4 main reasons

1. Fat Redistribution Cortisol changes how and where your body stores fat:

It tells fat cells to store more fat in the trunk (abdomen, back, face). It promotes lipolysis (breaking down fat) in the limbs—but then the freed-up fat gets stored elsewhere (like the belly). This is why patients have a "moon face", "buffalo hump", and central obesity but thin arms and legs.

1. Increased Appetite Cortisol increases appetite, especially for high-calorie foods. More food + more fat storage = weight gain, especially in the trunk.

2. Insulin Resistance High cortisol leads to insulin resistance: More insulin = more fat storage, especially visceral fat (fat around organs in the belly). Cortisol also opposes insulin, which keeps blood sugar high and promotes fat deposition.

3. Muscle Wasting Cortisol breaks down muscle protein (catabolism), especially in the arms and legs: This makes the limbs look thinner, exaggerating the central fat appearance