Presentation seminar in nutrition- stress, malnutrition and comfort food-LAST draft

Done by: Stephanie Nehme

Tutor: Ms. Zeina Nakat

“Stress, Malnutrition and Comfort Food”

Outline

I. Stress-induced overeating in today’s world

II. Types of stressors and their physiological responses

III. Causes and consequences of stress-induced overeating

IV. Human studies, results and analysisV. Preventions,

recommendations and solutions

VI. Conclusion

I. The Thrifty Gene Hypothesis• During evolution: a set of genes linked with fat storage has

been selected to ensure survival in environments with limited food supply.

• Contemporary environments: modernization and unlimited food availability promote a sedentary lifestyle and overeating.

The thrifty genes are still activated to increase energy storage for a different reason:

Psychosocial stress is a new feature of modern societies.

Increased prevalence of obesity.

Siervo , Wells, and Cizza, “The Contribution of Psychosocial

Stress to the Obesity Epidemic: An Evolutionary Approach”, 2009

I. Malnutrition During Stressful Periods

20% do not change their eating habits

80% change their eating habits

> 40% increase caloric intake

< 40% decrease caloric intake

Those who are at the upper range of

normal, are overweight, or are restrained eaters

Those who are of normal- or

underweight

The difference between the weight gainers and losers might be a consequence of higher insulin concentrations in people with higher body mass index.

Dallman ,"Stress-induced obesity and the emotional nervous system“, 2009

I. A Shift in Food Intake toward ‘Comfort Foods’

Stress typically favors those foods with increased fat and/or sugar content.

Dallman, "Stress-induced obesity and the emotional nervous system“, 2009

II. Types of Stressors

The following stressors can induce a stress response:

• Physical stressors • Chemical stressors• Physiologic stressors • Psychological or emotional stressors • Social stressors

Stressors can be short term (acute stress) or occur on daily basis (chronic stress).

Torres & Nowson, "Relationship between stress, eating behavior, and obesity“, 2007

II. Physiological Responses to StressorsHypothalamus–Pituitary–Adrenal (HPA) Axis

Adam & Epel, "Stress, eating and the reward system“, 2007

II. Physiological Responses to Stressors

Two of Cortisol's Primary Functions in the Body are:- Increasing blood sugar through gluconeogenesis- Aiding in fat, protein, and carbohydrate metabolism

Cortisol Counteracts Insulin by: - Contributing to hyperglycemia- Inhibiting the peripheral utilization of glucose = insulin

resistance further lipid accumulation Vicious circle:

III. The Causes of Stress-Induced Overeating Calorically-dense food intake:

High stress reactivity

Increase in cortisol

Greater intake of calories

Decrease the feeling of stress

Reinforcing subsequent eating of comfort food


III. The Consequences of Stress-Induced Overeating

Visceral Fat Accumulation:EXCESS [CORTISOL] visceral fat accumulationWhy? 1- glucocorticoid metabolism due to receptor density in intra-abdominal adipose tissue compared to other regions2- physiological [cortisol] whole body lipolysisHowever: Cortisol + INSULIN lipid mobilization and lipid accumulation


IV. Human Studies, Results and Analysis

First Study:“Stress and Food Choice: A Laboratory Study”:

• Aim: To investigate experimentally whether acute stress alters food choices during a meal.

• Design: 68 healthy, non obese, non smoking volunteers (27 men and 41 women).

• Methodology: Anticipation of a speech performance (of 4-minutes) was used as the stressor for the students, after which they were provided with a buffet lunch in the laboratory.

Oliver , Wardle, & Gibson , ”Stress and Food Choice: A Laboratory Study”, 2000


First Study:“Stress and Food Choice: A Laboratory Study” (cont’):

•Results: No evidence of a hypophagic stress response on

men nor a hyperphagic stress response on womenStress did increase intake of sweet and/or fatty

foods in emotional eatersWomen scored more highly on emotional eating

than men, as is typically foundThere is evidence that snack consumption may be

more susceptible to stress than meals

Oliver , Wardle, & Gibson , ”Stress and Food Choice: A Laboratory Study”, 2000


Second Study:“Food Selection Changes Under Stress”:Experiment I:• Aim: To stress whether stressed females subjects will eat

more of the foods normally avoided compared to unstressed female subjects

• Design: Two groups of female subjects (total # 34), one stressed and one control

•Methodology: Ten solvable or ten unsolvable five-letter anagramsSnack foods were providedRestrained scale questionnaire

Zellner, Loaiza, Gonzalez, Pita, Morales, Pecora, Wolf, “Food selection changes under stress”, 2006


Second Study:“Food Selection Changes Under Stress” (cont’):

Experiment I RESULTS:

Stressed subjects ate more of the unhealthy high-caloric sweet choice and less of the healthy sweet choice than did the unstressed subjects

No difference in intake of the salty snacks was observed because: women preferred the sweet foods to the salty ones or both salty snacks were high in fat.




Experiment II:• Aim: To investigate the proportion of restrained eaters.

• Design: 169 undergraduate student volunteers (128 females, 41 males).

• Methodology: “The Eating-When-Stressed Questionnaire” was administered to subjects to find out about their eating behavior under stress.




Experiment II RESULTS: Women (46%) > Men (17%) when

stressedMost people who report overeating

when stressed were restrained eaters (71%) (women (75%) > men (43%))

Restrained eaters exhibit disinhibition of their diet and eat foods they normally avoid: high calorie “junk food” (it made them feel better or because they tasted good).



Third Study:“Perceived Stress, Depression and Food Consumption Frequency in the College Students of China Seven Cities”:• Aim: To evaluate the association between perceived stress,

depression and food consumption frequency• Design: Cross-sectional data used from China Seven City Study

survey. Of the 2579 college students, 98.5% provided consents• Methodology: Depression scale, perceived stress scale and FFQ

Liu, Xie, Chou, Koprowski, Zhou, Palmer, Sun, Guo, Duan, and Sun, Johnson, “Perceived stress, depression and food consumption frequency in the college students of China seven cities”, 2007


Third Study: “Perceived Stress, Depression and Food Consumption Frequency in the College Students of China Seven Cities” (cont’):

• Results: Negative correlation of frequency of fresh fruit consumption with perceived stressPositive correlation of frequency of ready-to-eat food and snack food consumption with perceived stress

Liu, Xie, Chou, Koprowski, Zhou, Palmer, Sun, Guo, Duan, and Sun, Johnson, “Perceived stress, depression and food consumption frequency in the college students of China seven cities”, 2007


Fourth Study: “Are Stress Eaters at Risk for the Metabolic Syndrome?”• Aim: To examine the effects of self-reported stress-eating

tendencies (more-eaters vs. less-eaters) on changes in cortisol, insulin, adiposity, and lipid levels as well as food intake from baseline to exam periods

• Design: - Population: 131 medical students (55% women, 45% male).- Duration: two exam periods over 1 year.• Methodology: Students were asked to report stress-eating

tendencies and were assessed on body mass index (BMI), waist-to-hip ratio (WHR), nocturnal urinary cortisol, and insulin Epel, Jimenez, Brownell, Stroud, Stoney, and Niaura, “Are Stress Eaters at

Risk for the Metabolic Syndrome?“, 2004


Fourth Study: “Are Stress Eaters at Risk for the Metabolic Syndrome?” (cont’)

• Results:

Increased weight, BMI, nocturnal cortisol and insulin, and lipid profile (total/HDL cholesterol ration) during exam periods in more-eaters compared to less-eaters Metabolic Syndrome

Increased WHR in more-eaters but only among women

Epel, Jimenez, Brownell, Stroud, Stoney, and Niaura, “Are Stress Eaters at Risk for the Metabolic Syndrome?“, 2004


General Analysis of the Studies:

- Relation between stress, cortisol/insulin and overeating of comfort food is proven

- Personality characteristics play a role: stress more-eaters vs. stress less-eaters vs. stress no-change eaters

- Emotional eaters or restrained eaters are more prone to stress-induced eating of foods that are usually avoided

- Women are more affected than men- Metabolic Syndrome can be the result

V. Preventions, Recommendations and Solutions

1) Counseling:

A. Changing Eating Behavior: ABC Framework:

Antecedents (stimuli or cues)Behavior (response itself or eating)Consequences (reinforcement or reward) of the behavior

• The dietetic professional and the client must find ways to regulate the ABC Framework by:

Analysis of ANTECEDENTS to control or limit them Exploration of the eating BEHAVIOR Efforts are made to arrange CONSEQUENCES that will maintain

desirable behaviors.Holli, Calabrese, & Maillet, "Communication and education skills for dietetics professionals"


B. Cognitions: Cognitive events are conscious thoughts that occur in a person’s

stream of consciousness This self- talk can be (+), (-) , or neutral

• Cognitive distortions: The (-) thoughts that inhibit behavioral change

• Cognitive Restructuring:- Techniques involved with modifying the client’s thinking and the assumptions and attitudes underlying these cognitions - The focus is on the false thoughts and deductions

Holli, Calabrese, Maillet, "Communication and education skills for dietetics professionals"


• Phases of Cognitive Behavior Modification:

Help the client to:

The first phase: Understand the nature of the problem.

The second phase: Explore the cognitive problem and find a solution to disrupt the negative self-talk.

The third phase: Make actual change

+ follow up with the counselor is crucial for long-term modification.

Holli B. B., Calabrese R. J., Maillet. J. O., "Communication and education skills for dietetics professionals"


2) Physical Activity:

• Affects directly the modulation of the stress response • Improves insulin sensitivity• Enhances oxidative capacity of skeletal muscle• Improves psychological well-being and self-confidence

(serotonin)• Improves sleep patterns• Influences health-related behaviors (e.g. nutrition)• Helps coping with life’s stresses, particularly among high-risk

individuals. Chaput, Klingenberg, Rosenkilde, Gilbert, Tremblay, and Sj¨odin "Physical Activity

Plays an Important Role in Body Weight Regulation“, 2010

VI. Conclusion

YES!

OK sometimes, but always: NO

Or else

VS

Q&A

Thank you

ReferencesArticles:• Adam T. C., Epel E. S. (2007). Stress, eating and the reward system. 449–458. University of California, San

Francisco, Department of Psychiatry, United States.• Chaput J., Klingenberg L., Rosenkilde M., Gilbert J., Tremblay A., and Sj¨odin A. (2010). Physical Activity Plays an

Important Role in Body Weight Regulation. 1-11.• Dallman M. F. (2009). Stress-induced obesity and the emotional nervous system. 159-165.• Epel E., Jimenez S., Brownell K., Stroud L., Stoney C., and Niaura R. (2004). Are Stress Eaters at Risk for the

Metabolic Syndrome? 208-210. • Liu C., Xie B., Chou C., Koprowski C., Zhou D., Palmer P., Sun P., Guo Q., Duan L., and Sun X., Johnson D. (2007).

Perceived stress, depression and food consumption frequency in the college students of China seven cities. 748-754.

• Oliver G., Wardle J., and Gibson L. (2000). Stress and Food Choice: A Laboratory Study. 853- 865. • Siervo M., Wells J. C. K., and Cizza G. (2009). The Contribution of Psychosocial Stress to the Obesity Epidemic: An

Evolutionary Approach. 761-770.• Torres J. T., Nowson C. A. (2007). Relationship between stress, eating behavior, and obesity. 887–894. • Zellner D. A., Loaiza S., ZGonzalez Z., Pita J., Morales J., Pecora D., Wolf A. (2006). Food selection changes under

stress. 789–793.

Book:• Holli B. B., Calabrese R. J., Maillet. J. O. Communication and education skills for dietetics professionals. 1-379;

Fourth Edition.

Site: www.wikepidia.org

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Presentation seminar in nutrition- stress, malnutrition and comfort food-LAST draft