By Dr. Tro Kalayjian
While very few physicians have embraced remote monitoring, our practice has been thriving on the use of remotely monitoring patient biometric data. In our clinic, almost all of our patients have smart equipment in their homes which wirelessly sync with our practice.
We monitor body weight, fat mass, water weight, muscle mass, blood pressure, heart rate, heart rate regularity, and blood sugar—all remotely. The patient can remain in the comfort of their own home and data is wirelessly and securely submitted to our practice in real-time. This data is analyzed by me and my staff, and we use this data to help encourage our patients who are doing well in their journeys, but also it has helped us identify patterns that predict weight regain and has given our practice the unique ability to reach out to our patients in real-time to intervene, increase contact, and lend a helping hand when times are tough. In our practice, gone are the days when you see your physician six months later, after regaining 20 pounds.
Our patients have opened their homes and their lives to our monitoring and in turn, we are providing support and guidance when they need it most. Interestingly, upon analysis of our weight regain data we came across an interesting fact… the overwhelming majority of weight regain in our practice is due to… STRESS!
Whether physiologic or excessive, emotional/mental or physical, stress works in a number of ways to cause weight gain. And in our practice, we have found that its main mechanism is through increased hormonal hunger.
Stress sabotages patients first by causing massive shifts in their blood glucose, and this happens through several mechanisms, and I’ll explain why that’s important later, but first let’s walk through the science. Stress causes a decrease in insulin sensitivity in an effort to mobilize energy and make it available in case you need it for “fight or flight.”
Stress also increases glucagon, which increases glucose production via glycogenolysis and increased gluconeogenesis. Stress also increases epinephrine which increases delivery of gluconeogenic substrates from the periphery to the liver where it’s used to increase your glucose further. Epinephrine also decreases glucose utilization by peripheral tissues and decreases insulin secretion, worsening insulin sensitivity. And finally, stress increases cortisol and growth hormone, which further decreases the ability of tissues to use glucose and it further increases hepatic glucose production.
You may be thinking, all this science is interesting but what does it all mean? Let’s bring this down to a clinical level… Stress causes massive shifts in your blood sugars and decreases your body’s ability to control blood sugar. The drop in blood sugar after these wide swings will cause increased hunger by specifically acting on the reward centers of the brain. So even though you may have just eaten a massive meal, if you are experiencing a large drop in blood sugar, like those created during acute stress, you may find yourself hungry again.
Stress also causes a relative decrease in executive functioning—it LITERALLY creates a willpower deficiency. Even mild stress can cause a loss of prefrontal cognitive abilities, while more chronic stress causes actual architectural changes in the brain, making it harder for you to control the INCREASED urges for rewarding foods CAUSED by the stress. So not only does stress make you more hormonally hungry via insulin resistance and glycemic excursions, it also decreases your ability to resist your desire for super-rewarding hyperpalatable foods.
It’s a perfect storm. And once you eat that super-rewarding hyperpalatable food in your state of insulin resistance, this will lead to further glycemic excursions which leads to further uncontrolled hunger. Welcome to a state of always being hungry.
Bottom line: stress will make you more hungry. It will make the hormonal impact of crap food more pronounced and leads to a cycle of constant hunger. The basic strategy we tell our patients is to focus their hunger on foods that will satiate them, like meat, fish, poultry, eggs, green leafy vegetables and low carb fruit. We stop focusing on weight loss during stressful events and we focus instead on maintaining a state of satiety until the stress passes or eases up.
Dr. Tro Kalayjian is a physician who is board certified in Obesity Medicine and Internal Medicine. Dr. Tro’s Medical Weight Loss & Direct Primary Care is Rockland and Bergen County’s premier medical weight loss facility, with a focus on helping patients make drastic changes through lifestyle interventions. Visit www.doctortro.com/appointments/ or call 845-397-CURE to make an appointment.