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Guest Post: Emotional Distress And Weight Gain

Erik Hemmiingsson, PhD, Obesity Research Centre, Karolinska Institute, Stockholm, Sweden

Erik Hemmiingsson, PhD, Obesity Research Centre, Karolinska Institute, Stockholm, Sweden

Today’s guest post comes from Erik Hemmingsson, PhD,  a Group Leader at the Obesity Center, Department of Medicine, Karolinska Institute, Stockholm, Sweden. His group studies the role of psychological and emotional distress in weight gain and obesity by mapping life events that influence stress, metabolism and body weight. Erik has a PhD in Exercise and Health Sciences from the University of Bristol (2004) and a PhD in Medicine from Karolinska Institutet.

I work as a researcher in a specialized obesity treatment center at a university hospital in Sweden. My job is to develop new and more effective treatment and prevention methods so that we can hopefully confine obesity to the history books some day.

For many years I mostly did studies on behaviour therapy combined with low energy diets. Since this did not result in any major breakthroughs, I decided to try something a little different.

I had been aware of that many of our patients had experienced difficult childhoods. There were so many sad stories, but I didn’t fancy doing any research on the topic, it was too painful. But then my attitude gradually started to change about a year ago. It was clear that our current treatment methods were woefully ineffective, but I also became more receptive to all those troublesome stories from the patients. Enough was enough, it was time act. So, like Neo in the Matrix movies, I decided to take the red pill, and delve deeper into the very uncomfortable subject of childhood abuse and adult obesity.

I searched the literature and quickly saw that there were more than enough studies for a systematic review and meta-analysis. I enlisted the help of Dr Kari Johansson and Dr Signy Reynisdottir, and got to work.

What we found very much confirmed all those clinical observations, i.e. there was a very robust association between childhood abuse and adult obesity. The association was also very consistent across difference types of abuse, with an increased risk of about 30-40%. There was also a dose-response association, i.e. the more abuse, the greater the risk of obesity.

While this study confirmed something very important, it was also clear that not everyone who suffers childhood abuse develops obesity, or that all obese individuals have suffered childhood abuse, or the effects would have been even more pronounced. But for me, the study proved that stressful childhood experiences can easily manifest as obesity many years later. This led me even deeper down the rabbit hole. I wanted to know why.

I decided to try and piece together different ideas about how obesity develops in relation to stressful life events. This resulted in a new conceptual causal model consisting of six different developmental stages. Like many diseases, obesity development is more likely when there is socioeconomic disadvantage (applies mainly to Europe and North America). Socioeconomic disadvantage can very easily trigger a chain of events that include adult distress, a disharmonious family environment, offspring distress, psychological and emotional overload, and finally disruption of homeostasis through such mechanisms as maladaptive coping responses, stress, mental health problems, reduced metabolism, appetite up-regulation and inflammation.

Much more research is needed to validate the model, but if there is some truth to this theory, which the childhood abuse meta-analysis clearly suggests that there is, then my hope is that we can use this information to develop more effective treatment and prevention methods.

My other hope is that some of the truly horrendous stigma, shame and discrimination that the obese experience can gradually be alleviated, since there is clearly a lot more to obesity etiology than the commonly held preconception that obese individuals are merely lazy and overindulgent.

After having done all this work on obesity etiology, I would say that my top-3 reasons we have an obesity epidemic (in no particular order) are socioeconomic inequality, the junk food invasion, and psychological and emotional distress patterns (usually established at an early age). And when you combine all three you have the perfect storm for weight gain.

You can find more information at my blog at

Erik Hemmingsson,
Stockholm, Sweden


Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obesity Reviews (epub 15 August 2014).

Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obesity Reviews 2014, 15:769-779.


  1. It sounds like Erik Hemmingsson would benefit by talking to the folks doing neural plasticity work with developmental skills training – Laurel Mellin – Emotional Brain Training.

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  2. Hi Annette
    I am a big believer in emotional training, so I will definitely check this out, thank you!

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  3. Thanks for sharing this info on socioeconomic disadvantages. It will be interesting to see more research in that area. It’s so sad that obesity has become such a problem (for adolescents & adults), but it’s encouraging that we seem to be making some progress on root causes & solutions. I’d love to hear your opinion on some of the new, experimental “drugs” that are coming out to combat obesity. For example, ones like Gelesis ( which aim to control appetite. Look forward to your feedback and additional information.

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  4. Hi Christine
    I have quite low hopes for new anti-obesity drugs. Historically, they have been very hard to get approval by the FDA, mainly due to safety concerns. And even if new drugs can be approved, their efficacy is likely to be quite small, and you are also likely to regain any weight loss if you stop taking the drug, which means life-long medication.

    The hope, at least for me, is in trying to reverse the causes of weight gain, such as socioeconomic disadvantage, emotional and psychological distress, and junk food.

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  5. Sounds like you are doing great work. I actually came across that meta-analysis and was glad to see it was done. Yes, individual “flexibility” when exposed to early life stress would seem to be a reasonable hypothesis that there would be certain “energy saving” and protective mechanisms more highly engaged after a stress that calls for readaptation from lack of resources, 2nd hits, or the neuroendocrine profile coping strategies engaged. The socio-inequality has got legs with the striatum over-engagement (other predispositions-action) etc, and the fast food definitely (it makes stress more stressful), so then the emotional hyper-reactivity engages energy-saving or reallocation of resources/attention. I think you would also need to think of pesticide (endocrine disruption) and of course the diametric and spectrum influences leading to diverse “variations on the same tune” outcomes of stress and adaptation. I had put together a post (attempting at making it more tangible), but also expressing that these “stress mechanisms” like adaptation to early life leading to later life, is often ignored in favor of scientific logic of direct “cause-effect” (and hence thinking removing or adding things can give us immediate answers and solutions as opposed to needing re-calibrate an ecosystem balance disturb). Anyway, great work and important contribution!

    Link to my online post “Beyond the Calorie Model”

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  6. Hi Lori
    Thank you for your comment. You make many interesting points, and the brain in general remains relatively unexplored for obesity researchers, and this goes for stress as well, although more information about the toxic role of stress/distress is becoming more and more clear.

    There definitely appears to be energy saving through reduced basal metabolism as a result of stress and negative emotions, this is a very exciting field. Many obese people are probably in calorie-saving mode as a result of this, and this could play a huge part in the epidemic.

    I totally agree that toxicity in our food, air and water needs to be addressed as well, as this clearly “steals” a lot of resources from the kidneys and liver, etc. Ourt bodies are working overtime just to clear out the garbage, including junk food.

    We certainly need to recognize the powerful role that childhoods play in determining adult health and well-being, we all need a good start to thrive later on.

    Erik Hemmingsson

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