by Hilmar Wagner, MPH, RDN, CD
As you progress in your recovery from disordered eating, being able to use internal hunger and fullness cues can be a significant step towards self-regulation of intake. However, there are several important factors to help this important, but tricky, transition go smoothly.
Many people with an eating disorder experience body distortion, which means seeing and/or feeling like their body is different than it physically is. In order to gain awareness of internal cues such as hunger and fullness, it is necessary to be open to being in touch with the physical sensations in your body that are associated with a physical state of hunger and fullness. This means deliberately checking in with your body prior to, during, and following eating to reacquaint yourself with what hunger feels like and how that changes to a sensation of fullness as eating continues and eventually stops.
It is important to remember that an eating disorder creates distorted thoughts, beliefs, and judgments about food, eating, type, and amount of food eaten. Early on in recovery, hunger cues could be misconstrued as being a sign of safety or possibly self-control. However, for others it could signify the opposite—hunger could be viewed with anxiety and unease, perhaps linked with unmet needs or vulnerabilities.
Similarly, fullness cues frequently need recalibrating when first being explored. The sensation of fullness could be either exaggerated, i.e. sensing fullness when only a small amount of food has been consumed, which could be due to a fear of what eating a larger amount of food might mean, or conversely not sensing fullness until quite a large amount of food has been consumed. Working on separating the eating disorder meanings from the purely physical sensation allows individuals to respond appropriately to the signals they are receiving. Some people find using a hunger and fullness scale helpful in differentiating the various levels of either hunger or fullness. Below is an example of a scale that is used in many of our intensive treatment programs.
Early on in recovery, trying to be mindful of your physical sensations might produce too much anxiety. A certain amount of detachment from the food or eating process might be necessary in order to take in the amount and type of nourishment required for nutritional rehabilitation. This is why distractive conversation at the meal can be helpful until there is sufficient inner strength to be more present with the food or eating process.
Even when you’re ready to start incorporating internal cues, there will be occasions when relying on internal hunger or fullness cues is not possible or useful. In times of physical or emotional stress, such as illness or anxiety, the body diverts resources away from food and digestion, making internal cues absent or unreliable. Physical conditions, such as gastrointestinal disorders or bariatric surgery, can alter or diminish the usefulness of such cues as well. In cases such as this, either having an individualized meal plan to fall back on or being able to approximate the type and amount of food/liquids the individual needs will allow them to still nourish their body. Having these external or prescriptive alternatives can help prevent or diminish urges to either under or overeat.
Regaining the use of hunger and fullness cues can be an exciting and fascinating process, one which can help prompt a renewed, normalized trust in your body. It allows you to gain access to objective information you can use to fuel a full and vibrant life.
Hilmar Wagner is a Registered Dietitian/Nutritionist (RDN) and Certified Dietitian (CD) in the state of Washington. Hilmar joined the Emily Program in 2006, and currently serves as the Training Coordinator for Nutrition Services and Clinical Outreach Specialist. In this role he initiates and coordinates training of new dietetic staff, dietetic interns and continuing education for nutrition services for all Emily Program locations. He has presented on a wide range of nutrition topics at local, regional and national conferences. Hilmar received his Bachelor’s degree in Nutrition/Dietetics and Master’s in Public Health Nutrition from the University of Minnesota. He has worked in the field of eating disorders for the past 12 years. Hilmar has extensive experience working with clients of all eating disorder diagnoses in both individual and group settings. He has a particular interest in mindfulness and body-centered approaches to eating disorder recovery.
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