Rising Obesity: Could Stress Matter More Than Food?

The Worry“I would argue that chronic stress may be the single most common cause of obesity in modern society – even more common than food.” With these words at the opening of Obesity Treatment 2022, Lee Kaplan suggested that we should think about the possibility that we’re looking in the wrong places for the root cause of four decades of rising obesity. Virtually all efforts have gone into figuring out how “big food” has done this to us. Is it too much fat, sugar, and salt? Or maybe ultra-processed food?

The Common Thread of Rising Stress

Stress can play a major role in the development of obesity simply because it disrupts the normal physiological regulation of body fat mass, said Kaplan. Food is part of the process, but not the factor that instigates weight gain. It’s merely a tool to promote it. The source of weight gain in this scenario is the disruption of physiologic systems regulating fat mass.

In discussing this possibility, Fatima Cody Stanford pointed out that weight gain during the pandemic was initially ascribed to a possible reduction in physical activity. But many later studies painted a different picture, she said. Again, this lines up with the possibility that it may be chronic stress during the pandemic that can account for weight gain. What we eat and how we move might merely be a response to the stress.

In a recent review of research on this topic, Janet Tomiyama focuses on three mechanisms through which chronic stress causes obesity: cognitive, behavioral, and physiologic. She suggests that the bias to focus entirely on behaviors of eating and movement may be a serious mistake:

“Current obesity prevention efforts focus solely on eating and exercise; the evidence reviewed in this article points to stress as an important but currently overlooked public policy target.”

The Streetlight Effect

So it may well be that chronic stress is at least as important as food and exercise in the rise of obesity. This is a classic example of the streetlight effect. We have a bias to look for answers in the places that are most obvious or convenient – like an intoxicated person looking for his keys under a streetlight because that’s where the light is. Even though the keys were lost somewhere else.

Are we stuck on assuming that the food supply is the cause of all our problems with obesity? Perhaps this bias might explain why food policy has done so little to blunt the rise in obesity prevalence.

Click here for Tomiyama’s review of the relationship between chronic stress and obesity.

The Worry, etching by Theodor Aman / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


June 27, 2022

6 Responses to “Rising Obesity: Could Stress Matter More Than Food?”

  1. June 27, 2022 at 6:01 am, Al Lewis said:

    Hmmm…I would say that people have been stressed throughout history. We can’t imagine the stress of not knowing whether you will survive childbirth, or even feed your family on wages from the stockyard.

    Obesity is multifactorial, but one factor that doesn’t get enough attention is that the price per calorie of low-quality foods has been falling for decades in real terms. So like anything alese where prices decline, consumption increases.

  2. June 27, 2022 at 6:27 am, Mary-Jo said:

    Weight stigma and bias, little access to care, lack of insurance coverage, even subsidies for effective care are all factors, of themselves, that contribute to the occurrence of obesity. But what they also contribute to greatly is stress! In my mind, food is not really an outright stressor. Lack of food can be stressful and there’s even studies that show an association with food insecurity and obesity. It’s very hard to manage the food supply, but the the first factors I mention above can be managed so that regardless of food supply in quantity, quality, ‘healthy’ vs. ‘unhealthy’, if people with obesity get the care and support needed to treat and best manage their disease, it will collaterally decrease stress, hopefully, improving successful outcomes even more!

  3. June 27, 2022 at 7:34 am, Allen Browne said:

    Yup! As you say we may be looking under the wrong street light or perhaps we need to look beyond the street light. Certainly efforts with eating less and exercising more over the past 50 years would suggest that. We need to be objective in our analysis of results and creative/open minded as we look for ways to help people with the disease of obesity.

  4. June 27, 2022 at 8:26 am, John DiTraglia said:

    I agree with your conjecture more than Lee Kaplan’s.

  5. June 27, 2022 at 9:44 am, Angie Golden said:

    As always Dr. Kaplan opens conversations!! Thank you for giving us his thoughts. I believe the thought of another important area to assist patients is my take home for this. Not stress VS food but providing another area to work on. I have been using stress reduction techniques because of cortisol being obesigenic but now with the major voice of Dr. Kaplan we will likely see more attention to this important factor.

    • June 27, 2022 at 10:22 am, Ted said:

      You’re right. It’s so many factors that are triggering the rise in obesity. Environmental Drivers of Obesity