Chronic distress contributes to the development of obesity and comorbid
states. Stress is the disturbance of the complex dynamic equilibrium
that all organisms must maintain, and is associated with activation of
the Stress system comprising of the hypothalamic-pituitary-adrenal axis
and the arousal/sympathetic nervous systems. The stress system functions
in a baseline circadian fashion and interacts with other systems of the
organism to regulate a variety of behavioral, endocrine, metabolic,
immune and cardiovascular functions. The experience of perceived or real
uncontrollable intense and/or chronic stress (distress) may lead to
several psychopathologic conditions, including anxiety, depressive and
psychosomatic disorders, substance abuse, obesity and the metabolic
syndrome, and osteoporosis, as well as impaired reproductive and immune
functions. Developing children and adolescents are particularly
vulnerable to the effects of chronic stress. Both behavioral and
biological pathways are involved in the connection between chronic
stress and obesity in adults and children. Emotional “comfort”
eating, lack of sleep, impulsive behaviours and selection of specific
foods often characterize stressed individuals. In addition to specific
behaviours, dysregulation of the stress system through increased
secretion of cortisol and catecholamines, especially in the evening
hours, and in concert with concurrently elevated insulin concentrations,
leads to development of central obesity, insulin resistance and the
metabolic syndrome. In children, chronic alterations in cortisol
secretion may have additional effects on cognitive and emotional
development, timing of puberty and final stature. Obese children and
adolescents are frequently entangled in a vicious cycle between
distress, impairing self-image and distorted self-image, maintaining and
worsening distress