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SLEEP, STRESS, and SCRIPTSWhat’s Holding Back Your

Weight Loss?Holly F. Lofton, MD

Assistant Professor of Surgery and MedicineNYU Langone Medical Center

OBJECTIVES Discuss role of sleep deprivation on hunger/ weight

Define important weight related hormones

Discuss role of stress on fat storage

Review medications that typically cause weight gain

Present options to help combat weight gain related to sleep deprivation, stress, and medications

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Sleep and Weight Management

HOW TO GET A GOOD NIGHT’S SLEEP INFANTS 3-11 months 14 - 15 hours

TODDLERS 12 -14 hours

PRE-SCHOOLERS 11 - 13 hours

SCHOOL - AGED CHILDREN 10 - 11 hours

ADOLESCENTS 9 HOURS

ADULTS 7 - 9 HOURS

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Columbia University Study

GHRELIN- “hungry hormone”

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LEPTIN- “not hungry hormone”

LEPTIN and GHRELIN

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Hormonal Effects of Sleep Deprivation

Decreased Insulin Sensitivity Increased abdominal fat storage

Decreased Leptin Release from Fat Cells Increased Hunger Increased Food Intake

WEIGHT GAINJosiane L. Broussard, David A. Ehrmann, Eve Van Cauter, Esra Tasali, Matthew J. Brady;

Impaired Insulin Signaling in Human Adipocytes After Experimental Sleep Restriction A Randomized, Crossover Study. Annals of Internal Medicine. 2012 Oct;157(8):549-557.

Medical Study

Short sleep duration appears to be independently associated with weight gain, particularly in

younger age groups

There is a positive association between short sleep duration and future weight gain. This

relationship appears to wane with agePatel, SR and Hu, FB (2008). Short Sleep Duration and Weight: A Systematic Review. Obesity, 16:643-653.

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HOW TO GET A GOOD NIGHT’S SLEEP

INFANTS 3-11 months 14 - 15 hours

TODDLERS 12 -14 hours

PRE-SCHOOLERS 11 - 13 hours

SCHOOL - AGED CHILDREN 10 - 11 hours

ADOLESCENTS 9 HOURS

ADULTS 7 - 9 HOURS

GHRELIN

LEPTIN

SLEEP DEPRIVATION

SLEEP HYGIENE

Avoid daytime naps

Same sleep/ wake times every day

Avoid vigorous activity, caffeine, nicotine, alcohol, stimulants near bedtime

Small evening meals, snacks

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SLEEP HYGIENE Shift Workers: Maintain Circadian Rhythm – light exposure in

“daytime” and close blinds 2 hours before bed

Avoid eating, reading, watching TV, etc in bed

Comfortable, quiet sleep environment

TAKE HOME POINTSleeping less than 7 hours for even 1 night can cause:

unfavorable hormonal balance increased hunger fat deposition in organs insulin resistance cravings for high calorie foods

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Medications That May Cause Weight Gain

Psychotropic medications• Some SSRIs (paroxetine, mirtazapine)• Tricyclic antidepressants – “triptylines”• Atypical antipsychotics (olanzapine, risperidone, clozapine)• Lithium

Diabetes medications• Thiazolidinediones (eg. pioglitazone) –actos, avandia• Sulfonylureas – glyburide, glipizide• Insulin

Hormonals/contraception/steroids• Estrogen• Progesterone (eg depot progesterone preparations)• Prednisone

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Medications That May Cause Weight Gain

Migraine prophylaxis• Tricyclic antidepressants – “ -triptylines”• Beta blockers - metoprolol

Antihypertensives• Beta blockers - metoprolol

Neuropathic analgesics• Gabapentin*• Tricyclic antidepressants• Pregabalin

Antiepileptics• Gabapentin - neurontin• Valproic acid - depakote• Carbamazepine - tegretol

ELIMINATE UNNECESSARY CALORIES

3500 calories =1 lb

Extra 100 calories per day over 1 year

10 lb weight gain

4 Hershey’s Kisses2 tablespoons regular cream cheese5 tablespoons liquid non-dairy creamer5 Plain hard pretzels (2 oz.)

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200 CALORIES

MEDICATIONS Topiramate has been shown, in some studies, to

reduce appetite and limit weight gain (particularly weight gain associated with atypical antipsychotics)

Metformin is being studied to see if it may reduce weight gain and/or the risk of developing diabetes associated with some psychiatric medications

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TAKE HOME POINT

Be proactive in weight management when on certain medications

Focus on low calorie density foods, regular exercise

Minimize duration of therapy

ACTION PLANConsult with dietician or physician

weight management specialist

Monitor response to medication to minimize duration of therapy

Consider weight-neutral alternatives

Regular exercise

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Stress and Cortisol

What Is Cortisol? Steroid hormone secreted by the adrenal

gland in response to stress and in normal circumstances

Increases blood glucose (sugar) by increasing glucose production in the organs

Suppresses immune function Enhances lipogenesis (fat production)

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Stress and CortisolAnger Anxiety

CORTISOL

Fright Stress

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Cortisol (Stress) ResponseBody needs to refuel in response to “threat”

Increased desire for carbohydrates and fats STRESS EATING

Moves fat to deposits in the abdomen

Medical Study 7965 British civil servants

Measured work stress and BMI at baseline and 5 years later

Men with BMI< 22 stress associated with WEIGHT LOSS

Men with BMI >27, stress associated with WEIGHT GAIN

Kivimaki, M, et al. Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. Intl Journal of Obesity (2006) 30, 982-987.

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Medical Study

Women with mostly abdominal obesity produce especially large amounts of cortisol when faced with a difficult task AND consumed more calories

afterwards

Epel, ES Stress and Body Shape: Stress induced cortisol secretion is consistently greater among women with central fat. Psychosomatic Medicine. 2000. 62: 623-632

Medical Study

Subjects prone to binge eating have higher cortisol levels upon

awakening and after a physically stressful task

Gluck, ME et al. Cortisol stress response is positively correlated with central obesity in obese women with binge eating disorder (BED) before and after the cognitive behavioral treatment. Annals of the New York Academy of Sciences. Dec 2004.1032: 202-207.

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Battling Stress-Related Weight Gain 30 – 90 minutes exercise

Relaxation Exercises

Yoga/ Meditation

Cognitive Behavioral Therapist

Battling Stress-Related Weight Gain Ask yourself “Am I truly hungry?”

Keep comfort foods out of home/ office

Don’t skip meals

Record mood and eating habits and develop coping skills

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Battling Stress-Related Weight Gain

Claims of cortisol-reducing supplements have NOT been substantiated with medically

sound evidence

Exercise is the best method to reduce cortisol levels in response to stress AND burns

calories

Overeating may lead to temporary satisfaction

Staying healthy is the ultimate victory over

stress

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TAKE HOME POINT

Stressful circumstances cause increased cortisol secretion and, thus, increased

fat production and cravings

This can be overcome with stress management techniques

SUMMARYSleeping less than 7 hours a night for as few as 1 night can cause unfavorable regulation of leptin/

ghrelin and lead to : hunger, fat deposition in organs, insulin resistance, and cravings for high

calorie foods

Some prescription medication leave the user prone to weight gain. If these are necessary, being proactive to minimize weight gain is

essential

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SUMMARYEmotional and physical stress can cause elevations

in cortisol that trigger abdominal fat deposition and stress eating

Healthy amounts of sleep, exercise, stress management skills as well as a carefully planned

diet can help combat weight gain related to hormonal factors

THANK YOU

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