The scale described below is as follows:
0 =no hunger
2.5 =minimal hunger
5 = moderate hunger
7.5 =moderately intense hunger
10 =intense hunger
A person, who has a normal relationship with food, may fluctuate on the hunger scale between a 0 for no hunger and approximately a 5 for moderate hunger. This person may eat approximately five times a day.
Hunger in Anorexia Nervosa
A person with anorexia nervosa may stay between a 4 and a 10 on the hunger scale. To avoid eating, this person may drink low calorie beverages, eat low-calorie foods or take stimulants, gum, etc. The avoidance of food usually occupies the entire day at frequent intervals. Sleep is disrupted secondary to intense hunger and food related dreams.
When a person with anorexia begins to monitor their hunger it can be difficult because they are accustomed to ignoring body signals and talking themselves out of hunger. Also, if this person is at a low body weight (malnourished) they may have an insatiable appetite even while giving themselves full permission to eat. Therefore, they may feel they are obsessed with food but in reality it is their bodies natural response to starvation.
Constant hunger can be scary because the person may feel that it will never go away and they will gain weight excessively. It is helpful to reassure the person that their unusual hunger will decrease as their body returns to healthy state. It is also important to encourage the person not to initiate any purging behaviors. Reviewing some of the physical challenges (in the Bulimia section below) may help to discourage those behaviors from starting.
Hunger in Bulimia Nervosa
Hunger, in a person with bulimia, will fluctuate between both ends of the scale because the person avoids eating throughout the day, using food avoidance behaviors, bingeing and purging. Before the person binges they may have extreme hunger at a level 10, when they eat they may drop to a 0. Then if they purge, their hunger rises quickly to a 10. It is likely that the person will continue to cycle their bingeing and purging and their hunger will travel up and down the scale repeatedly.
Someone with bulimia may be very afraid of food and any eating episode because they have experienced a hunger that is insatiable. Sometimes they are able to continue to eat to their stomach is full capacity without ever feeling satiated.
Purging behaviors in a person with bulimia may be triggered by stressful life events. Also, a person who binges and purges often will experience physical changes that make stopping the cycle extremely difficult.
When a person binges, their body is able to absorb some carbohydrate, it will not absorb fat or protein (which both increasesatiety). The body may learn that a large amount of food is necessary in order to adequately meet the body’s energy needs. For example if someone binges on 7,000 calories and the body absorbs 700 before the rest is purged, the body may initiate eating 14,000 calories in order to meet a 1,400 calorie energy requirement.
The body will also become accustomed to living on a high carbohydrate diet and will release high amounts of insulin into the blood in order to use the food. If the person purges, the insulin remains in the blood and will drop the blood sugar level. This causes an intense hunger and the person may continue the cycle. This practice always keeps the body in a low-blood-sugar state, some persons are misdiagnosed with hypoglycemia. Also, the body may get into the habit of releasing a large amount of insulin whenever the person eats. Consequently, if the person tries to eat a normal size meal there may be a higher level of insulin in the blood, their blood sugar will drop and hunger will still be present after eating. This may cause the person to initiate another eating experience.
It is helpful to let the individual know that their extreme hunger is a physical consequence of past behavior and not just a mental obsession. It may take several months of normal, regular food intake for the body to relearn the metabolic consequences of eating food previously purged. It can be helpful to let the person know that within six weeks the intense hunger may be at a more tolerable level.
For more information on this topic please read: “Eating Disorders Nutrition Therapy in the Recovery Process”, Reiff and Reiff.
Written by: Rebekah Mardis, RD, CDShare