3/3/23

Appetite
Introduction to the bio-
psychology of eating
(PSYU1_X1101 – 2023)
LEAH DUDLEY

Introduction

There are two aims for today’s

lecture
― Understand what makes you
start and stop eating
― Understand what happens
when this goes wrong

The organisation of this lecture is

based around addressing these
aims
― The control of eating –
biological, psychological and
environmental
― Breakdown – obesity, dieting,
eating disorders, starvation

Content Ahead

Please note that today I will

be addressing topics
relating to eating
behaviours, including:
• Disordered eating:
• binge eating,
• bulimia,
• Anorexia, and
• the influence of starvation
on psychological states

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Support Services
IF ANY OF THIS LECTURE’S CONTENT RAISES ISSUES FOR YOU,
PLEASE CONTACT ANY OF THE FOLLOWING SUPPORTS SERVICES.

University Counselling Service: Phone 02 9850

7497

Mental Health Information Service: for information

about your nearest free service phone 02 9816 5688

Beyond Blue: Website: www.beyondblue.org.au or

Phone 1300 22 4636

Lifeline: www.lifeline.org.au or Phone 13 11 14

Why do scientists study eating?

• Eating has a big impact on your health (and pocket)
§ By 2025 - 1 in 3 Australian adults will be obese
§ Many will develop obesity-related diseases
§ Poor quality diet linked to cancer and heart disease
§ Eating disorders personally costly and hard to treat – Anorexia is the deadlist of all
psychiatric conditions
§ Diet-related illness costs our health system about 60 Billion $/year (y)
§ Diet is the leading cause of preventable death in the US (including alcohol &
smoking)

• Eating is big business in Australia

§ Processed food manufacture has a turnover of around 74 Billion $/y
§ Fast food sales alone are worth 17 Billion $/y
§ Food & liquor account for 46% of retail spending - 112 Billion $/y
§ Food exports are worth 30 Billion $/y – 11% of our total exports

• If you want to get people to eat more or less - you have to

understand what makes them eat…

Terms & Definitions

“Obesity; Fat”
• I’ll use these terms throughout today in the scientific meaning of them both and
discuss the health-related consequences of both – this is not to say it is good or
bad to carry extra body fat or to dismiss the complexities that determine any
individual’s body weight.

• So, what is obesity?

― It is determined by a person's body mass index (BMI)
― This is your weight in Kg divided by your height in M 2
― BMI provides an estimate of how much fat you have
― Normal BMI is 18.5-25; 25-30 is overweight and 30+ is obese

• When I use the term ‘fat’

― It is determined by a person's body mass index (BMI)
― Referring to the amount of white fat cells stored on a person's body (we have
more when we consume more energy (calories) than we expend.

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How do we control food intake?

Body Environment
• Biological • External Forces
o Energy levels o Food
o Sensation o Time & Place
o Digestive organs o People & Leisure
o Portion & plate

Brain
• Biological & Psychological
o Neurochemicals & Brain
structures
o Conscious/unconscious

Eating

Body - Energy levels

• The body has two modes of energy storage
― A short-term store using glucose (less important for intake)
― A long-term store using fat (more important for intake)

• Changes in body fat affect appetite

― Fat cells secrete a hormone called leptin
― More fat = More leptin, suppressing appetite
― Less fat = Less leptin, allowing food intake to increase

• This is a great example

of a homeostatic system
(when it works!)

The OB/OB mouse can’t make leptin

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Body - Sensation
• Food flavour drives intake
― Taste, smell and touch form flavour
― We are hard-wired to like sweet, salty, and
fatty things
― These flavours gets associated with the food’s
appearance and smell
― Then when we see/smell nice food we want to
eat it

• Sensory specific satiety slows intake in a meal

― The more we eat of a specific food, the more
our liking for it declines
§ It acts to signal the end of a meal (before
stomach and gut signals tell your brain
you are full)
§ It also drives dietary variety
Buffet diners eat more 9

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Body - Digestive organs

• Multiple systems are involved in digesting
food, and all send signals to the brain about
their status
• What are some of these signals?
― Stomach is distended or empty
― Gut and stomach taste receptors
― Stomach is emptying its nutrient rich
content (chyme) into the small intestine
― Gut bacterial signals of fat content The gut itself has a mini-brain, with 500
Million neurons (the enteric nervous
system). It is roughly as complex as the
entire nervous system of the domestic
• How are these signals communicated to the cat
brain?
― Nerves (e.g., vagus)
― Hormones (e.g., CCK & ghrelin)
― Nutrients (e.g., blood lipoproteins)

Pic Ref: Dr Zhi Yi Ong (UNSW) Role of hindbrain neurons in cue-induced feeding 10
behaviours (2023)

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Brain - Neurochemicals

• Many neurochemicals modulate eating

• Two important examples are serotonin (SE)
and dopamine (DA)
― Increased levels of both suppress
appetite
§ Most commercial appetite
suppressants are SE or DA agonists
(i.e., these drugs bind to SE or DA
receptors)
§ Many common psychiatric drugs
affect these neurotransmitters, and
so many also affect body weight

• Neurochemicals are modulated by events

in the body
― Leptin (from fat cells) stimulates release
of CRH in the brain (corticotrophin
releasing hormone) suppressing appetite
― Ghrelin (from stomach) stimulates
release of NY (neuropeptide Y) in the
brain increasing appetite

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Brain - Locations
• Which are important, what do they do, and
how do we know?
― Hypothalamus (lesions, imaging)
• Ventromedial nucleus (stop eating)
• Lateral hypothalamus (start eating)
§ CRH and NY exert their effects here

― Cortical (lesions, imaging)

§ Frontal (impulsivity)
§ Insula (interoception)
― Limbic system (lesions, imaging)
§ Hippocampus (memory) Mr Henry Molaison (HM)
• Eating and HM
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Environment - Food

• A potent means of getting you eat is to show you food

― If you like it, this will trigger a desire to eat and a cephalic phase
response (salivation, insulin release etc)
• All of this is pretty sensible from an evolutionary perspective,
because in the past if you came across ‘good’ food it would be very
sensible to eat it

• However, we can’t now escape from palatable food

― Everywhere there are snack machines, coffee shops, delis and
supermarkets all packed with delicious food
― There are few social prohibitions on eating – anywhere and anytime
is fine
― Food advertising is ubiquitous
§ In the US 4.2 Billion dollars is spent per year advertising just fast
food

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Environment - Time and place

People can be quite habit bound

― They often tend to eat at the same
time (& place) each day
― Time of day (& place) then become
associated with eating
― These can then become cues to
trigger hunger and eating
§ You can see this clearly when
you travel across multiple time
zones and you get hungry at
inappropriate times

When people are placed in deep caves,

with no cues to the passage of time, eating
behaviour changes significantly
― The size of the last meal then dictate
how long it will be before the next
meal - not the time on the clock

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Environment – People and Leisure

SOCIAL FACILITATION OF EATING

• One of the most potent

effects on how much we
eat is the number of
people we eat with
― These effects occur for all
meal types
― They occur with family,
friends, partners and even
strangers
― They also occur in animals More people, more eating

Why?
Primary stimulus is thought to be the
physical presence of co-eaters &
anticipation of the social interaction

Ruddock, H.K., Long, E.V., Brunstrom, J.M. et al.

(2021)
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Another important appetite

stimulant: TV
― TV is the principal leisure activity
of most Westerners
― Eating with TV can stimulate
eating in several ways
― Adverts, learning & distraction –
to name a few

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Environment – Portion and plate

‘THE PORTION SIZE EFFECT’

People tend to eat what is in front of them

― If you have a large plate you will eat
more than if you have a small one
― If you are given a larger serving you
will eat more
― Average portions sizes have increased
in recent times

Mean portion sizes in the US are on average

25% larger than in France
― So are plate sizes, recipe book
portions, and even guidebooks focus
more on portion size in the US than in
France
• A candy bar in Philadelphia was
41% larger than the same candy bar
sold in Paris.
• A soft drink was 52% larger, and a
hot dog was 63% larger.
• A carton of yogurt was 82% larger.

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All these forces – so who’s in

charge?
• Who is in charge – body, brain or ‘self’?
― When and how much we eat seems to be mainly driven by
environmental factors that we are not usually aware of – mindless
eating – environment/brain
― Biological factors are probably only important at the extremes
(starvation/gross over-indulgence) – body/brain
― Conscious control of food intake probably only plays a small role –
self-brain

A crucial conclusion – the brain ultimately controls how

much we eat, so when control of eating breaks down, this is
a brain-related problem

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Breakdown - Obesity

Obesity is the main eating-related health problem

― Obesity causes chronic illness – Type II Diabetes, circulatory disease,
joint damage, cancer (and many more)
― All of these diseases are costly from a personal, social and economic
perspective

People in the West have been getting fatter

over the last 50 years, with obesity rates
tripling or quadrupling in many countries
― On the obesity leader board…
§ Among OECD countries Australia is
3rd (US 1st, NZ 2nd )
§ Among all nations Australia is 31st
(Pacific island states are the top 7)

So how prevalent is obesity in Australia and

in NSW?

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Breakdown - Obesity - Prevalence

Prevalence for adults in Australia
and NSW, and kids in Australia
(like other industrialised nations)

Overweight & obese in NSW, 2015

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More recently
AUSTRALIAN INSTITUTE OF HEALTH AND WELFARE

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Breakdown - Obesity - Why?

• People in the West have gotten much fatter over the last 50 years
• The basic reason why is simple
― Energy intake exceeds energy expenditure
― Excess energy is then turned into fat and stored in white fat cells
• The key thing is that our environment has changed
― We move less and we eat more
― While our genes have not changed, they are still very important
in determining who gets fat – which sounds confusing doesn’t it?
§ Identical twins’ studies show that 70% of their variability in
weight can be accounted for by shared genes
So why do genes matter?
• In an environment where food is scarce and you
have to work very hard to get it, no one gets fat
and genes that predispose to weight gain can not
influence body weight
• However, in an obesogenic environment, genes
that predispose to weight gain can be very
influential, making some people much fatter than
others
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Foresight – Obesity System Map

COMPLEXITY OF OBESITY: CONTRIBUTING FACTORS

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Breakdown - Dieting
• Dieting is still the principal form of treatment for obesity
• Dieting is also very popular amongst the population at large
― Over 70% of adults claimed to have dieted
― Most people diet because they believe that weight loss will make them
more attractive
― People have very unrealistic expectations about dieting
• All diets work by limiting energy intake (calorie deficit)
• Most attempts at dieting end in failure – why?
― It relies on conscious regulation of food intake, which needs masses of
self-control
― Most attempts at dieting are too short (4 weeks vs. 20+ weeks)
― Most lost weight is regained even in controlled clinical trials (see graphs
below)

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Fad Diets
https://eatrightchicago.org/fad-diets/.

•1820: Vinegar and Water Diet – made popular by Lord Byron

•1825: Low-Carbohydrate Diet – first appeared in “The Physiology of Taste”
by Jean Brillat-Savarin
•1903: Fletcherizing – Horace Fletcher promotes chewing food 32 times
•1925: Cigarette Diet – “Reach for a Lucky instead of a sweet.”
•1928: Inuit Meat-and-Fat Diet – caribou, raw fish, and whale blubber
•1930: Dr Stoll’s Diet Aid – first of the liquid diet drinks
• Hay Diet – carbohydrates and proteins are not allowed at the
same meal
•1950: Grapefruit Diet – also known as “Hollywood Diet”
• Cabbage Soup Diet – flatulence is listed as a main side effect
•1961: Calories Don’t Count Diet – FDA filed charges regarding diet’s
claims
•1976: Sleeping Beauty Diet – individual was heavily sedated for
several days
•1981: Beverly Hills Diet – only fruit for first 10 days, but in unlimited
amounts
•1990: Cabbage Soup Diet – diet from 1950’s resurfaces on the Web
•2001: High Protein, Low Carb Diet – 1994 diet updated
•2006: Maple Syrup Diet – features a special syrup-lemon drink
•2008: Banana Diet – bananas for breakfast, plus room-temperature water
•2010: Baby Food Diet – basic plan: 14 jars of baby food a day, optional
adult dinner

http://www.eatright.org/NNM/content.aspx?id=5334

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Restrained vs Intuitive Eating

Relationship to: Body Satisfaction, Self-esteem & BMI

Intuitive eating is better for lower

weight, body satisfaction & BMI

Study: Strodl et al. (2020) A cross-country examination of

emotional eating, restrained eating and intuitive eating:
Measurement Invariance across eight countries. Body
Image, 35:245-254. doi: 10.1016/j.bodyim.2020.09.013.
Epub 2020 Nov 2. PMID: 33147542.

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Recommendations
FRUIT + VEG + EXERCISE

For healthy people I would not

recommend dieting, instead I would
focus on making some simple
changes to prevent further weight
gain and get fit!

Exercise all you can, eat

loads of fruit and veg, avoid
soft drinks, limit
processed/fast food

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Eating Disorders

• National Eating Disorder Awareness Week (US)

― February 27th – March 5th, 2023

5 types of eating disorders in the DSM:

1. Anorexia Nervosa,
2. Bulimia Nervosa,
3. Binge Eating Disorder (B.E.D.),
4. Avoidant Restrictive Food Intake
Disorder (A.R.F.I.D.), and
5. Other Specified Feeding or Eating
Disorder (O.S.F.E.D.).

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Eating Disorders

Only very high-level to introduce you at this stage of your degree – it

is a lot more complex and not all community members are included in
the general research however (studies use very select samples often
WEIRD populations), more is needed to adequately support these
groups including the neurodiverse and transgender community.

Overview & outcomes:

Eating disorders are internalizing disorders – behaviors exhibiting severe and
persistent disturbance in eating behaviors and associated distressing thoughts
and emotions.

Current diagnostic approaches make treatment and recovery difficult

• Highly complex - 40-60% of all ED “other specified feeding and ED”
• Only 40-60% with ED recover
• 40-50% with an ED migrate within 5 years to a different ED
• 80% with an ED have a co-occurring internalizing disorder (mood, anxiety,
trauma related, or OCD)

Forbush, et al., (2018) 29

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Breakdown – Eating disorders

Binge eating disorder

• Repeated binges, no compensation – in 9-18% of obese people

Anorexia nervosa (AN)

• Dietary restriction (and/or purging), intense fear of weight gain, disturbance of

body image – in 0.5-2% of women
• No single cause – multi-factorial
• Significant genetic components (obsessive compulsive traits – perfectionism,
rigidity), common appearance at menarche coincides with a major redistribution
of body fat creating a ‘window of vulnerability’
• Stress, adverse life events, cultural emphasis on thinness also play a role
• Difficult to treat and most lethal of all psychiatric disorders (5-10% lifetime
mortality)

Bulimia nervosa (BN)

• Binge eating with compensation, adverse self-evaluation – in 1-3% of women

• Multi-factorial, but far easier to treat than AN

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Muscle Dysmorphia & Orthorexia

Muscle Dysmorphia:

• Body Dysmorphic Disorder subclass.

• Centered around building more muscle – preoccupied
with body being too small or insufficiently muscular
• More common in men (2.2% vs 1.4% in women)

Orthorexia Nervosa:

• Not formally recognised

• Not in DSM -5th Ed - but becoming more recognised.
• Obsession with “healthful/proper/clean eating”.

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Breakdown - Starvation
• Around a billion people don’t get enough to eat
― Malnourishment exerts its worst effects on children, “…The psychological aspects
stunting their growth, permanently lowering IQ and of starvation are unbelievable.
limiting future earning power We went there because we were
― In all people malnourishment impairs immunity and
this is what takes so many lives when there is a concerned about people abroad
famine and wanted to do what we
could to help those less
• Starvation, not surprisingly, has a big impact on
behaviour fortunate than ourselves, and I
― This was studied intensively by the US Minnesota think we lost that feeling after
Starvation Study about two months. At the end
― The effects are best described by Samuel Legg, one
of the volunteers… of 5 months of starvation our
attitude was “to heck with the
people abroad; I am hungry”.
That was all that was important.
The only important thing left
was whether I was ever going
to get food. I was only
interested in myself…”
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Conclusion

You might want to think about the broader

implications of scientist’s conclusion, that On a more individual level, you can easily
much of our eating is ‘mindless’ improve your dietary behaviour and lower
your risk of all those obesity related
This is important because it touches on a red diseases
button issue in politics, freedom to choose Eat more fruit and veg and less processed
versus regulation and the ‘nanny state’ food – and exercise more
If we mindlessly eat our way to being obese Irrespective of dietary fads (e.g., keto, paleo
can we truly say that we have chosen to do diet etc) this basic advice is very well
so? supported and has remained unchanged for
There are powerful lobby groups that say over 70 years.
people do choose what they eat and so
effectively choose to get fat
Funnily enough most of them sell food
implicated in weight gain – soft drinks,
chocolate, crisps and fast food…
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Diet, Mood, & Lifestyle Study

CHECK IT OUT ON SONA

3-week diet change study:

Investigating the effects of diet

change on mood, and lifestyle.

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Support Services
IF ANY OF THIS LECTURE’S CONTENT RAISED ISSUES FOR YOU,
PLEASE CONTACT ANY OF THE FOLLOWING SUPPORTS SERVICES.

University Counselling Service: Phone 02 9850

7497

Mental Health Information Service: for information

about your nearest free service phone 02 9816 5688

Beyond Blue: Website: www.beyondblue.org.au or

Phone 1300 22 4636

Lifeline: www.lifeline.org.au or Phone 13 11 14

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