Elevated Cortisol Levels Persist in Obese Women with BED After CBT and Weight Loss
Reprinted from Eating Disorders Review
May/June 2004 Volume 15, Number 3
©2004 Gürze Books
Hypercortisolemia, or higher-than-normal levels of cortisol, has been reported in persons with bulimia nervosa and obesity. Stress can precipitate binge eating, and increased cortisol is related to both central body fat and food intake after laboratory-induced stress.
Marci E. Gluck, PhD, and colleagues at St. Luke's Roosevelt Hospital, New York City, recently investigated the relationship between cortisol and waist-hip ratio (WHR) in 22 obese women (BMI >27). Eleven women had binge-eating disorder (BED) and 11 others acted as controls.
The women underwent a cold pressor test in which they immersed one hand in ice water for 2 minutes. Blood was drawn at several intervals and assayed for cortisol and insulin. Twenty women (10 BED, 10 non-BED) completed the second phase of the study, in which they were randomly assigned to either 6 weeks of cognitive behavioral therapy (CBT) and diet (5 non-BED, 5 BED) or to a wait-list control group (5 non-BED, 5 BED).
Higher cortisol levels reported in the BED group
The BED group had higher morning basal cortisol levels than did the non-BED group and a trend for greater AUC (area under the curve ) cortisol levels following the test; this became significant after controlling for AUC insulin. Those in the BED group who had CBT lost more weight than did women in the control group. Waist-hip ratios did not differ between the two groups. WHR was related to AUC cortisol and peak cortisol response in the BED group only. There were no BED, intervention, or interaction effects on morning basal cortisol level after the stressor test, both before and after controlling for insulin. The correlation between WHR and both AUC cortisol and cortisol stress response after the stress test remained significant only for the women with BED.
A maladaptive axis?
Dr. Gluck and her colleagues note that their findings indicate the presence of a hyperactive hypothalamic-pituitary-adrenal axis in BED patients that is related to abdominal obesity and that persists even after treatment and weight loss. This suggests a maladaptive pattern of stress reactivity that could contribute to BED. Dr. Gluck's group described their findings at the 2004 International Conference on Eating Disorders in Orlando.