We frequently converse of weight as a matter of simple arithmetic—energy in, energy out. However the physique doesn’t work like an equation when it’s grieving or underneath continual stress. It behaves extra like a survivor, clinging tightly to sources within the face of perceived hazard. And in that physiological equation, cortisol—our main stress hormone—performs a central position.
The cortisol connection
Cortisol is launched by the adrenal glands in response to emphasize by means of activation of the hypothalamic-pituitary-adrenal (HPA) axis. Below acute stress, this response is adaptive. However with continual psychological stress, particularly following vital life occasions, cortisol stays elevated—and that shift modifications all the pieces.
Based on a 2021 evaluate printed in Weight problems Opinions, extended cortisol elevation is related to elevated stomach adiposity, altered glucose metabolism, and a disrupted urge for food signaling system, notably within the hypothalamus. A examine in Psychoneuroendocrinology discovered that people with greater continual stress and elevated cortisol ranges skilled higher issue with weight reduction, even when following a caloric deficit.
Put merely: Your physique doesn’t know the distinction between grief and famine. It simply is aware of one thing is mistaken. And in response, it holds on to fats as a organic insurance coverage coverage.
GLP-1s aren’t magic—particularly when stress persists.
GLP-1 receptor agonists like semaglutide and tirzepatide have proven spectacular ends in many sufferers. However their efficacy nonetheless is determined by the underlying hormonal atmosphere.
A 2023 article in The Journal of Scientific Endocrinology & Metabolism famous that continual elevations in cortisol could attenuate the appetite-suppressing results of GLP-1s, and may additionally have an effect on insulin sensitivity, compounding the metabolic challenges in confused people. This may clarify why some sufferers—notably these underneath duress—reply much less robustly to medicines that appear virtually miraculous for others.
Managing cortisol in a weight-obsessed world
Whereas we are able to’t get rid of life stressors—particularly the monumental ones like grief—we are able to modulate how our our bodies reply to them. Analysis helps a number of non-pharmacologic methods for regulating cortisol ranges: constant sleep, mindfulness-based practices, trauma-informed remedy, light motion like yoga or strolling, and even structured social connection. A 2020 meta-analysis in Well being Psychology Evaluate discovered that people who engaged in common mindfulness or stress-reduction interventions had considerably decrease cortisol ranges and improved metabolic markers. Importantly, these approaches aren’t about speedy weight reduction—they’re about restoring stability to an endocrine system that’s been hijacked by continual alarm. For sufferers like me, and possibly like yours, the actual work isn’t about punishing the physique for gaining weight—it’s about serving to it really feel protected sufficient to let it go.
The set level principle and life after loss
There’s additionally the query of set level principle—the concept that the physique “defends” a selected weight vary, adjusting starvation and vitality expenditure to maintain you there. Traumatic occasions, extended stress, and even medicines like corticosteroids can shift that set level upward. As soon as that occurs, returning to a earlier weight turns into biologically more durable, not simply psychologically more durable.
After my sister died, I gained 30 kilos in simply 4 months. At first, I didn’t battle it. I used to be grieving, exhausted, and emotionally uncooked. Meals introduced temporary moments of consolation in a season the place consolation was in any other case exhausting to seek out. However ultimately, I attempted to show it round. I cleaned up my weight loss program. I returned to train. I even started a GLP-1 receptor agonist, hoping it’d jump-start what felt like a stalled metabolism. That was three months in the past. I haven’t misplaced a single pound.
It’s potential, based mostly on rising proof, that grief itself could also be a set point-altering occasion. The loss rewires your sleep, your urge for food, your intestine microbiome, and your endocrine system. That’s not a willpower downside. That’s a whole-body recalibration.
A distinct form of compassion
Weight regulation is commonly framed as a easy matter of self-discipline or willpower, however this overlooks the complicated interaction between stress physiology, neuroendocrine response, and emotional burden. When a affected person says they’ll’t drop some weight, it might mirror greater than way of life habits—it might point out a physique responding appropriately to continual stress or unresolved grief. Slightly than defaulting to assumptions, clinicians ought to contemplate the chance that weight acquire is, at instances, a physiological protection—a sign of dysregulation, not indulgence. Understanding this distinction can shift the medical method from correction to help.
Sarah White is a nurse practitioner, small enterprise proprietor, and premedical scholar based mostly in Virginia. With a background in medical observe and caregiving, she brings a singular perspective to the intersection of medication, household life, and neighborhood service. She volunteers with the Medical Reserve Corps and is making ready to use to medical college in 2026.
Sarah can also be the founding father of two rising ventures: Wrinkle Relaxer, the place she focuses on aesthetic remedies, and Bardot Boutique Aesthetics, an area for curated magnificence and wellness companies.
