Let’s talk about neurotransmitters.  Specifically, dopamine and serotonin, the “reward” and “feel good” chemicals in the brain that are inextricably intertwined with our perception of appetite.  Appetite is about so much more than just hunger or our need to fuel our bodies.  Appetite is emotional regulation, stimulated by powerful emotions and our baseline psychological state.  Appetite is also a product of social intercourse.  Stress initiates the release of cortisol, which also stimulates appetite, and so we quickly reach for a sugary snack like a donut to calm our nerves and sedate us, sometimes fragmenting into common eating disorders such as bulimia and anorexia nervosa.

During my employment as a Clinical Nutritionist at a medical weight loss clinic for just over a year, I quickly learned that most folks whom I was counseling did not primarily struggle with hormonal or metabolic derangement, they suffered from psychiatric disorders connected with food.  They did not really need my help to tell them what to eat. They already knew that the foods they were eating were bad for them.  Their appetite was driven by depression and anxiety, not hunger or a caloric energy deficit.  Most of them were also obese, which is etiologically driven by the underlying comorbidities of Metabolic Syndrome, further exacerbated by insulin and leptin resistance resulting in dysregulation of grehlin and leptin signaling.  These individuals facing psychosocial obstacles to healthy eating required interventional treatment by a qualified psychiatric professional in close collaboration with myself and the Functional Medicine physician who was my employer at the time.

Personally, whenever I feel hungry, aka a “healthy appetite”, the first question I always ask myself is simply:  “Am I truly hungry or just bored and depressed?”  Or maybe I’m just confusing hunger with thirst (another often overlooked factor).  “Appetite” is a loaded word.  Take for example the French tradition of the aperitif, which I clinically define as choosing to become slightly inebriated and spike one’s blood glucose in an effort to artificially stimulate appetite prior to a meal.  I’m pretty sure that our hunter-gatherer ancestors did not enjoy the luxury of consuming an aperitif before they went on a hunt for bison.  We can ramble on and on about advanced concepts of nutrition and metabolism as science, but the reality is that there is much more to appetite than biochemistry!  When we reach for a bag of potato chips or a tub of ice cream, we are motivated by our reptilian brain, not our higher brain functions that know full well how bad those substances are for us.  It’s about “comfort foods” and instant gratification, gluttony and sloth, a salve on our emotional wounds.  I therefore unashamedly propose a politically incorrect hypothesis, i.e. that most obese unhealthy people don’t need a nutritionist.  What they really need is a good psychiatrist!  I wonder if it’s too late for me to get a dual Masters in Nutrition and Psychology?


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