One of the common complaints we hear from parents in our practice is that their child who is living with an eating disorder says they do not feel hungry, and therefore they do not have to eat. Not eating is one of the biggest mistakes folks can make when it comes to early eating disorder recovery. The problem is that the eating disorder has turned off your child’s hunger and fullness cues, which makes their body an unreliable way to tell them when it is hungry and time to eat.
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What are Hunger and Fullness Cues?
We are all born with natural, intuitive signals that let us know when we should eat and when we should stop eating. This is our body’s way of telling us when we are hungry, and likewise when we are full. This is what we refer to as our hunger and fullness cues. For most folks, this is something we don’t have to pay much attention to as our body is so effective at self-regulation. However, if your child has been living with an eating disorder they have likely lost touch with these hunger and fullness cues over time.
Eating Disorders and Hunger & Fullness Cues
After a prolonged period of time where the eating disorder has told your child that they are not hungry or they do not need to eat, their body eventually stops sending out those hunger and fullness cues. This is one of the many ways the body tries to conserve energy in the presence of an eating disorder. When this happens, your child is not able to recognize when they are hungry. They may also feel full most of the time, or they may not recognize when they are full. However, this does not mean that they do not have to eat.
How your child’s hunger and fullness cues are affected depends on which eating disorder your child is living with. They may be on opposite ends of the hunger and fullness scale. For example, if your child is living with anorexia nervosa, they may be refusing to eat even when the body is hungry. Or, if your child is living with bulimia they may continue to binge eat even when their body is sending signals of fullness. Over time, the eating disorder silences these intuitive cues.
“Nice to Haves” vs “Must Haves”
When the body is in a state of starvation, it is not functioning optimally and many of our systems are affected. Essentially, the body is in a state of survival. At Change Creates Change Eating Disorder Care, we call this the “nice to haves” vs the “must haves”. The body shuts down systems that fall under the “nice to have” category, and only uses energy toward the “must haves”. Unfortunately, hunger and fullness cues fall under the “nice to have” category. If your child is living with an eating disorder, the body will recognize that the hunger and fullness cues it sends out are being ignored, so it will stop using energy to send them out. This is one of the body’s ways of trying to conserve as much energy as possible in a starved state.
Restoring Regular Cues
Restoring regular hunger and fullness cues takes time. In the meantime, a registered dietitian nutritionist will likely recommend that your child eats through their feelings of fullness. They may also have your child eat regardless of how they are feeling physically and emotionally. This is called mechanical eating, or “eating by the clock”. This is a technique we often use in the early stages of eating disorder recovery in children and teens to restore regular eating.
At the beginning stages of recovery, your child will likely complain that they do not feel hungry, or that they always feel full. They may even complain that they feel nauseous or bloated. That is valid. However, the truth is that they feel that way and they still have to eat. Even though your child does not feel hungry, their body may actually be starving because their hunger and fullness cues have been “turned off”.
Restoring regular eating can help your child reconnect with their hunger and fullness cues. To do so, a dietitian nutritionist will develop a personalized plan for your child that will define when your child will eat all meals and snacks. Typically, humans function best when we eat 3 meals and 3 snacks each day.
What To Do When My Child Doesn’t Feel Hungry
Let’s circle back to that complaint we often hear from eating disorders in children – they just do not feel hungry so they are not going to eat. First, your child needs to recognize that that is the eating disorder voice speaking. Your child cannot listen to that voice because that will keep them stuck in the eating disorder. When your child is telling you they can’t eat because they don’t feel hungry or they feel full – we need to challenge that thought pattern and encourage them to eat anyway. A strategy we recommend is to gently remind the child that we hear that they aren’t feeling hungry, but their hunger and fullness cues aren’t working optimally yet – so they need to eat anyway. This is where mechanical eating comes in. When we eat by clock, the body can learn to rebuild that trust, and hunger and fullness cues will be more easily recognized by your child.
If this sounds familiar to you, know that you are not alone. Our team of expert dietitian nutritionists and therapists believes in giving parents the tools and skills they need to help their child recover without colluding with the eating disorder. Click the button below to enroll in our free, on-demand webinar hosted by our Clinical Lead, Jillian Walsh, RD, RP.
