Chapter 14. Health at Every Size

Factors Affecting Energy Intake

Physiology

In the last few decades, scientific studies have revealed that how much we eat and what we eat is controlled not only by our own desires but is also regulated physiologically and influenced by genetics. The hypothalamus in the brain is the main control point of appetite. It receives hormonal and neural signals, which determine if you feel hungry or full. Hunger is an unpleasant sensation of feeling empty that is communicated to the brain by both mechanical and chemical signals from the periphery. Conversely, satiety is the sensation of feeling full and is also determined by mechanical and chemical signals relayed from the periphery. The hypothalamus contains distinct centers of neural circuits that regulate hunger and satiety (Figure 14.7).

A sagittal view of the brain
14.7 Sagittal view of the brain.

Hunger pangs are real and so is a “growling” stomach. When the stomach is empty, it contracts, producing the characteristic pang and “growl.” The stomach’s mechanical movements relay neural signals to the hypothalamus, which relays other neural signals to parts of the brain. This results in the conscious feeling of the need to eat. Alternatively, after you eat a meal, the stomach stretches and sends a neural signal to the brain, stimulating the sensation of satiety and relaying the message to stop eating. The stomach also sends out certain hormones when it is full and others when it is empty. These hormones communicate to the hypothalamus and other areas of the brain to either stop eating or find some food.

Fat tissue also plays a role in regulating food intake. Fat tissue produces the hormone leptin, which communicates to the satiety center in the hypothalamus that the body is in a positive energy balance. The discovery of leptin’s functions sparked a craze in the research world and the diet pill industry, as it was hypothesized that if you give leptin to a person who is overweight, they will decrease their food intake. Alas, this is not the case. In several clinical trials, it was found that people who are overweight or obese are actually resistant to the hormone, meaning their brain does not respond as well to it.[1] Therefore, when you administer leptin to an overweight or obese person, there is no sustained effect on food intake.

Nutrients themselves also play a role in influencing food intake. The hypothalamus senses nutrient levels in the blood. When they are low, the hunger center is stimulated, and when they are high, the satiety center is stimulated. Furthermore, cravings for salty and sweet foods have an underlying physiological basis. Both undernutrition and overnutrition affect hormone levels and the neural circuitry controlling appetite, which makes losing or gaining weight a substantial physiological hurdle.

Genetic Influences

Genetics certainly play a role in the percentage of body fat and weight and also affect food intake. Adopted children are typically similar in weight and body fatness to their biological parents. Moreover, identical twins are twice as likely to be of similar weight as compared to fraternal twins. The scientific search for obesity genes is ongoing and a few have been identified, such as the gene that encodes for leptin. However, overweight and obesity that manifests in millions of people are not likely to be attributed to one or even a few genes, but to the interactions of hundreds of genes with the environment. In fact, when an individual has a mutated version of the gene coding for leptin, they are obese, but only a few dozen people around the world have been identified as having a completely defective leptin gene.

Psychological/Behavioral Influences

When your mouth waters in response to the smell of a roasting Thanksgiving turkey and steaming hot pies, you are experiencing a psychological influence on food intake. A person’s perception of good-smelling and good-tasting food influences what they eat and how much they eat. Mood and emotions are associated with food intake. Depression, low self-esteem, compulsive disorders, and emotional trauma are sometimes linked with increased food intake and obesity.

Certain behaviours can be predictive of how much a person eats. Some of these are how much food a person heaps onto their plate, how often they snack on calorie-dense, salty foods, how often they watch television or sit at a computer, and how often they eat out. A study published in a 2008 issue of Obesity looked at the characteristics of Chinese buffet patrons. The study found that those who chose to eat immediately before browsing the buffet used larger plates, and a fork rather than chopsticks, chewed less per bite of food, and had higher BMIs than patrons who did not exhibit these behaviours.[2]

Of course, many behaviours are reflective of what we have easy access to—a concept we will discuss next.

Societal Influences

It is without a doubt that society affects what and how much we eat. Portion sizes have increased dramatically in the past few decades. For example, a bagel is now more than twice the size it was in the 1960s. Today, teenagers have access to a massive amount of calorie-dense foods and beverages, which is a large contributor to the recent rapid increase in overweight and obesity in adolescents in this country.

Most fast food items have little nutritional merit as they are highly processed and rich in saturated fat, salt, and added sugars. Despite fast foods being a poor source of nourishment, we spend over one hundred billion dollars per year on fast food, up from six billion dollars in the early 1970s. The fast food business is likely to continue growing in North America (and the rest of the world) and greatly affect the diets of whole populations. Because it is unrealistic to say that we should abruptly quit eating fast food to save our health, society needs to come up with ideas that push nutrient-dense whole foods into the fast food industry. You may have observed that this largely consumer-driven push is having some effect on the foods the fast food industry serves (just watch a recent Subway commercial, or check the options now available in a McDonald’s Happy Meal). Pushing the fast food industry to serve healthier foods is a realistic and positive way to improve the Canadian diet.

Tools for Change

Support the consumer movement of pushing the fast food industry and your favourite local restaurants into serving more nutrient-dense foods. You can begin this task by starting simple, such as requesting extra tomatoes and lettuce on your burger and more nutrient-dense choices in the salad bar. Also, choose their low-calorie menu options and help support the emerging market of healthier choices in the fast food industry. In today’s fast-paced society, it is difficult for most people to avoid fast food all the time. When you need a quick bite on the run, choose the fast food restaurants that serve healthier foods. Also, start asking for the caloric contents of foods so that the restaurant becomes more aware that its patrons are being calorie-conscious.

 

Eating Disorders

Although the mainstream media typically projects young, cisgender women to be at the greatest risk of developing eating disorders, recent studies have shown that the prevalence of eating disorders is the highest among transgender and gender-diverse (TGD) people.[3] It is true that eating disorders are extremely complex, manifest in many different ways, and thus cannot be attributed to a single cause. However, one thing that is commonly understood is that all eating disorders allow individuals to alter their physical characteristics to conform to their gender identity and its associated societal norms. Moreover, the increased rates of body dissatisfaction among TGD people are a strong predictor for the development of disordered eating patterns.[4] Although not all transgender people choose to alter their physical appearance, many undergo gender confirmation surgery and hormone replacement therapy to attain ‘feminine’ or ‘masculine’ features. On the other hand, some TGD people also resort to less invasive and more cost-efficient options such as dietary constraints and exercise, which can eventually lead to unhealthy and disordered behaviours as they strive to achieve their desired appearance.[5]

Studies have shown that most TGD people have been victims of some form of discrimination, abuse, or trauma, and therefore, seeking help for an eating disorder can be anxiety-provoking. Additionally, finding a healthcare provider that respects their gender identity, pronouns, and preferred name can also be extremely challenging. Therefore, the first step in prompting long-term wellness among TGD people is to create more accessible and inclusive eating disorder healthcare services that cater to their needs and identities.[6]

 


  1. Dardeno TA, Chou, SH, et al. Leptin in Human Physiology and Therapeutics. Front Neuroendocrinol. 2010; 31(3), 377–93. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916735/?tool=pubmed. Accessed September 22, 2017.
  2. Levin BE. Developmental Gene X Environment Interactions Affecting Systems Regulating Energy Homeostasis and Obesity. Front Neuroendocrinol. 2010; 3, 270–83. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903638/?tool=pubmed. Accessed September 22, 2017.
  3. Riddle, M.C., Safer, J.D. Medical considerations in the care of transgender and gender-diverse patients with eating disorders. J Eat Disord 10, 178 (2022). https://doi.org/10.1186/s40337-022-00699-3
  4. Riddle, M.C., Safer, J.D. Medical considerations in the care of transgender and gender-diverse patients with eating disorders. J Eat Disord 10, 178 (2022). https://doi.org/10.1186/s40337-022-00699-3
  5. Riddle, M.C., Safer, J.D. Medical considerations in the care of transgender and gender-diverse patients with eating disorders. J Eat Disord 10, 178 (2022). https://doi.org/10.1186/s40337-022-00699-3
  6. Ekern, J. (2020). Why Transgender People Are More Likely to Develop an Eating Disorder. Eating Disorder Hope. https://www.eatingdisorderhope.com/blog/transgender-people-likely-develop-eating-disorder#:~:text=The%20researchers%20found%20that%2015,0.55%25%20of%20cisgender%20heterosexual%20men.

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Human Nutrition Copyright © 2022 by Luisa Giles and Komal Dhaliwal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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