Stress, Appetite, and the Hidden Complexity of Prediabetes in Obesity

Dr. Nitin Kapoor, Professor and Head (Unit 1), Dept. of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) India. 

The pathway from obesity to diabetes is rarely straightforward. New findings suggest that chronic stress—measured as allostatic load—may quietly shape how prediabetes evolves, particularly in people carrying excess weight.

In a cross-sectional study of adults with obesity, researchers compared prediabetes phenotypes defined by a 75-g oral glucose tolerance test: impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and the combined IFG + IGT phenotype. What emerged was striking. Individuals with both IFG and IGT showed significantly higher allostatic load, greater body weight, and greater insulin resistance than those with either abnormality alone, independent of aerobic fitness.

Hormonal patterns also differed. The IFG + IGT group had lower fasting ghrelin levels, a key appetite hormone, while PYY levels were similar across groups. Self-reported hunger and fullness did not vary, yet there was a tendency toward greater preference for fatty foods in the combined phenotype.

These findings add nuance to the prediabetes pathway in obesity. Chronic physiological stress appears linked to altered appetite signaling and metabolic strain, especially in those with combined glucose abnormalities. Prediabetes is not a single state—it is a spectrum. Recognizing how stress biology intersects with appetite and insulin resistance may help clinicians intervene earlier, before the pathway progresses to overt diabetes.

(Source: Malin SK, Heiston EM. Appetite Regulation and Allostatic Load Across Prediabetes Phenotypes. Nutrients. 2026 Jan 3;18(1):158. )