March 15, 2018

“I Can’t Tell When I’m Full” – Dr. Ashley Solomon

i am always hungryWith my littlest one, there’s no question of when he’s had enough to eat. He pushes away his milk like it’s toxic and his bowl and spoon tend to end up squarely on the floor. Lucky me!

As an eating disorder specialist, I find it fascinating to watch the ways young children respond to their own eating cues.

Most of us start out with a strong, intuitive sense of our bodies' physiological needs and are able to respond in kind. Our bodies give us signals of hunger and fullness, and we start or stop eating accordingly.

For many of us, though, the hungry/full signal-response pattern is more complicated. Our eating patterns are shaped by external influences:
  • Family rules around mealtimes
  • Cultural messages about “good” and “bad” foods
  • Exposure to different types of foods
  • Exposure to diet culture
And, if we have a history of disordered eating behaviors, like restricting our food or binge eating, our ability to detect and respond to our body’s cues can really suffer.

Restricting and binge eating

The restrict-binge cycle can be one of the most detrimental influences on our ability to feel fullness and hunger.

When we diet or restrict what we consume, our body operates as if it’s in starvation mode, just like in earlier times when there were periods of famine. Our bodies try to conserve energy and signal us in all the ways it can to get energy.

For many of us, this eventually sets us up to binge eat. Binging was actually adaptive once upon a time, because our bodies were trying to consume as much as possible when it was available, fearful that there would be another “famine.”

Today, when a wide variety of food is largely available to many of us, you can imagine what binge eating or severe restricting does when repeated over and over. Both our physical and our psychological tools for detecting our own hunger and fullness are disrupted. The hormones that signal our brains to eat or to stop eating are dysregulated. Our sense of trust in our bodies is threatened.

Feeling hunger and fullness

One of the first steps in learning to re-establish the connection with our satiation (fullness) is to distinguish between what might be emotional vs. physical hunger.

Emotionally driven hunger:
  • Comes on suddenly
  • Feels as though it can only be satisfied with a specific food
  • Feels as though it must be satisfied urgently
  • Feels like it exists in your head or mind
  • Pulls for you to be uncomfortably full or stuffed before it eases
Physical hunger:
  • Generally, comes on more gradually
  • Tends to reside in the physical body
  • Generally, goes away when you are physically satisfied
Jessica Barth-Nesbitt, a registered dietitian and certified eating disorder specialist with whom I work closely, recommends using a hunger and fullness scale to begin redeveloping our awareness of our cues.

Using a hunger and fullness scale

A hunger and fullness scale helps you determine the intensity of your hunger.
  • 1 (extreme hunger) — feeling completely famished, and maybe even feeling weak
  • 3 (hunger) — your stomach may signal that you feel hungry
  • 6 (pleasantly full) — feeling satisfied
  • 10 (extreme fullness) — feeing physically ill and extremely uncomfortable because of fullness
Ideally, you don’t allow yourself to experience either end of this spectrum (a 1 or a 10).

Identifying hunger

The goal is to start eating when you are at around a 3 or 4, per the scale above. This is around the point at which your stomach may be signaling to you that you’re feeling hunger. Food becomes more appealing and appetizing when you’re in this range, but you still have a sense of control over the choices you’re making around eating.

Identifying fullness

We aim to stop eating when we reach around a 6, per the scale above. This is around the time that you will feel pleasantly full and satisfied. The physical sensations that accompany this will be a little different for each person. Generally, our stomachs do expand some when we eat and our hormones signal to the brain that we are “rewarded” for eating – it feels good to have nourished ourselves!

Practice body awareness

Again, for those who have been living with eating disorder behaviors for a long time, re-establishing these signals can take some time.

The hunger and fullness scale is something that can be used before, during, and after each time of eating to start practicing the awareness needed in this process. It can also help to take a mindful breath before identifying your “number” on the fullness scale. And if you’ve eaten past the point of comfortable fullness, remember not to beat yourself up. This is a practice for a reason, and there will be times that we miss the mark.

If you are still struggling to know what your body is telling you, consider what other factors may be making this difficult to assess.
  • Is your eating environment too stressful or distracting to be attuned with yourself?
  • Are you suffering from anxiety or depression? Those conditions can alter your appetite significantly.
  • Are you taking medication? Some medications might make this challenging as well.
Consider how you can create frequent, predictable, low-stress eating times in your day, as much as possible. And be sure to connect with a medical or mental health provider if you’re struggling with physical or emotional problems that are throwing off your internal cues.

If you have questions about eating disorder symptoms or if you are concerned that a loved one might have an eating disorder, you can call us at 877-711-1878 to speak with a Masters-level clinician.

Ashley Solomon, PsyD is Director of Clinical Outreach at Eating Recovery Center, Ohio.

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