Dawn Noe, RD, CDE - Final presentation for 10.6.15 Spreecast through Cleveland Clinic

1. Stress, Overeating, and Weight:
Understanding the Connection
October 6, 2015
Dawn Noe, RDN, CDE

2. “Recipe” for Overeating
Example from Michele May, M.D.
“Recipe” for Overeating
Example from Michele May, M.D

3. “Recipe” for Instinctive
Eating
Example from Michele May, M.D.
“Recipe” for Instinctive Eating
Example from Michele May, M.D

4. Stress and Overeating
Stress, stress related hormones, and the effects of
high-fat, sugary “comfort foods” can 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.

5. Focus on Stress – Don’t Ignore it!
- To change our stress and how we respond to it, we must
be aware of the stress and our reactions
- Take a minute to consider how (or if) you manage stress.
Do you…
• Power through
• Stick your head in the sand
• Procrastinate (move on to something less stressful and
avoid the actual current problem?)
• Overwork, smoke, OVEREAT, drink alcohol to excess,
isolate yourself, or take out frustration on others?
- The above behaviors tend to make the stress worse.
- Do you pause and take a few deep breaths? If not, we’ll
practice this today.

6. There are many kinds of stresses…some stresses are universal such as the loss of
a loved one or a birth of child.
• Physical Stress
- Fatigue and sleep deprivation, poor nutrition, lack of physical activity,
illness, pain, and others.
• Emotional Stress and Depression
- Boredom, loneliness, anger, frustration, happiness, depression, etc.
- Emotions provide information and it is important to practice noticing what
you’re feeling without judging it.
• Stressful Thinking
- How you think about stress and how you react to it can actually increase
the stress.
- Stress can be a result from your perception and interpretation of life’s
events.
Explore Your Stresses

7. Stressful Thinking
Example:
Speaking in public is a great example of how each of us
thinks and responds to stress differently. For one person,
public speaking could cause a pounding heart, dry throat,
and an increase in stress. To another person, it is an
exciting opportunity to share information with others.

8. Stressful Thinking
• Thoughts that can increase stress include:
- “I feel like everything is out of control!”
- “I have to get this perfect.”
- “I can do it all, have it all, and be it all!”
• A more realistic thought response to stress:
“I’m feeling overwhelmed and tense. I can’t do everything on my to do list, but no one
could. I’m doing my best.”
Reacting to stress in a realistic manner is like imagining yourself at the center of the
tornado. You are centered while everything whirls around you.

9. Accept the Stress So You CAN Manage It!
• The demands in life for our time and energy can lead to:
- Unrealistic expectations
- A sense of urgency
- More stress
- Stressful thinking
• When you accept the stresses you can’t control you can choose how
you react to the stresses you CAN control
• Everyone has stresses, strengths and limitations
- At times, we’ll need to use self-compassion about what we do well.
- We may need to ask for help and that’s okay.
- Saying no to someone else is saying yes to yourself.
- As with all behavior changes, setting boundaries and expectations (with
ourselves and with others) takes practice and gets easier over time.

10. What is Your Stress Response?
Does Stress Causes Changes in Your Routine?
• Food Choices: Eat stress foods for comfort
• Schedule: Change your meal schedule (skip meals,
mindless snacking, eat on the run?)
• Sleep: Have trouble sleeping.
- Lack of sleep can increase hunger and appetite.
• Physical Activity: Exercise less

11. Stress Response:
Stressed people also lose sleep, exercise less, and
drink more alcohol, all of which can contribute to
excess weight.

12. Stress in the Short Term:
• Hypothalamus
- Produces a hormone called
corticotropin-releasing hormone,
which suppresses appetite
• Brain
- Signals the adrenal glands to
increase the hormone epinephrine
also called “adrenaline”
- When you are in this “fight-or-flight”
stage - eating is put on hold until
the stress goes away
If stress persists: adrenal gland releases a hormone called cortisol which actually
increases the appetite
Once stressful episode is over cortisol will drop unless stress persists it can leave the
cortisol levels stuck on “on” and stay elevated

13. Stress in the Long Term:
http://fitness.makeupandbeauty.com/stress-hormone-cortisol-and-weight-gain/
o Physical or emotional distress has
been shown in animal studies to
increases the intake of food high in
fat, sugar, or both
o High fat and sugar-filled foods
reduce the stress affect in parts of
the brain that produce and process
stress and related emotions
o Treating the stress with food may
“turns off” the stress response.
o THIS MAY INCREASE OUR STRESS -
INDUCED FOOD CRAVINGS!
o High cortisol levels, in combination
with high insulin levels, may be
responsible vs ghrelin, a “hunger
hormone,” may have a role

14. Research Findings
• Harvard researchers have found that:
- Stress is associated with weight gain, but only in people 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 levels
• In 2007, British researchers found that:
- People with high cortisol levels were more likely to snack in response to daily
hassles compared to low-cortisol responders
- How much cortisol people produce in response to stress may be a factor
• Some research suggests a gender difference in stress-coping behaviors
- Women more likely to turn to food
- Men more likely to turn to alcohol or smoking

15. Food Behaviors and Stress
• Do you know which foods you tend to eat due to stress?
• Do you know how much you eat? (Is it a portioned amount or until the
bag or container is empty)
• Tips for changing stress-related eating behaviors:
- Try replacing comfort foods (think: potato chips or ice cream) with these
nutritious snacks:
• Nuts
• small amount of fruit
• Crunchy veggies and dip
• Soup broth
• If you crave carbs, try complex carbs like air-popped popcorn or whole
grain English muffin
- Portion out the food instead of eating from containers – OR purchase pre-
portioned foods (ex. 100 calorie snack packs of nuts)
- Keep tempting comfort foods out of the house
- Even better, try using non-food related stress reducing activities instead

16. Stress Management and Weight Loss
• National Weight Control Registry
- Tracks over 5000 participants
• Lost 30 pounds and kept it off for at least 1 year
• Most exercised by WALKING for 1 hour per day =
8,000-18,000 steps depending on the intensity (light
walk to running)
• Most of these people use a stress management
technique

17. Non-Food Ways to Manage Stress
• Meditation
- Studies show that meditation reduces stress
- Meditation may also help people become more mindful of food choices.
- There’s an app for that!
• Cleveland Clinic Stress Meditations (iPhone)
• Relax Melodies, Headspace, Take a Break! (both Android and iPhone)
• Exercise
- Intense exercise increases cortisol levels temporarily, but low-intensity exercise seems to reduce
them.
- Some physical activities, such as yoga and tai chi, have elements of both exercise and meditation.
• Other exercises can act like meditation because you'll often find that you've forgotten the day's
irritations and concentrated only on the activity.
- Increases your brain's feel-good neurotransmitters, called endorphins.
- Can improve your mood and increase self-confidence
- Improve your sleep, which is often disrupted by stress.

18. Non-Food Ways to Manage Stress
• Social Support
- Friends and family seem to have a buffering effect on the stress
that people experience.
• Research suggests that people working in stressful situations, like
hospital emergency departments, have better mental health if they
have adequate social support.
• Forgive Others
- Holding grudges leads to psychological stress and higher heart rates
• Therapy or Counseling
- Helpful for reshaping our thoughts about daily stresses
- Managing depression/emotions
- Experts in behavior change

19. Stress Busters
4 Great Ways to Manage Stress
1. Positive Self Talk
• I will do the best I can
• I can get help if I need it.
• We can work it out.
• I won't let this problem get me down.
• Some day I'll laugh about this.
OR
• I don’t have 45 minutes for the gym, but I can go for 20 minutes. I’ll burn more
calories than if I didn’t go at all.
• I haven’t lost as much weight as I had wanted, but I have lost some and weight
loss reduces health risks.
2. Emergency Stress Stoppers
• Take 5 Deep Breaths
• Take a walk
• Don't be afraid to say "I'm sorry" if you make a mistake.
• Break down big problems into smaller parts. Make one phone call or email, etc.

20. Stress Busters
3. Take 15 Minutes Every Day for Something You Enjoy
• Read a book or magazine
• Start an art project (paint/draw, create a scrap book)
• Take up a hobby, new or old.
• Spend time with friends or children.
• Sew, knit or crochet.
• Listen to music
• Take a nature walk — listen to the birds, identify trees and flowers.
• Make a list of everything you still want to do in life.
4. Learn How To Relax and Practice Often
Let’s Practice Today!
1. Sit in a comfortable position with your feet on the floor and your hands in your lap or lie down. Close
your eyes.
2. Picture yourself in a peaceful place. Perhaps you're lying on the beach, walking in the mountains or
floating in the clouds. Hold this scene in your mind.
3. Inhale and exhale. Focus on breathing slowly and deeply.
4. Repeat for 5-10 minutes.
4 Great Ways to Manage Stress

21. Questions?

22. Sources
• Adams CE, et al. “Lifestyle Factors and Ghrelin: Critical Review and
Implications for Weight Loss Maintenance,” Obesity Review (May
2011): Vol. 12, No. 5, electronic publication.
• Manzoni GM, et al. “Can Relaxation Training Reduce Emotional Eating
in Women with Obesity?” Journal of the American Dietetic
Association (Aug. 2009): Vol. 109, No. 8, pp. 1427–32.
• Mathes WF, et al. “The Biology of Binge Eating,” Appetite (June 2009):
Vol. 52, No. 3, pp. 545–53.
• Spencer SJ, et al. “The Glucocorticoid Contribution to Obesity,”
Stress (Feb. 6, 2011): Vol. 14, No. 3, pp. 233–46.
• Vicennati V, et al. “Stress-Related Development of Obesity and
Cortisol in Women,” Obesity (Sept. 2009): Vol. 17, No. 9, pp. 1678–83.
• http://amihungry.com/stress-management-101/
• http://www.health.harvard.edu/newsletter_article/why-stress-causes-
people-to-overeat