How Cortisol Can Affect Your Weight, According to Endocrinologists

Stress can affect the body in many different ways. One of the hormones that’s released to help your body manage stress is cortisol, and experts say that chronically elevated levels of this hormone can make it difficult to lose weight. Below, doctors explain the connection between weight and cortisol.

First, know that ‘cortisol imbalance’ is not a legitimate medical diagnosis and instead comes from misinformation, says Dr Maria Teresa Anton, an endocrinologist and lifestyle-medicine educator. “Many patients are misled by this description.”

Like many hormones in your body, cortisol serves an important purpose and fluctuates regularly. If you believe your cortisol is consistently elevated, experts say lifestyle changes like getting enough sleep and exercising regularly can often help keep cortisol levels in check. In cases where your doctor suspects serious cortisol overproduction (or underproduction) problems, they may order blood, saliva and urine tests.

Below, endocrinologists explain what cortisol is, the symptoms that point to elevated cortisol levels and how to lower your stress levels.

What is cortisol?

Cortisol is one of the main hormones your body releases to manage stress, says Dr Avantika Waring, an endocrinologist specialising in diabetes care. “It’s always naturally present in the body, but levels increase and decrease depending on the time of day, and depending on your overall stress levels,” she explains.

Cortisol affects blood pressure as well as blood sugars, adds Dr Waring. “When your body is under stress, it needs more energy, so cortisol stimulates your liver and your muscles to make and release glucose (or sugar) into the bloodstream to meet that need.” Cortisol also raises your blood pressure, so your heart can pump more blood quickly to your muscles, helping you kick into gear for stressful situations, she notes.

Cortisol levels will fluctuate during the day depending on many factors, says Dr Andres Splenser, an endocrinologist specialising in diabetes and metabolism. Normal cortisol production starts early in the morning before we wake up as our body’s way of getting the system ready for the day, and starts to come down in the late afternoon and evening when we’re not stressed, he explains. “The human body likes to run on a circadian rhythm starting with sunrise and ending with sunset, so think of cortisol as a hormone that peaks during the daytime hours and comes down after dark when we’re going to sleep and not stressed,” he says.

When the body is stressed by illness, poor diet, sleep deprivation or other external factors, cortisol production will increase for short periods of time, Dr Splenser notes. Cortisol rises and falls throughout the day as well; levels are affected by exercise, stress, infection, obesity and medications, says Dr Florence Comite, an endocrinologist and precision-medicine specialist.

How does cortisol affect weight?

Under normal circumstances, cortisol shouldn’t affect your appetite, says Dr Splenser. “However, when we’re stressed by different factors like sleep deprivation or excess worrying, cortisol production can increase and lead to excess hunger,” he notes. Prolonged exposure to high cortisol can predispose someone to weight gain, insulin resistance, higher risk of type 2 diabetes and high blood pressure, adds Dr Splenser.

Cortisol can influence weight in several ways, says Dr Anton. One of the primary mechanisms is its role in metabolism. “When cortisol levels are elevated for prolonged periods, it can lead to increased appetite, particularly for high-kilojoule foods, and storage of excess fat, particularly in the abdominal region,” Dr Anton explains. Cortisol can also interfere with your body’s ability to efficiently use insulin, which can contribute to insulin resistance and weight gain, she adds.

In other words, when under high stress, your body wants to hold on to as many kilojoules and as much fat as it can to fight any incoming illnesses or injuries, says Dr Waring. “High cortisol levels released during stress can increase appetite, and also increase glucose production by your body. When glucose levels are high, your body has to release more insulin, and that results in the extra glucose being stored as fat.” So high cortisol levels can increase weight, in particular by adding fat in certain places like the stomach, she explains.

How to know when cortisol levels are high

Firstly, it’s important to know that there’s a difference between stress-related high cortisol levels, and when the body overproduces cortisol consistently, says Dr. Waring. “When cortisol is consistently overproduced, people can experience weight gain in the belly and around the face and neck, acne, muscle weakness, certain skin changes, and headaches.” If your doctor suspects serious cortisol overproduction problems, they will likely perform blood, saliva, and urine tests, Dr. Waring notes.

When cortisol is temporarily high because of stress, people can feel fatigued and have trouble shedding pounds despite diet and exercise, continues Dr. Waring. “In these cases, formal cortisol testing is not recommended, and lifestyle changes can often help reduce overall stress,” she advises.

According to Dr Anton, these are the common signs of high cortisol levels to watch for:

• Weight gain – especially around the abdomen
• Fatigue
• Muscle weakness
• Irritability
• Difficulty concentrating
• Chronic stress

Constant exposure to high levels of cortisol in your body can lead to Cushing’s syndrome, which is characterised by symptoms such as a fatty hump between the shoulders, a rounded face or purple stretch marks on the skin, says Dr Comite. “Cushing’s syndrome can instigate high blood pressure, bone loss and diabetes,” she notes.

To effectively measure levels of cortisol, you’ll need to undergo blood, urine and saliva tests, says Dr Comite. “Because cortisol rises and falls throughout the day, the saliva test, taken four times during a day to notice patterns, is among the most accurate,” she adds.

Keep in mind that low levels of cortisol are also a cause for concern and may indicate Addison’s disease, a chronic autoimmune condition, says Dr Comite. “Symptoms of Addison’s disease include low glucose, low blood pressure, weight loss, dehydration, muscle weakness and abdominal pain, among others.”

How to balance cortisol levels

There are a few ways you can balance or lower your cortisol levels on your own, says Dr. Waring. These include “getting enough sleep each night, exercising regularly, practicing mindful breathing and meditation, eating a balanced, nutritious diet, and more.” In particular, eating healthy, colorful fruits and vegetables that are high in antioxidants can reduce inflammation and therefore lower total body stress, so increasing your intake may help you, Dr. Waring advises.

Managing your stress levels through restorative practices such as meditation, yoga, massage, or simply going for a walk can help you sleep better and reduce stress and its negative effect on glucose, says Dr. Comite. It’s also essential to establish boundaries, prioritize self-care, and seek support when needed, adds Dr. Anton.

How to prevent and combat weight gain due to cortisol levels

It’s important to recognise that while cortisol can contribute to weight gain, it’s just one piece of the puzzle, says Dr Anton. “Weight management is a multifaceted process that involves various factors, including genetics, metabolism, lifestyle habits and environmental influences.” By addressing stress and cortisol levels alongside adopting a balanced lifestyle, you can better manage your weight and improve overall wellbeing, she notes.

Note that if your high cortisol levels are due to excess cortisol production by the adrenal glands, then medical evaluation and treatment are the only way to combat weight gain, says Dr Splenser. “However, for most individuals, cortisol levels will increase slightly with stress from work or from lack of sleep, but long-term can contribute to weight gain and difficulty losing weight.” It’s important to realise that if you’re gaining weight due to this cause, it’s likely a sign that your lifestyle, diet, sleep habits and overall health aren’t optimal, he explains.

It’s never too late to try to correct these factors, and start by focusing on getting at least seven to eight hours of sleep a night, eating a healthy diet (mostly Mediterranean or plant-based), and adding 30 minutes of exercise five days a week, Dr Splenser advises.