. I love the hey Robin, how you doing? And I love saying hi to other people. Right. And then I come home and I can actually still do other things at home that I didn't do at the gym.

It's a supplement. So it's it's a way to actually have the best of both worlds. But I love that you said that because I feel the same way. If anybody knows that show. Cheers.

You know, I want to go. Everybody knows my name. You know that. You know, it just feels really good when when people say hi and recognize you and you have that again, that sense of community.

And I love community. The end of the word community is unity, right? And I always like to come back to that because we are this unified, unified, you know, and it's you know, I think in America we can get a little focused on like productivity and efficiency.

And that's part of what makes us great. But, sometimes, you know, instead of focusing on things like community and, that that has an importance too. And you mentioned, like, we can see the difference in people's brains.

And so it is part of help. It's not selfish to, spend time with your religious community. It's not selfish to spend time in a fitness community. It's not selfish to have a knitting club or a book club or, go ride horses.

Like whatever that thing is that brings you joy and brings you community. It doesn't all have to be efficient. It's good for us to sometimes just do things for joy and community.

Yeah. And it's so interesting because we don't think of that as being something that's important for our health and to decrease our stress and to ultimately affect our weight.

Right. We don't think about being with other people as being a prescription for health, but Harvard Research actually says it's the top of the prescriptions for health.

This is the one thing that we need to focus on. So it's so interesting and it's it's really and it's free. Right? It's so easy to do. It's free. Right.

Just talking to other people, being around other people. Yeah. We, have a lot of this interesting data about longevity and these like blue zones.

Building community and connection

Right. And one of the things that looks to be one of the keys in these places where people live longer is community, right? Like they have this sense of purpose and they have community.

And so, it's not indulgent. It is really important to our health to to have that network, to have that human connection. I love that you brought that up, because I was actually in one of the blue zones last month in Sardinia.

So blue zones to me is fascinating. Understand, for those who don't know what it is, the areas in the world as, as Carolyn mentioned, that, Doctor Frankel mentioned that, have the greatest quantity of people that live to be 100 in and more and older. Right?

And they are not only living long, they're living healthy and long. And so I want to visit all the blue zones. And I went last month to the very first blue zone, which is in Sardinia, which is an island off the west coast of Italy.

And I had the the privilege of being in the home of a family in the blue zones and spending several hours talking with them. And what you said is true, right?

It's that that sense of community was palpable. Like that was the one thing I took away was their strong sense of community. The family unit, the friends.

It was something that I hadn't experienced before. So many, the, the grandmother, she's 97. She invited me to our 100 year birthday party in three years.

She was smart and funny and clear. And then her daughters and the granddaughter and then the friends. And it was just this. It was a beautiful thing to witness and feel.

They don't have assisted livings. They don't have nursing homes. I mean, they just all take care of each other. And it was it was really beautiful. So I'm so glad that you brought that up.

Well, we've talked about a lot of different things here in terms of weight stress and some real concrete solutions to what next steps might be if if someone is struggling with that relationship between stress and their health.

What didn't we cover? Why do we want to make sure people, learn? Yeah. Well, they might be saying, well, like, how do I relieve my stress once I figure it out, you know, so we talked about what and why, but I frequently get that whole question, you know, like, how do I relief my stress?

And there are multiple ways to do that. I love teaching, what I call the bottom up, top down approach, which means that it's based on the fact that you can't think a thought and feel a feeling in your body at the same time.

Try it. It's really hard, right? So it's really hard to think a thought and feel a feeling in your body at the same time.

Practical ways to relieve stress

And so when your brain is full of 60,000 thoughts per day, most of them not so nice, those are the thoughts that are driving the behaviors that are causing ultimately the weak in.

We come back to our body and we figure out how to become re and body, to come back into our body and out of busy thinking mind. And so I teach multiple different ways to do that.

One is focusing on your breath, breathing in a way that's calmer, another is moving in a way. There are several different ways you can move your body to feel calmer.

Meditation, which can be many different types of meditation. Guided meditation for those with very busy minds, works the best. Life coaching is what we can do after we've created that balance, that homeostasis, we brought those cortisol levels down and found that balance in our body between stress and relaxation.

Then we can start to work with the thoughts through life coaching. So really understanding that there are lots of tools that you can utilize to feel better quickly and recognizing that also food creates mood.

And so when you are eating foods that are healthful, lots of plants, vegetables, fruits, nuts, seeds, legumes in their whole form, it also decreases your stress and makes you feel calm, grounded, and clear.

And when you're eating that sugar and saturated fat and all the chemicals that you can't pronounce or spell right, those actually have been shown to increase your stress, anxiety, and depression.

So we want to focus on also the food that we're putting in our mouths. Wonderful. Well thank you so much for joining us Doctor Tiger. If someone wants to connect with you, find more.

Where can they find you?

Where to learn more and connect

Yeah, they can find me on my website WW dot stress free and dot net and it's there. You'll find a few I have for actually free short stress relief tools.

If you want to get started, my podcast Stress Free M. D podcast is on there also on all major platforms, and there's online programs and coaching information and retreats as well.

Wonderful. Well, thank you so much.

Robyn Tiger, MD, DABLM

How Stress Influences Weight Gain