Originally created 04/30/01

Past 40, weight gain may be stress related



Dr. Pamela Peeke isn't subtle when expressing her distain for dieting. "Dieting is the single most horrific thing. ... It's the most stressful experience men or women could self-induce."

The National Institutes of Health researcher offers another solution to controlling weight and promoting a healthier lifestyle: Learn to control your stress.

In her bestseller published last year, "Fight Fat After Forty," the internist targets what she calls "toxic stress" as the culprit in putting on "toxic weight" - the kind of life-threatening fat that collects in the abdomen instead of the hips, turning what one of her patients described as an "hourglass figure into a shot glass."

While these sound like marketing buzzwords, the assistant clinical professor of medicine at the University of Maryland School of Medicine said there's strong science to back it up.

Peeke, a former NIH research fellow who works in the developmental endocrinology branch of the National Institute of Child Health and Human Development, said three things typically happen, particularly to women, when they enter their 40s.

First, they become more sedentary, which contributes to a lowered metabolism. Second, their sex hormones decline as they approach menopause. Estrogen promotes fat storage in the hips, thighs and buttocks - primarily as a repository of fat for breast-feeding. As estrogen disappears, the fat storage site shifts to the abdomen, she says. Those with more fat in the belly than the hips face higher risk of cardiovascular disease, diabetes and cancer.

If a woman remains active, this shift shouldn't contribute to any significant or life-threatening disease, or major weight gain. But all too often, women are also dealing with chronic, unrelenting stress, which Peeke says produces a flood of cortisol from the adrenal gland. Prolonged cortisol secretion triggers the flow of insulin, a potent appetite stimulant and fat storage hormone that causes even more weight to settle in the waist.

The abnormally high cortisol in the bloodstream also triggers an unrelenting appetite for fat and carbohydrates, she says.

People display three distinct eating responses to stress. There are stress resilient individuals, stress overeaters and stress undereaters. The resilient person adapts to stress, perhaps with exercise or meditation. But both the overeater and undereater see stress as uncontrollable, which keeps cortisol continually elevated. For these individuals, the goal is to become stress resilient.

In her book, Peeke outlines seven-day meal plans customized for each stress eater. Among her mantras: Toss out all those fat-free foods. They replace fat with sugar and tempt stress overeaters to overindulge.

And when you eat is just as important as what you eat. She emphasizes the importance of mid-morning and mid-afternoon snacks, smaller portions (what she calls "woman food") and avoiding refined and processed sugars and starches.

And try to finish dinner by 8 p.m. ("If you eat after 8, you gain a lot of weight.")

A centerpiece of her weight-management advice is teaching people to effectively navigate what she calls the CortiZone, the time from 3 p.m. through evening when cortisol and adrenaline levels decrease in the bloodstream and individuals are at greatest risk for stress eating. That's the time when "the vending machine is calling you," she says.

Plan ahead by having high qualitylow-stress foods on hand, such as fruits and vegetables, low-fat yogurt or cottage cheese.

Peeke, who is in her mid-40s, is a stress overeater. Any kind of licorice - Good and Plenty, Twizzlers, etc. - pushes her stress buttons. Once she recognized how stress was affecting her, especially during the CortiZone, she learned to bring it under control. "It's all about being aware."

Exercise and meditative practices such as massage or yoga have a big impact in reducing coritsol in the body. Recognizing the power of the mind over the body is crucial in keeping stress and weight gain in check, she says.

"This isn't hoochie coochie, woo woo, medicine anymore."