• Hunger is a strong physiological sensation regulated in the hypothalamus.

• Appetite—physiological, psychological and social—influences eating behaviour.

• Distinguishing between biological hunger and emotional hunger is important.

• Nutrients in food vary in their ability to suppress hunger, and dietary fat has the least effect on decreasing total energy consumption.

Hunger is the strong physiological sensation which drives us to find and eat food. It has been called a ‘biologically useful sensation’ because of its obvious survival value. It is part of wider appetite mechanisms which include psychological dimensions.

Our hunger and appetite mechanisms, however, seem to provide little defence against the variety of food and ever-present cues to eat in our modem society. Genetic research is now showing that the feeling of ‘fullness’ or ‘satiety’ may be partly genetically determined, such that some people have better switch off mechanisms to tell them that they are full. Recent insights into the complexity of the human feeding machine may help us to resolve some old puzzles and lay the basis for a more thorough understanding of eating and obesity.

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By definition, adolescence is a difficult time, a period of rapid growth and development. No big revelation there, but a point worth keeping in mind. Hormones flood the body, triggering an incredible number of physical and emotional responses. A young teenager’s body grows in all directions-taller, wider, thicker. The overall shape changes too. Most of these changes are directly related to sexual development.

For boys, maturity means broader shoulders, facial hair, deeper voice, and genital enlargement. Each of these is basically a desirable event, serving to enhance the boy’s feelings of masculinity. One other point: Nobody sees the changes in a boy’s sexual organs. They are-no pun intended-a private matter.

Maturity is a different experience for a girl. The physical changes are more obvious to everyone. Her breasts develop, her hips widen. The reproductive organs mature and menstruation begins. Her sexual growth takes more of a psychological toll. Girls can’t help comparing themselves to their peers; boys can’t help noticing the change.

With the onset of menstruation, a girl comes to associate maturity with perhaps excruciating pain, blood, uncontrollable mood changes, and the “hassle” of dealing with menstrual flow. The female body needs a certain percentage of fat tissue before menstruation can begin and continue. Maturity is thus directly tied to an increase in body fat.

The massive physical overhaul of adolescence requires an enormous amount of energy to sustain it. That energy, of course, comes from food. No wonder teenagers are always hungry!

As a rule, kids handle the trauma of adolescent development surprisingly well. It is, after all, an exciting time. The thrill of dating, the sense of growing independence, and the incredible energy of being young compensate, at least to some degree, for the stress of change.

Not everyone, however, is well equipped emotionally and psychologically to adjust to these physical and social demands. For some young girls, this sudden awareness of their sexuality, plus the pressure to develop new kinds of relationships with boys (and with other girls, for that matter) is too much. Add to this mix a family situation that fails to prepare the girl to cope with such changes and you have a recipe for trouble.

Whether consciously or unconsciously, some girls connect eating and body development. They think, “If I could just control my eating, I can control the changes in my body.” Doing so means they can avoid all the problems of puberty.

One of my patients, a fourteen-year-old girl named Kate, reached 112 pounds. She then became anorexic and starved herself down to 83 pounds. During treatment she agreed to return to a weight between 101 and 105, which was the range at which menstruation had stopped. She stated adamantly that she “never wanted to get back up to one hundred and twelve again.”

We explored the reason for her attitude. It turns out that, shortly before her illness began, she had walked past a construction site. In typical fashion, the construction workers whistled at her; one yelled out, “Nice ass, baby!”

Unfortunately, this type of emotional harassment exists everywhere, and I think it’s disturbing to every woman. Teenagers, sadly, are often least able to cope with it. Kate felt humiliated and embarrassed. Later she began to sense, more or less consciously, that if her weight dropped she wouldn’t have to cope with that kind of abusive and unwanted sexual attention. A girl of eighty-three pounds, whose body has the silhouette of a ten-year-old, is at very low risk of being told she has a “nice ass.”

Of course, girls are often flattered at being noticed by people they know and like. They appreciate compliments from people they trust. But for a girl who is overwhelmed by such attention, or who is unprepared to deal with it, the “safer” option might be to starve herself and avoid such confrontations entirely. That option-anorexia nervosa-is anything but safe.

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His words stung, but Anita knew that her doctor was right. She weighed 157 pounds and she also had diabetes—a bad combination, to say the least. “He kicked me in my pants, and that’s what I needed,” says the 67-year-old Newport, Pdiode Island, resident.

Determined to get in shape, Anita immediately enrolled in a 4-day hospital weight-loss program, where she learned the importance of eating better and exercising more. She began applying ° her new nutrition knowledge immediately, making healthier food choices and controlling her portion sizes.

For exercise, Anita decided to try walking. But she knew that she’d need support—someone to prod her out the door when she felt like staying at home. So she recruited some friends to join her. “Most of them are about my age, and like me, they want to exercise to keep themselves fit and healthy,” she says.

Anita and her exercise buddies have established a daily routine. They choose a time and place to meet, then set out for a brisk 3-mile walk. For Anita, knowing that people are counting on her helps her shake off any thoughts of skipping her workout. “Maybe it’s a little cold or windy, or maybe I just don’t feel like walking,” she says. “I think of my friends waiting for me, and I don’t want to leave them stranded.”

When Anita goes to Florida for the winter, she doesn’t leave her workout behind. She has exercise buddies there, too. Every day, they meet at 9 o’clock in the morning for a walk up and down the beach.

Anita’s buddy-system approach to exercise helped her take off 38 pounds, which she has kept off for 6 years. And with her doctor’s guidance, she was able to taper off the insulin that she used to control her diabetes.

WINNING ACTION

Do walking workouts with a friend. In one survey, women cited having an exercise buddy as one of the main reasons they were able to stick with a fitness program. Finding an exercise buddy has several advantages. You develop a sense of obligation to the other person, so you’re less likely to skip a workout. You motivate one another and maybe engage in a bit of friendly competition. And you’re safer when you’re with someone than when you’re alone.

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