Disorders of Hunger

The clinical eating disorders, anorexia nervosa and bulimia nervosa, are commonly believed to encompass major disturbances of hunger. Yet the role that hunger may play is not entirely clear. Contrary to the literal meaning of the term, 'anorexia' is not experienced as a loss of appetite. Rather, clinicians recognize that anorexics may endure intense periods of hunger during their self-restricted eating. For some, their strength in resisting intense episodes of hunger provides a feeling of self-mastery and control that is absent in other areas of their lives. Research suggests that restricting anorexics (compared with those who binge) have the greatest blunting of hunger response, and that this disturbance in hunger is not a product of other areas of perceptual confusion.

There is evidence that in conditions of total starvation hunger may become temporarily diminished. This circumstance is extremely rare and obviously relatively brief. Once eating is recommenced, hunger returns rapidly and with extreme intensity. The accounts of the male volunteers who submitted to a 6-month period of semistarvation during World War II (the 'Minnesota Experiment') are a testament to the extreme power of hunger. Referred to as semistarvation neurosis, these men's activities were shaped by their need for food. And their hunger experience was extreme. Nearly two-thirds reported feeling hungry all the time and a similar proportion experienced physical discomfort due to hunger. Participants described a marked increase in what was referred to as 'hunger pain.' For some this was mildly discomforting and vaguely localized in the abdomen. For others, it was extremely painful. This account is especially useful in reminding why energy-reduced diets aimed at achieving weight loss are often difficult to maintain and easy to abandon.

Like anorexia, bulimia finds its literal meaning in changed hunger — 'ox hunger.' Again, however, the term is imprecise. Close analysis of the precursors of binge episodes show hunger to be lower than it is prior to a normal meal. In addition, while the urge to eat may be strong during a binge, the large amount of food consumed implies some defect in satiation rather than in hunger. And binging is often a well-practised behavior that develops and changes with time. As with anorexics, it is likely that a stable eating pattern is necessary in order to normalize the experience of hunger, a process that may take a long time to establish.

The question of whether obesity reflects a disorder of hunger is now regarded as largely redundant. Obesity is strictly a disorder of weight, and as such reflects potentially long-term failure in the regulation of energy balance. There is hardly any evidence of heightened levels of hunger contributing to excessive energy input. However, an exception to this is the rare disorder Prader-Willi syndrome. Genetically determined and characterized mainly by intellectual disability, obesity is a well-recognised feature of the syndrome. Emerging research suggests that the excessive levels of food intake are associated with both a delayed reduction in hunger while eating and a more rapid return to premeal states when eating has finished. Clearly, a better understanding of the biological events that accompany such aberrant eating patterns will strengthen understanding of the psycho-biological framework that supports hunger.

See also: Appetite: Physiological and Neurobiological Aspects; Psychobiological and Behavioral Aspects. Carbohydrates: Requirements and Dietary Importance. Eating Disorders: Anorexia Nervosa; Bulimia Nervosa. Famine. Food Choice, Influencing Factors. Obesity: Definition, Etiology and Assessment. Starvation and Fasting. Weight Management: Approaches.

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