Being overnourished, metabolically unhealthy, and under-muscled is often driven by hypercortisolemia from chronic stress, leading to catabolism of lean tissue and anabolism of fat tissue.

“one of the clinical scenarios that I I see a lot of that I think plays a significant role in um the state of overnutrition right so you know again I've talked about this when I look at somebody I want to know these three things really quickly right are you overnourished or undernourished or adequately nourished are you adequately muscled or under muscled uh are you metabolically healthy or not um and depending on on where you fall in that Matrix like you have to decide whether calories need to stay the same up or go down now one of the scenarios that is I think most clinically vexing is the person who is uh overnourished typically metabolically unhealthy typically underused so that's a pretty common phenotype right you're a little too fat you don't have enough muscle and you're not metabolically healthy um and a big part of the driver is the uh uh basically the hypercortisolemia that accompanies sympathetic overdrive so an individual that is under so much stress chronic stress um that you basically can't stop the glucocorticoids from chronically being catabolic to lean tissue and anabolic to fat tissue”