OBJECTIVE: Stress is associated with body mass gain in some people but with body mass loss in others. When the stressor persists, some people adapt with their stress responses, whereas others do not. Heart rate variability (HRV) reflects autonomic variability and is related to stress responses to psychosocial challenges. It was hypothesized that the combined effects of stress exposure and autonomic variability predict long-term changes in body form. METHODS: Data of 1,369 men and 612 women from the Whitehall II cohort were analyzed. BMI, hip-to-height ratio, and waist-to-height ratio were measured at three time points over a 10-year period. HRV and psychological distress (General Health Questionnaire) were assessed. RESULTS: Men with high psychological distress were at risk of developing an increased waist-to-height ratio (F = 3.4, P = 0.038). Men with high psychological distress and low HRV were prone to develop an increased body mass and hip-to-height ratio (psychological distress: F = 4.3, P = 0.016; HRV: F = 5.0, P = 0.008). Statistical trends showed that women displayed similar patterns of stress-related changes in body form (P = 0.061; P = 0.063). CONCLUSIONS: Assessing psychological distress and autonomic variability predicts changes in body form. Psychological distress was found to be associated with an increased risk of developing the wide-waisted phenotype, while psychological distress combined with low autonomic variability was associated with an increased risk of developing the corpulent phenotype.