She has a personal trainer, a style consultant, a dietician and a chef. She has close to 49 million fans across the globe - and she is incredibly influential. Yet when 168cm-tall TV talk show celebrity Oprah Winfrey ballooned to 91 kilos in 2008, she knew it wasn't only the result of a malfunctioning thyroid or lack of exercise.
It was all about stress - "my life was out of balance, with too much work and not enough play, not enough time to calm down," she was quoted as saying.
She admits having abused food, using it as a drug "to comfort, to soothe, to ease stress'' after she was diagnosed with an over-active thyroid. "When I stop and ask myself, ‘What am I really hungry for?' the answer is always ‘I'm hungry for balance, I'm hungry to do something other than work.' If you look at your overscheduled routine and realise, like I did, that you're just going and going and that your work and obligations have become a substitute for life, then you have no one else to blame. Only you can take the reins back,'' she said in her magazine Oprah.
And her problems weren't that she was a celebrity juggling an enormous workload. It was, according to experts, all down to her gender. "We know stress can lead to obesity,'' says Nancy Petry, of the Department of Psychiatry at the University of Connecticut. Her finding mirrors the study conducted at Yale, which showed that non-overweight women who are vulnerable to the effects of stress are more likely to have excess abdominal fat.
"We all have some stress in our lives,'' says Dr Salvin George, Specialist Internal Medicine at MedCare Hospital, Dubai. "But it's the more dangerous chronic stress which one needs to keep a look out for. Chronic stress is the result of prolonged issues such as workplace stress, marital issues and financial burdens, to name a few.''
Women are twice as vulnerable to stress as men. Dr Rita Valentino, a neuroscientist at The Children's Hospital of Philadelphia, found women are more sensitive to even low levels of a chemical produced at times of anxiety called corticotropin-releasing factor (CRF) and less able to cope when levels are high. That may explain why women are believed to have higher rates of depression, post-traumatic stress disorder and other anxiety problems than men.
Stress is also a reason why women reach for the cookie jar, perhaps hoping that munching on snacks will help them feel better.
"Food is... a cheap drug. It makes us feel better, at least for a very short while," says University of California-San Francisco psychologist Elissa Epel. "Few of us reach for carrot sticks in [stressful] situations. Instead, we crave sweet, salty, and high-fat foods because they stimulate the brain to release pleasure chemicals that actually do reduce tension."
This soothing effect becomes addictive, so every time you're anxious, you begin reaching for fattening foods, she says. But, according to Epel and colleagues, comfort food results in high levels of abdominal fat with a dampened-down stress response system.
Cortisol is the main culprit and the reason we crave junk food in times of stress. "Anxiety-ridden tension triggers the body to react by producing stress-related chemicals such as cortisol, which help in what is popularly called the ‘fight or flight' response," says Dr Salvin.
"In the short term, it prepares the body for dealing with a problem efficiently but if prolonged, as is the case with chronic stress, it can have a negative and damaging effect on the organs in our body."
While small increases of cortisol have some positive effects - a quick burst of energy, heightened memory functions and lower sensitivity to pain - it's important that the body's relaxation response be activated so the body's functions can return to normal following a stressful event. But when we are really stressed for a prolonged period of time, the high levels of cortisol make the metabolic rate slow down, meaning weight gain. (See box)
Dr Saliha Afridi, Clinical Psychologist and Managing Director at The LightHouse Arabia, a community mental health clinic in Dubai, explains that besides the many physiological effects cortisol has on the body, it also acts on the brain and decreases our powers of self-control. Cravings are more pronounced when people are stressed, depressed or angry.
"Essentially, emotional eating activates the pleasure centres of our brain and brings temporary relief from our pain," she says.
Stress Guru Carole Spiers, an international motivational speaker and best-selling author of Show Stress Who's Boss!, agrees that many women will turn to food for comfort during times of stress. "However, the converse is also true - that many people will miss meals when they are under pressure. Because they are so busy, they may start eating badly and snacking at their desks,'' she says.
She quotes the example of a client who began putting on weight due to her lifestyle. "She was working as an Employee Relations Manager in a bank and survived on caffeine and junk food. Her metabolism had slowed right down as she was not eating the right foods and she was putting on a considerable amount of weight. Because of her time pressures, she did not take any exercise or time away from her frenetic life.''
So essentially, the more you are under stress, the more likely you are to put on weight.
Managing the work/life balance
In the Gulf, the whirlwind of business brunches, deadlines, not to mention the bumper-to-bumper traffic on the way to and from the office all contribute to stress, which can result in a plethora of health conditions.
"High-stress careers certainly increase stress levels," says Carole. "The sleepless nights before a meeting, long working days, and then having to make excuses to their families for not being home with them… These pressures are relentless and many women tell me that they never get any time or space for themselves.
"Financial pressures worldwide mean that stress is indeed on the rise as many women are challenged to keep their jobs. Women have to manage their work/life balance. It is still usual for the woman to take the children to school, run the home, do the homework and put a meal on the table. All of that and look good in the evening when their husband comes home."
Work stress is the reason many women in the UAE reach for chocolate. Miranda El-Shentinawi, an executive personal assistant in Dubai, says her weakness for sweets at times of duress has caused her weight gain. "Whenever I'm under work-related stress, I attempt to fulfil my emotional needs with candy,'' says the 42-year-old, who is aiming to get rid of around 9kgs she piled on over the last year. "Having that chocolate was a temporary solution, as the stress did not vanish after having it."
She is now on a strict diet and is also exercising regularly.
Ancy S, a resident of Sharjah and a manager of a furniture company, also found she had put on close to 11kg last year, a period when she was undergoing severe stress.
"It was a bad year,'' she admits. "Things were not going right at work. Some of the projects I was working on got delayed due to various reasons. I was also having some family problems back in India. All this caused me to neglect eating healthily and I gained so much weight. A doctor I consulted suggested that apart from eating healthy I also needed to destress if I needed to lose weight.''
Stress is bad for your health and so is obesity. An estimated 20 per cent of the population here have diabetes (compared to the world average of six per cent). Also, it has the second-fastest growing incidence of cardiovascular diseases - both the biggest by-products of stress.
Indian women are a stressed lot - global research firm Nielsen conducted a study last year that found Indian women are the most stressed on earth. And that may be due to the stress of being an expatriate.
Amazingly, 87 per cent of Indian women admitted feeling stressed most of the time, with 82 per cent also saying they had insufficient time to relax.
The high stress levels of women is reflected in the obesity levels as well. An Indian National Family Health Survey conducted in 1988-89 (the most recent available official figures) found that 18 per cent of women aged 15-49 in urban India were overweight - that's almost one in five.
It's not unusual for expatriates to turn to food to cope with stress. Moving to a new country, meeting new people, new social dynamics and a new job can be major stressors.
According to Carole, there are a few peculiar factors responsible for women experiencing stress in the UAE. "Some women may not have been brought up to go out to work never mind hold a managerial post. There might have been an expectation of them going to school, college, getting married and having children but a full-time career is a relatively new concept for some women in the UAE. However, many of them want to take their role alongside their male counterparts in the workplace.
"These women may well feel the need to excel, look good, be professional, not be too strident in their behaviour and achieve the right balance, Most women aspiring to senior management positions believe the glass ceiling to career progression is still there."
But it's not just career women who may be at risk of stress-related health conditions. Stay-at-home expatriate mothers could be putting on more than the ‘Dubai kilos'.
"Women are usually good at multitasking and it does not necessarily increase stress levels,'' says Carole. "But they will experience stress if they are not in control of their lives. While everything is running smoothly, then stress levels will be low but as soon as something goes wrong, for instance a child falls sick, the routine will then be broken and it is easy to experience stress at this point.''
Also, leading an expat life is not easy: "People need a structure and peer group support in which to work and they need a framework of people around them to provide this,'' says Carole. "Expatriates don't necessarily need an increased support system but... a good deal of their support is at home in another country and hence they will be experiencing a gap in their lives.'' This could contribute to stress.
Carole suggests putting ‘me time' into your diary every day; eating regularly and maintaining a healthy diet; learning to say ‘no' to excessive demands at work and at home, and taking at least 20 minutes of exercise per day.
It may seem like a lot but take these tips on board and you'll find that you are much more in control of your life - and your dress size.
Cortisol acts as a potent signal to the brain to increase appetite for certain foods, especially carbohydrates and fats (because of their high calorie levels) which explains the binge eating of unhealthy food that occurs during stressful times.
"When the stressful event is over, there is likely to be excess of glucose available for the body which is often converted and stored as fat for future use," says Dr Salvin.
In response to the rise in glucose comes the rise in insulin. When this happens time and time again, day after day, the body develops insulin resistance. The excessive secretion of cortisol, along with a reduced secretion of some hormones, including testosterone, causes the body to store fat, lose muscle, slow metabolic rate, increase appetite and of course, consume more food - especially carbohydrates. And while this formula worked well for our ancestors who had to spend hours hunting and gathering food, our stressors - such as tight deadlines - don't usually involve physical activity. The result: we end up taking in more calories than we burn.
When the stress is constant, the body is unable to return to normal, resulting in higher and more prolonged levels of cortisol in the bloodstream. This leads to higher blood pressure, impaired cognitive function and blood sugar imbalances such as hyperglycemia. Cortisol also signals the body to store fat in the abdomen where there are more receptors for cortisol and a greater supply of blood.
Don't feed your stress habit
Learn to take a break. During stressful and difficult times - when you get into an argument with your best friend, or get yelled at by your boss - take a short break from whatever you are doing and learn to relax.
Make sure your blood sugar levels don't drop. If they're low, you're more likely to turn to high-sugar/high-carb foods. Eat something healthy every few hours.
Manage your stress. Life will always have stressors; learn to cope with them. Don't turn to food in times of stress.
Don't work out on an empty stomach. Choose high-protein snacks half an hour before you go to the gym. Unsalted raw nuts, low-calorie protein snack bars are great options.
Once in a while, eat a bit of what you are craving since this will help you avoid feeling denied of treats.
Reach for fruit when a sugar craving hits.
Centre meals and snacks on complex carbohydrates: Fresh fruits, vegetables, legumes and whole grains offer abundant vitamins, minerals and fibre but little fat.
Learn to satisfy thirst with water. Water fills the stomach between meals and dilutes the metabolic wastes generated from the breakdown of fat.
Adopt a lifelong "eating plan for good health" rather than a "diet for weight loss". That way, you will be able to keep the cravings at bay for good!
Information courtesy: Dr Saliha Afridi and Lovely Ranganath, Senior Nutritionist with Healthtrendz, Dubai World Trade Centre
Simple steps to help keep stress at bay
The Mayo Clinic (www.mayoclinic.com) offers a few stress management techniques to combat stress-related weight gain.
Recognise the warning signs of stress, such as anxiety, irritability and muscle tension.
Before you begin tucking into a meal, ask yourself why you're eating - are you truly hungry or is it because you feel stressed or anxious? Don't skip meals, especially breakfast.
Identify comfort foods and avoid having them in your home or office.
Learn problem-solving skills so that you can anticipate challenges and cope with setbacks.
Practise relaxation skills, such as yoga, massage or meditation.
Get enough sleep.
With additional reporting by Anand Raj