How to Cope with Extreme Hunger in Eating Disorder Recovery

One of the most frightening experiences of eating disorder recovery is the uncertainty – how long will this take? What’s happening in my body? Is this how recovery is supposed to go? 

Given the unpredictable nature of hunger and appetite, it’s no surprise that this topic on extreme hunger is one of my most popular posts. With that being said, I hope you take comfort in knowing you are not alone. You are not doing recovery wrong and there is an explanation for this phenomenon. 

What is extreme hunger?

Extreme hunger is exactly what it sounds like – it is the feeling of having an unexplained, larger than normal appetite. It is a normal biological response to food restriction and common among those recovering from eating disorders, from the diagnosed, to self-identified and sub-clinical “disordered eating”. 

Why does it happen?

Extreme hunger is a colloquial term with a biological explanation. Let me back up:

When food is restricted, your body shifts the way it uses energy. Digestion and metabolism slow down. You may find yourself actually getting full more quickly than before. This is your body’s way of conserving energy. You might get used to not feeling hunger cues. 

Related: What does hunger feel like?

When refeeding begins, your digestion kicks back into gear at variable speeds. On the one hand, extreme hunger may just feel extreme compared to what you were eating before entrenched in an ED. It may actually be an appropriate level of hunger. 

But for others, it is truly a larger-than-normal appetite and need for food driven by hypermetabolism. Hypermetabolism is when your body’s need for energy surpasses what we might expect based on predictive equations like those used in online calorie estimates. I like to describe this as your body’s attempt to make up for lost time. It’s trying to recoup all the calories and nutrients that were recently restricted. 

It is not just physical

While extreme hunger has a biological basis, it is not purely physical. You may feel physically full but still have lingering food noise, cravings, and thoughts about food. This can be an indicator that your body still needs more calories despite your stomach being physically full. After all, our stomachs have a limited capacity and during the refeeding process, calorie needs can be extremely high, especially if someone is still growing, developing, or particularly active. 

The brain also plays a role. Even if someone physically has met all of their calorie and nutrient needs, the brain is still malnourished and may fixate on food as a survival mechanism. Food restriction is a true threat to our survival and our brain’s role is to keep us safe. This has been demonstrated in the Minnesota Starvation Experiment (note – I’m intentionally not linking to this as it does discuss specific calories and numbers..) 

What does extreme hunger look and feel like?

Extreme hunger is hunger despite having just eaten. You may be thinking about food all day long and feel like you need to eat every hour. You may have a full stomach, and still want to eat more. 

Common Fears

The most common fear I hear is the fear that you are binging. There may be fear of eating beyond your prescribed meal plan, or losing control. This is completely understandable given the nature of eating disorders. (FWIW: if you have a dietitian that tells you that you shouldn’t need more than your meal plan suggests, respectfully, find another dietitian.)

I used to try to differentiate between binge eating and extreme hunger. These days, I don’t find it that helpful. For many of my clients, binge eating is a manifestation of extreme hunger. After all, most binges are preceded by restriction. By this logic, I like to tell clients that binge eating is ok. With few exceptions, there are very few risks associated with short-term binge eating. That being said, please talk to your treatment team if you have concerns. There are circumstances when eating a large volume of food can be dangerous (i.e. those at high risk for refeeding syndrome.) There are also circumstances where binge eating is not related to restriction.

What not to do

Don’t panic! For many, extreme hunger is to be expected. It is part of the process. 

Additionally, don’t restrict yourself. Restriction will just prolong the experience. Personally, I like to be proactive rather than reactive about hunger. Look at your day and eating structure. See if you can get ahead of it by eating more earlier in the day. 

When does it get better?

It is so hard to determine how long extreme hunger will last. There’s not much research out there, and what is out there is a summary of reddit experiences (published since I originally wrote this post – time flies!!)

I can confidently say that the slower you go, the longer it will last. But I also appreciate that recovery is a process and doesn’t happen overnight. 

I’ve had clients with relatively short-lived restriction cycles that have gotten relief from extreme hunger in a few weeks. Others with more enduring eating disorders may notice it sticks around for years or longer. 

When to seek support

Please seek support as soon as you are ready! Most people underestimate how much restriction has affected them. Working with an eating disorder dietitian can make recovery feel much less overwhelming.

Disclaimer: 

This blog post is NOT medical advice and is meant for educational and informational purposes only. Always consult with your doctor, therapist, dietitian, or qualified health professional if you have concerns about your eating behaviors.