Over 80% of people with post-traumatic stress disorder (PTSD) will go on to become overweight or obese (with the majority becoming obese).1 

People with PTSD also have higher rates of developing other physical health problems, including: abdominal obesity, high blood pressure, high blood sugar, insulin resistance, high cholesterol/dyslipidemia, increased risk of blood clots, systemic inflammation, impaired immunity, autoimmune conditions and chronic pain.1 

Why does this happen?

There are a multitude of different factors at play in PTSD, but here are the top 5 reasons why this condition is likely to result in weight gain (and associated metabolic changes).

 1. Certain medications contribute to weight gain. 

Antidepressants such as Mirtazapine, Paroxetine and Amitriptyline are the most likely to result in significant weight gain.2, 3 Although, antidepressant use in general puts people at higher risk of gaining weight in the first six years.4  Low mood can also result in less motivation to eat nutritious food and engage in physical activity.5

In addition to antidepressants, most antipsychotic medication also cause weight gain by affecting appetite control and energy metabolism.6  The worst offenders tend to be Clozapine and Olanzapine, followed by Quetiapine and Risperidone.2  

2.  Binge eating and emotional eating become more likely. 

Binge eating is 2-3 times more likely in PTSD because people often use food as a way to cope with stress and other emotions.5,7 . People with PTSD are also more likely to crave sweets and carbohydrate-rich foods.7

3.  Sleep is disrupted

Insomnia and sleep disturbances are key elements of PTSD.1  People with PTSD also have higher rates of sleep disordered breathing and sleep movement disorders.1  Insufficient sleep (<5-6 hours per night in adults) puts people at higher risk of obesity because fatigue can reduce physical activity levels and insufficient sleep causes metabolic changes which increase appetite and makes people crave high fat and carbohydrate-rich foods.1,8  Combine this with the fact that even partial sleep deprivation for a few nights can make the body more resistant to insulin, and this can start affecting blood sugar levels down the road.8

4.  Chronic stress (and/or lack of sleep) leads to cell damage. 

Cell damage causes inflammation in the body and this inflammation can cause insulin resistance, increased blood sugar levels and higher rates of cardiovascular disease.1

5 . PTSD changes brain function

Changes to the limbic-neuronal structure/function (especially when combined with high levels of stress hormones) can affect appetite, metabolism and make “comfort foods” seem more rewarding.1

What should case managers and solicitors do?

1. Make sure you are monitoring the weight of your clients with PTSD.  Refer to a dietitian particularly if there is a 10% weight gain within a 3-6 month period.  Weight loss has actually been found to help improve symptoms of PTSD.9

2. Arrange for an annual health check for these clients.  They should have their blood sugar, blood pressure and cholesterol levels monitored annually due to their increased risk.

3. Do whatever you can to encourage clients to become more physically active.  An increase in physical activity has been linked to a decrease in PTSD symptoms as well.5

4. Screen clients for sleep apnoea and refer on to a sleep clinic if required.  Treating the conditions which interfere with sleep can have a massive impact on improving someone’s physical and mental wellbeing.

Weight is a complicated issue, particularly after a catastrophic injury, because it is influenced by so many factors in a person’s life.  There are at least 18 factors that I screen for when assessing a client with weight issues, including medication, stress levels, sleep and emotional eating.  There is such a strong association between mental health issues, physical health, eating habits and weight that a dietitian should be included in the multi-disciplinary team for these clients.  For more information or to refer a client, please get in touch at info@specialistnutritionrehab.co.uk.