April 3, 2020
Coronavirus-related stress to have an impact beyond the current measures
The explosive rise in the spread of COVID-19 and the associated health and safety measures has had a global impact on the way we all move from one day to the next. Understandably, uncertainty around the virus itself, the limited evidence for how to best treat it, scarcity of medical supplies, interruptions to the food supply, economic and employment challenges and the prospect of prolonged isolation has many people feeling overwhelmed and anxious.
Before we go any further, let’s take a moment to acknowledge that such feelings are not only understandable and normal, but completely reasonable in the face of this situation. We are, each of us, figuring this out one day at a time. Understanding that we’re in the midst of a highly irregular event, we know that stress is going to happen. We can’t prevent that. However, proactive stress management can help to make the coming months a little easier. While acute stress can be life saving, our bodies simply aren’t built to sustain stress over long periods of time.
Acute stress v. chronic stress
To understand the long term impact of stress, it’s important to first understand how and why stress manifests in our bodies and the purpose it serves in the short term. Acute, or short term, stress is a function of our natural fight or flight response, and it can actually be incredibly beneficial because it captures our attention.
Acute stress can increase our visual acuity, decrease pain, increase blood flow and boost our immune system, among other outcomes. And all of it happens in the name of survival. The trouble comes when we remain in a state of stress for an extended period of time. Our bodies aren’t meant to persist in survival mode — that’s when stress becomes dysfunctional, maladaptive and incredibly problematic.
Long term, or chronic, stress diminishes all of the benefits of acute stress and further, takes a toll on our health beyond the loss of those outcomes. In a state of chronic stress, our bodies lack the ebb and flow of the hormones stress responses trigger, creating a cascade of potential health risks. At a glance, the problems can include decreased cognitive ability, diminished decision making ability, more pronounced pain, reduced immune function, increased blood sugar, poor sleep and high blood pressure.
Chronic stress and obesity
During this most unique of times, Obesity Medicine Specialists, and all clinicians, should be especially mindful of the potential impact of stress on obesity and obesity related chronic diseases. During any patient encounter, patients should be informed how to recognize signs of mental stress, and how it is a potential threat to their health — points of particular concern include increased blood sugar, high blood pressure, challenges fighting off viral lung infections and increased severity of obesity. Patients with obesity should be given specific guidance on how to safely maximize optimal nutrition and physical activity — especially during periods of shelter-in-place orders.
Staying home is a critical measure to keep ourselves and others safe and reduce the spread of the virus; however, it is not a condition without challenges. In particular, staying home may result in reduced physical activity and may also limit access to healthful eating options. These facts paired with the increased mental stress of this time present the potential to worsen obesity and obesity-related chronic diseases — including cardiovascular and lung diseases, hypertension, immunopathies and diabetes mellitus, all of which can contribute to increased risk of COVID-19 infection and more severe outcomes as a result of infection.
One of the many systems activated by our fight or flight response is the sympathetic nervous system, which increases production of the hormones epinephrine and norepinephrine, both of which increase blood flow. Over a sustained period of time, that increased blood flow creates increased blood pressure, which can lead to hypertension. All of which can contribute to a persistently increased heart rate. For patients, it’s often effective to think of it like this: Chronic stress kicks the circulatory system into overdrive, making the heart work harder for potentially weeks or months at a time. That added strain can exacerbate other underlying conditions or put people with obesity at greater risk of developing additional comorbidities.
Similarly, when the body is in a state of fight or flight it will increase cortisol production to ensure all of the necessary energy is present to preserve life. Over the course of weeks or months, these increased levels of cortisol production naturally result in increased blood sugar. Likewise, the fight or flight response might trigger increased production of glucose in the liver, once again contributing to elevated levels of blood sugar and creating greater risk for pre-diabetes or diabetes, an area of particular concern for those living with obesity.
While not unique to coronavirus, perhaps, but certainly of particular concern at this time is the fact that people with obesity often experience significant symptoms from viral lung infections. As a result, the added struggle of a depleted immune system because of chronic stress could make COVID-19 recovery exceptionally difficult.
Finally, stress during these times may not only further worsen the immune system, but can also worsen obesity. For many, staying home may mean less access to healthful eating options, and may promote reduced physical activity. Additionally, the stress response may prompt emotional eating, night eating and binge eating as coping strategies. The potential of worsening of obesity as the result of increased mental stress from COVID-19 could also further worsen obesity related chronic diseases, as explored above. Those with obesity should not only be mindful of the unique adverse consequences of COVID-19 itself, but also how the stress of these challenging times may have longer term health consequences, well beyond COVID-19.
Coping with stress during the time of COVID-19
While we can’t yet know exactly what the long-term impact of COVID-19 will be on the world and on the health of people everywhere, we know from experience with chronic stress brought on by war and catastrophic events in history that there will be fallout. We haven’t yet found a cure for coronavirus, but we can look to proven stress management practices to attempt to curb the lasting impact of this pandemic.
When counseling patients about healthy practices during this time, consider these stress management tactics:
- Feel your feelings: We can’t hope to make it through this situation without acknowledging it. Give yourself permission to feel what you feel. Understand that this is a stressful and disruptive time for the whole world on every level: individuals, groups and societies are feeling this. Recognize that it is human to have setbacks and imperfect days and then ask yourself what you can do to redirect those feelings.
- Take everything one moment at a time: We cannot know what the endgame will be for COVID-19 and the lack of definition can take a powerful psychological toll. Rather than contemplating the prospect of months of quarantine and uncertainty stretching out ahead, focus on today, or better yet, manageable moments of today. What can you do right now to feel better? What can you look forward to in the next hour? What’s something you’d like to accomplish today
- Find ways to stay physical: The whole world suddenly understands the charm of going for a walk, but when the weather is bad or regional shelter-in-place orders prohibit wandering around the neighborhood, finding ways to keep moving gets a bit more challenging. Try these suggestions. Next time you’re on the phone, pace. Put your laundry away one item at a time — throw on some music to make it fun. Take a lap around the yard or house. Try your hand at hula-hooping or a game of Twister.
- Stick to your routine — and your care plan: Now isn’t the time to let the personal routines and acts of self-care that help you thrive slip. Keep up with any medications and doctor recommendations. Get enough sleep and pay attention to your body. Likewise, consider who the people are that play an important role in your life and reach out to them. Make use of FaceTime, Zoom, Google Hangouts and other digital solutions to tap into your support system in a meaningful, engaged way.
- Be mindful about inactive solutions: Passive stress relievers such as surfing the internet, watching tv and playing video games might feel like the obvious choice to pass the time, but too much time spent on those activities can have declining returns. Indeed, too much screen time could potentially worsen obesity as it distracts from opportunities to be active and mindful.
- Practice active stress reduction: Mix up your quarantine routine with a walk, a conversation with a good friend, a puzzle, a book, yoga, tai chi, meditation, a board game, something creative or indulging in a favorite hobby. Pick something meaningful to you and focus on that instead of that one thing you couldn’t get at the store or what tomorrow’s homeschooling session will look like. For a little extra help, try out apps such as: Breethe, Headspace and Pzizz.
- Look to the helpers: Fred Rogers said it best, “Look for the helpers. You will always find people who are helping.” In times like these, finding some way to join their ranks can be incredibly powerful and beneficial. You’ll be doing something good for the community and creating positive social connections. Now more than ever, meaningful contributions can’t be overlooked as a great practice in stress relief.
We, like the rest of the world, will be watching COVID-19 unfold in the coming weeks and months and checking in with helpful insights and practices as it makes sense to do so. Together, we will get through this. Stay safe.
The Obesity Medicine Association (OMA), the largest medical organization of clinicians, is providing live and online education and resources to treat and manage your patients with obesity. You can find hundreds of online education courses at www.omacademy.org.