Learn How Recalibration Is The Cornerstone Of Long-Term Weight Loss

Recalibration - by Dr. Gina Scarano-Osika

Anorexics typically present to treatment with an average daily intake of 100-300 calories. They sincerely feel "full" after eating very little. By ignoring hunger pains in the beginning of their illness, they eventually eat less and less. As discussed in Chapter One, as they eat less, their BMR reduces, they need less food, and they feel less hungry. Most relevant to this chapter, however, is that the stomach is made out of muscle and it shrinks as food becomes less and less available. This shrinking of the stomach serves the purpose of re-calibrating their hunger and fullness cues; the smaller the stomach, the easier it is to feel full. Whereas a healthy female feels full after eating 2000 calories, the stomach of an anorexic has shrunk to the point that they feel full after eating only 100-300 calories; their hunger and fullness cues have become re-calibrated. This re-calibration drastically reduces hunger, thus reducing the drive to eat, which will ultimately conserve food and increase survival.

When I treat anorexia, I ask the patient to make a choice: he/she can continue to listen to their own "false" signals, or they can trust that their current hunger and fullness cues are distorted because of their illness. Their feeling of fullness after a small snack is "the anorexia talking." Teaching an anorexic why and how to override their fullness cues (and continue eating) is a significant step toward correcting their internal calibration. Likewise, if an anorexic says, "Well, I don't have to eat now because I am not hungry," I again tell them that the lack of hunger is part of the illness and they need to eat anyway in order to get better. In addition to stabilizing weight within a healthy range, another treatment goal for an anorexic is to consume the number of calories needed to maintain this healthy weight. Only after they achieve (or surpass) their target weight can they begin to trust their hunger and fullness cues.

For a person who eats too much, the same process is at work. When you override fullness cues, your stomach stretches, which means that you will be able to hold more food the next time you eat. Whereas an anorexic's stomach shrinks, the stomach of an overeater gets bigger and bigger, which makes being able to trust fullness cues very difficult. In fact, some patients have asked me to define fullness for them. When you overeat, listening to feelings of fullness can be as confusing as trying to read a roadmap upside-down. Similar to anorexia, understanding BMR can help you re-calibrate and more clearly define your hunger and fullness cues. Your BMR tells you the number of calories that your body will use for fuel. The upper limit of your BMR corresponds to what fullness should feel like at the end of a day. Consequently, eating above your BMR is non-essential eating and driven by some other factor. Eating beyond the upper limit of your BMR is your signal to start analyzing why you want to eat, since you are not eating out of necessity.

For example, let's say it is 8 p.m. and you have already eaten the 2500 calories required by your BMR. If you feel hungry, you need to ask yourself, "Am I really hungry or am I comfortable and satisfied?" It is at this point that you will be able to determine when your emotional or non-essential eating begins. From that, you can look at environmental stressors that may be causing you to feel hungry when you really are not (which will be discussed in a later chapter). Without knowledge of how much your body needs, it will be very difficult for you to define your hunger and fullness cues, which is the cornerstone of long-term weight maintenance.

Excerpt from Chapter Two of "Friendly Mirrors and Contented Closets"
by Dr. Gina Scarano-Osika