Many of us are familiar with a tendency to eat in response to a non-catastrophic stress event. (Impending plane crashes, avalanches, or lighting strikes rarely call for snacks.) An income tax audit, burst water pipes, a fender bender, or a long delay in an airline departure may make us first gnash our teeth, and then put something in our mouths. Sooner or later, ways to cope with the stressful situation are generated (i.e., the plane departs), and we no longer feel the need to use food as an emotional pain reliever.
There are some stressful situations so prolonged that even the memory of them can provoke overeating for many weeks, even months, after the stress is over. I recently visited with S, a friend whom I do not see often because we don’t live in the same city, and we hadn’t seen each other in over a year. I was shocked by how much weight she gained. Never thin during the time I knew her, she was now morbidly obese, and my plans for us to walk a few blocks to a restaurant were dropped because she couldn’t walk more than a few feet. Catching up with each other’s news, I waited to hear about some stressful situation that might explain her weight gain, but there was none. She had recently retired, but was actively developing a non-profit enterprise she had long dreamed of. Friends, financial situation, and family were all fine, according to her account of the past year.
So why the weight gain? She had told me many times that she ate out of stress, but there was no obvious recent stress to explain her adding at least 40 pounds to her frame over the past 12 or so months.
Later on, as we reminisced about her past job, the reason for her overeating became clear. She had taken on a project no one else in her company wanted to try, due to high risk of failure. She succeeded by tirelessly working, getting no more than 3 hours of sleep a night for months on end. Indeed, she had time for nothing else except work, and once told me that she caught herself dozing while standing up and another time, leaving for work, she’d forgotten to put a skirt on over her slip.
This was no recent event, the project was completed successfully at least five years earlier, but the emotion with which she described her work was as intense, as if she had finished it a few days before our lunch. She told me over and over again how hard she worked, how many more hours she clocked than her staff did, how her meals were eaten at the company cafeteria, and at night these meals were supplemented by snacks from the vending machines.
“I had time for nothing else but work. Nothing…” she recounted.
Now it seemed as though leaving work, this company that demanded so much from her, was causing a delayed stress response. Perhaps the overeating and subsequent weight gain was her way of coping with the stress from that time. Certainly she must have experienced not only intense fatigue, but also the fear that her coworkers were right and the project could nor would not succeed.
S is so obese that some type of bariatric surgery may be suggested to her as a way of bringing her weight to a manageable level. Certainly her inability to walk because of shortness of breath was very worrisome. Yet should she opt for such a procedure, or any other weight-loss intervention, it was doubtful that she or her medical/nutrition team would recognize the reason for her substantial weight gain. Nor is it likely that S would reveal the reason for her ballooning into morbid obesity, as she probably is unaware of it. And yet will she be able to keep her weight off unless she recognizes the reasons it was gained?
Overeating in response to a delayed stress reaction may be common, but it’s often unrecognized. Many times a physician will ask about previous stress in trying to understand why a new medical problem has arisen. The stressful event may have occurred months ago, but the aftermath may show itself in rashes or insomnia or mysterious aches and pains. The physician is probably less likely to look at someone who has gained a great deal of weight recently to ask about past stressful events. And to be fair, the patient may not be able to make the connection, either.
Stress may be close to the top of a long list of reasons why people gain/lose/regain weight, or can’t lose it at all. If it is ignored or underestimated in developing an effective weight loss intervention, then the probability of long-term weight loss success is diminished. The dieter might be better served by focusing on the emotions behind the overeating before being treated for the overeating, or at least at the same time. It may take longer to deal with the psychological aspects of weight gain, and required weight loss, as other than the physical, but doing so will guarantee a better long-term outcome.