Going through treatment for anorexia nervosa can feel scary for many different reasons: your body is changing, you’re eating regularly for the first time in a long time, and you’re facing the discomforting thoughts and emotions that you had been numbing with disordered behaviors. Another factor that can cause a lot of distress and anxiety? Extreme hunger in anorexia recovery.

Though not everyone goes through this, many people recovering from anorexia report wanting to eat all the time, even shortly after finishing a meal. Some become concerned that they've swung from one end of the eating disorders spectrum to the other, going from restricting to bingeing.

Though it can feel unfamiliar and alarming, this extreme hunger during anorexia recovery is a normal biological response as the body replenishes and renourishes itself—and it's actually a positive thing. “Your body is resetting, it's healing, and you're getting closer to that baseline metabolic state that your body needs to get back into,” says Equip Lead Dietitian Stephanie Kile, MS, RDN. “From a clinical standpoint, that's the goal you're working toward. We want to honor and allow that healing to happen.”

Read on to learn about the link between anorexia recovery and extreme hunger, as well as how to manage both the hunger and any emotional distress it causes you or a loved one.

What counts as “extreme hunger”?

“Extreme hunger” in recovery doesn’t have a precise definition or specific criteria. “It's kind of a colloquial term used in treatment settings or among patients to describe what feels like constant hunger that shows up during treatment and recovery,” explains registered dietitian Erin Decker, MS, RD, LDN.

This hunger can present in many ways, including:

• Feeling hungry within an hour of eating a balanced meal
• Needing to eat larger servings of food to feel satisfied
• Being so full your stomach is distended, yet still thinking about food and wanting to keep eating
• “Food noise”, or intrusive, insistent thoughts about food

All of this can cause fear and confusion. “It's such a scary feeling,” Kile says. “The patient never wanted to honor hunger, and now they have this overwhelming sense of hunger.” Anxiety, guilt, and shame are also common emotions. “The patient is coming from a place of, 'I used to have control around food, and now I'm eating all this food,'” Decker says.

Signs of extreme hunger

If your loved one in anorexia recovery experiences extreme hunger, you may notice signs such as the following, Kile says:

• Taking larger portions of foods
• Eating seconds or thirds
• Eating a greater variety of foods, including those they had stopped eating
• Requests for foods they enjoyed in the past
• Increased distress after eating

If you observe changes like these, it’s important not to comment on them. “Let the person do what they need to do to fuel their body so they can keep feeding themselves,” Kile recommends. And if they express any negative emotions or seem troubled by how much they’re eating, you can tell them, “Your body is healing. We are trying to honor that, and so that's why you ate that food. It's not bad or good, it's what you needed.”

Is extreme hunger the same as binge eating?

Many patients who report extreme hunger in anorexia recovery express concerns that they are now binge eating. That's perfectly understandable—and it's also not what's going on.

“Binge eating is not always but more often diagnosed under emotional aspects,” Kile says. “We lean toward food due to past comforts and things like that.” For those who binge eat, the behavior is often a coping mechanism, or a physiological response to short-term restriction. But for those recovering from anorexia, eating in response to extreme hunger is driven by a biological need for nourishment and for healing the body after a long period of malnourishment. “You are fueling your body in the way it needs to be fueled during this timespan of increased healing and increased needs,” Kile explains.

Why does extreme hunger occur in anorexia recovery?

As with many things related to eating disorders, there isn't one reason why extreme hunger occurs in anorexia recovery. Instead, several factors appear to be at play, including hypermetabolism, hormonal changes, an altered perception, and a person’s original body composition.

• Hypermetabolism: Some patients experience increased metabolism when they shift from undereating to giving their body the nourishment it needs. “Your body is trying to heal and repair any damage previously done while also keeping you alive. It's saying, 'We need to replenish stores that were lost during your time of extreme restriction,' so your needs and your hunger increase,” Kile explains. Your body needs fuel so your brain, heart, digestive system, muscles, and everything else can return to optimal functioning. In response to getting more nourishment, your body is turning on systems that may have been turned off or in low power mode, which increases your energy needs.
• Hormonal shifts: Anorexia leads to changes in the levels of different hormones that regulate hunger. Then, during recovery, these hormones reregulate: leptin increases, ghrelin decreases, and peptide tyrosine tyrosine (PYY) decreases. As these levels normalize, “typical” hunger signals re-emerge. But at first, these signals may seem louder to someone who has been restricting and ignoring their body's messages to eat for some time.
• Altered perception: “Coming from a restriction background, your hunger during recovery might feel really extreme compared to what's been your baseline hunger,” Decker says. “This is normal.” Over time and with support from your care team, what seems extreme now may begin to seem more normal or acceptable.
• Body composition: According to some studies, how much fat and muscle mass you lose during restriction may dictate your hunger. Your body wants to get back to your original levels of both, and sends signals to the brain to eat enough to achieve this goal.

How long does extreme hunger last in recovery?

Extreme hunger can last anywhere from a couple weeks to more than a year, Kile says. It all depends on the individual.

“In my experience, it's variable,” Decker says. “The longer you've been restricting, and if you are not fully committing to your recovery plan, the more it will be drawn out. You will be in that space of extreme hunger as you are gradually restoring your nutrient needs. Generally speaking, the sooner you dive into your recovery plan, the faster you will get through it, because you're giving your body what it needs.”

Is extreme hunger associated with any other eating disorders?

While extreme hunger is most associated with anorexia, it can occur after any long-term restriction. Since most eating disorders are ultimately rooted in restriction, this means it can show up in any eating disorder diagnosis.

How to manage extreme hunger

Although having extreme hunger can be overwhelming, there are ways to manage both the actual hunger and any emotional distress (or to support a loved one dealing with extreme hunger).

1. Follow your meal plan

This typically includes eating three meals a day and anywhere from three to five snacks. “Eating every three to five hours will help you stay on top of that hunger and make it less daunting to eat the volume of food you're consuming,” Kile says. Having balanced meals and snacks—with a mix of carbs, fat, and protein—will also help you feel fuller.

2. Give yourself permission to eat

If you want ice cream, have it, even if you haven't in years. Since that may stir up a lot of anxiety, you might work with your registered dietitian or therapist to explore why you haven't had it in so long, why it feels scary to eat it, and how you could incorporate it into your meal plan.

3. Talk it out

Work with a therapist or dietitian who is informed about anorexia and can explain what is going on, Kile suggests. They can also help you address any guilt, shame, or anxiety. And have a support system—like your parents, a partner, or a friend—who can listen when you simply need to get the thoughts out of your head. This can help your emotions feel less overwhelming—or even silly.

4. Distract yourself

Puzzles, playing games, watching TV, reading a book, and drawing are all healthy ways to take your mind off of any anxiety during a meal. Afterward, a hot shower, walk in nature, or dancing to your favorite music may help.

5. Practice mindfulness

Many people find deep breathing to be helpful when emotions have their mind abuzz. Others like meditation or progressive muscle relaxation. See what works for you.

6. Be patient

If you honor your body’s biological need for more nutrition, this extreme hunger will lessen as it recovers, Kile says. Be compassionate with yourself and give yourself the grace to feel all that you feel while exploring a freer way of eating.

Anorexia recovery and extreme hunger don't have to be feared

As scary as it might seem, extreme hunger is a natural and expected part of anorexia recovery. After a period of restriction, your body needs to repair and replenish, so your nutritional needs are greater. “Your body is kind of making up for lost time,” Decker says. In turn, it turns up the volume on your hunger so you get the message: “I need more food!” This isn’t weakness, or failure—it’s healing.

You can get through this, and the sooner you can respect your own hunger and follow your meal plan, the sooner it will quiet down. If you don't already have support, working with both a therapist and a registered dietitian who understand and have experience helping patients with anorexia can be a gamechanger. A therapist can help you work through the emotional and mental challenges, and a dietitian can help you identify balanced meals and snacks and set a regular eating schedule to get ahead of extreme hunger.

Recovery is possible, and before you know it, your hunger won’t seem as scary.