Can anxiety make you fat? The answer is an emphatic “Yes.” If someone finds it hard to accept this assertion, it may be because it’s hard to grasp how anything that seems to be occurring in the mind could make an apparently unrelated something happen in the body.

The best way to understand the process by which anxiety is translated into excess weight is to visualize the body as a continuing messaging system whose complexity dwarfs the distribution systems of Amazon and UPS put together. While you are feeling a mental state you call “anxiety,” your body is undergoing a complex set of processes known as “stress,” or “the stress response.” The stress response calls forth an outpouring of a dazzling array of hormones (norepinephrine, cortisol, dopamine, and others), but for the purposes of this brief piece let’s focus first on cortisol, the single hormone within the stress response that is primarily responsible for fat formation.

Before he developed the South Beach Diet, Dr. Arthur Agatston, a cardiologist, noticed that many of his obese cardiology patients at risk for developing type 2 diabetes displayed what is called “metabolic syndrome,” a condition with three well-recognized symptoms: “central obesity” (i.e., belly fat); “insulin resistance”; and “reactive hypoglycemia.” What Dr. Agatston discovered in 2003 has since been reinforced by Dallas and Melissa Hartwig in their admirably rigorous 2012 book, It Starts with Food. According to the Hartwigs, chronic elevated cortisol levels are responsible for doing the following three things: increasing blood-sugar levels by impairing glucose uptake from the bloodstream; contributing to insulin resistance; and “preferentially direct[ing] body fat to the abdominal region.” All of the major markers for metabolic syndrome, and thus fat formation, are right there, courtesy of chronic elevated levels of cortisol.

And while we’re on the word “chronic,” if you are a chronically stressed-out individual, most of the stress you are undergoing on a daily basis may have retreated below your conscious awareness. If you are suffering from chronic stress, you may not be the only one blind to it; your doctor (probably also a chronically stressed-out person) may not even see that your problem is related to stress, since in this culture we define stress as “business as usual.”

When in a recent New York Times column titled “What Cookies and Meth Have in Common,” Dr. Richard A. Friedman wrote, “Now we have a body of research that makes the connection between stress and addiction definitive,” what did he mean, exactly? To figure it out we must turn to the neurohormone dopamine. Stress also causes the release of dopamine from the brain’s limbic system; this dopamine then binds to specific receptors in the brain. When the body is undergoing large amounts of stress, or undergoing it too often (which according to Dr. Friedman can occur simply from eating excessively fatty or sugary food), correspondingly large amounts of dopamine are released. However, these larger-than-normal releases of dopamine paradoxically cause the body to damp down the number and effectiveness of its existing dopamine receptors. This process is a capsule summary of addiction of all types, and any type: a stressful event is experienced by the body, which causes a large release of dopamine, which release eventually causes a reduction in receptors, which then leads to withdrawal symptoms once the first flood of dopamine has subsided and the body feels its loss. The constant and unending (but ultimately futile) search for more gratification from addictive substances is the essence of how addiction works, and what it is all about.

Let’s be crystal clear: with compulsive (i.e., addictive) eating, food functions not as nourishment but as a narcotic, a substance capable of instilling an artificial feeling of calm and serving to keep unwelcome thoughts out of awareness.

My own experience with this basic truth was instructive. When my husband died nearly four years ago, I found my eating spiraling out of control. Because I was eating too much, I was gaining weight steadily, so I therefore faced a life of widowhood in which I would continually get fatter and fatter, which I certainly didn’t want. But I also didn’t know what to do: I could think of no way on earth to bring my eating under control. Suddenly one day I said to myself, “Wait a minute! You’ve already written a book on this subject!” At that moment I realized for the first time that the function of my excessive eating at this particular point in my life was to keep my grief-stricken thoughts out of consciousness (the food-as-narcotic connection).

I understood that if I wanted this unhealthy pattern to stop I had to be willing to eliminate the foods that I had been having constant cravings for, so right away I cut out all wheat, sugar, and dairy from my diet. (I also included chocolate among the foods to be eliminated, but it had already been eliminated under the category of “sugar”.)


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