Causes, Diagnosis, Treatment and More

Cortisol belly is weight gain in the abdominal area, sometimes referred to as abdominal obesity, caused by an excess of the stress hormone cortisol. It can happen to anyone experiencing prolonged stress.

Other factors can also contribute to fat accumulation in the abdomen. Abdominal obesity is common: approximately 53% of adults in the United States experience the condition, and it is more common in people with uteruses.

Treatment for cortisol belly usually requires individuals to identify stressors and reduce them. Avoiding smoking, getting more sleep, and seeking mental health care can help.

Cortisol belly is often referred to as “stress belly” because of weight gain in the abdominal area during periods of increased stress. You may first notice a change in your appearance and not any other related symptoms.

However, cortisol belly can cause several symptoms you may not immediately associate with increased abdominal fat. People with cortisol belly may experience the following symptoms:

• Weight gain in the abdomen 
• Stretch marks
• Anxiety and depression
• Increase in appetite and food intake
• Easy bruising 
• Muscle weakness 
• High blood pressure

Other symptoms of excess cortisol can include a rounded face (sometimes called moon face), excess fat deposits above the collarbone and between the shoulder blades, diabetes, and osteoporosis (brittle bones).

Increased abdominal fat can heighten your risk for cardiovascular disease, diabetes, and other health conditions. Abdominal weight gain is complex, so if you have concerns about a change in your appearance, talk with a healthcare provider about possible diagnoses, including cortisol belly.

When you experience stress, your body adapts to confront the perceived threat in a reaction known as the fight or flight response. Your heart rate and blood pressure increase, your body releases more glucose to fuel your muscles, and you become hyperaware of your surroundings.

When this happens, your body also releases a stress hormone called cortisol from the adrenal glands, located on top of your kidneys. These responses typically help your body overcome immediate stressors.

However, when you face a period of prolonged stress (e.g., divorce, chronic illness, school), the constant release of cortisol can have negative effects on your body. For example, it can:

• Make you less sensitive to another hormone called leptin, which is the hormone that makes you feel full after eating
• Increase your food intake and raise your blood sugar
• Affect your fluid balance and increase your blood pressure
• Affect your mental health and make you feel more anxious, irritable, or depressed
• Make it harder for your immune system to work effectively

Cortisol belly is one symptom of having too much cortisol in your body, likely from long periods of stress.

Risk Factors

Anyone can develop cortisol belly, but it’s more common in adults with uteruses. Risk factors for developing excess cortisol in the body that can lead to cortisol belly include:

• History of prolonged stress
• Childhood exposure to trauma 
• Chronic pain 
• A diet high in added sugar 
• Frequent alcohol consumption
• Sleep deprivation (not getting enough or quality sleep)
• Mental health conditions 
• Use of steroid medications
• Cigarette smoking

There are tests available to help detect excess cortisol in your body. If you are experiencing unexplained abdominal weight gain, your healthcare provider will ask about your medical history as well as your diet, lifestyle, and general health.

They will then ask you to describe where you’re gaining weight in your body and when you started noticing it. Your provider will also ask you about any stress you’re experiencing and if your stress is recent or if you’ve been experiencing stress for an extended period.

To understand if the weight gain in your abdomen is from cortisol, your healthcare provider will need to test cortisol levels in your body. Cortisol is not released at a constant rate—your body releases more cortisol in the morning and less in the evening. Cortisol tests are designed to take that into consideration.

Cortisol tests come in several forms, including:

• Hair test: This test examines long-term cortisol levels in your hair. 
• Urine test: This test measures the amount of cortisol in your urine throughout the day and at night. You may need to urinate into one or more jugs for 24 hours or urinate on small cards each time you go to the bathroom. 
• Saliva test: This test measures cortisol in your saliva. You may need to give one sample or several over 24 hours. In some cases, your provider will have you take a saliva sample around 11:00 pm on three different nights to measure your levels.
• Blood test: Your provider will take a blood sample in the morning and afternoon to measure your blood cortisol levels at these times. This helps them determine if your body is making cortisol when it should. 
• Dexamethasone suppression test: This test attempts to temporarily stop your adrenal gland from producing cortisol using the synthetic steroid dexamethasone to determine if your body is producing excess cortisol. Your provider will instruct you to take either a low or high dose of the medicine at 11:00 pm, and they will measure your cortisol levels at 8:00 am the following day.

Rarely, excess cortisol is a sign of Cushing’s syndrome. This syndrome occurs when small tumors in your pituitary gland, an area in your brain that helps make cortisol, increase the amount of cortisol your body produces. Your healthcare provider may also check your adrenal gland to see if it’s working properly. If your provider suspects Cushing’s syndrome or a problem with your adrenal glands, they may order additional tests.

Cortisol belly is often a symptom of a long-term stress response. To treat cortisol belly, your healthcare provider will first recommend lifestyle changes to help reduce stress. Certain lifestyle changes can help reduce stress and excess cortisol and support your overall health, including the following:

• Get more than six hours of sleep per night 
• Increase your physical activity, such as by walking or practicing yoga 
• Support your mental health 
• Practice mindfulness and meditation 
• Reduce your alcohol consumption
• Avoid smoking

Your healthcare provider may recommend medication in some instances for high cortisol. For example, medications for high cortisol levels are often used to treat Cushing’s syndrome, a rare cause of high cortisol in the body. These medications work by reducing the amount of cortisol released by your adrenal glands.

Cushing’s syndrome treatment may also involve stopping or avoiding the use of steroid medications. Your provider may also recommend taking certain vitamins or minerals, like magnesium, to help reduce cortisol levels.

Many factors, including excess cortisol, can influence abdominal weight gain. The best way to prevent cortisol belly is to prevent your body from making and releasing too much cortisol.

If your high cortisol is caused by a health condition such as Cushing’s syndrome, treating that condition can help reduce cortisol levels and improve or prevent cortisol belly.

In most cases, however, stress management is the best way to help prevent cortisol belly. Strategies include the following:

• Do activities and hobbies you enjoy
• Get enough sleep
• Increase your physical activity 
• Support your mental health
• Talk to loved ones
• Eat a balanced diet

Increased cortisol levels associated with cortisol belly can have several long-term complications. Abdominal weight gain is associated with an increased risk of cardiovascular disease and metabolic syndrome (a grouping of risk factors, such as obesity and high blood pressure, that can increase your risk for heart disease, stroke, and diabetes).

Increased cortisol throughout your body can also put you at an increased risk for developing the following conditions:

• Osteoporosis, a condition that causes weak and brittle bones
• Chronic fatigue syndrome 
• Rheumatoid arthritis
• Mental health conditions like depression or anxiety

Life with cortisol belly will vary greatly from person to person. Weight gain caused by excess cortisol can look different for everyone. For some people, it may affect their body image. In addition to appearance, excess cortisol may change other aspects of your health that can affect your quality of life.

For example, prolonged stress can make it harder for you to cope with stressful situations and can negatively affect your mental health. You can typically manage cortisol belly by implementing lifestyle modifications. Speaking with your healthcare provider is the first step to improving cortisol belly symptoms.