- A Loss of Appetite in the Elderly
- A Loss of Appetite in a Parent or Senior Loved One
- What Should I Be Concerned About?
- How Can I Stimulate an Appetite in the Elderly?
- Eating To Encourage a Good Night’s Sleep
- Telltale Signs It’s Time to Treat Your Depression
- What to Eat When You’re Depressed
- Has Anxiety Killed Your Appetite? Here’s What to Do About It.
- The fight-or-flight response shifts focus to the root of stress
- Physical sensations from stress can suppress appetite
- How to regain your appetite if you lose it
- Appetite Changes Reflect Distinct Subgroups of Depression
- How is Anxiety Linked to the Loss of Appetite?
A Loss of Appetite in the Elderly
Last Updated: November 12, 2019
A loss and changes in appetite are a natural part of aging. Although poor appetite doesn’t necessarily indicate a serious health problem such as dementia in the elderly, it is still critical to make sure seniors get enough nutrients. Along with some warning signs to be mindful of, there are some easy ways you can help your senior loved ones get the right nutrition.
Learn more from A Place for Mom’s expert nutritionist, Heather Schwartz, RD, who shares her advice on what to do if your elderly parents are turning down meals.
A Loss of Appetite in a Parent or Senior Loved One
Although it’s normal for our appetites to change with age, several different factors can also cause a loss of appetite in the elderly:
- Lack of energy to cook and tiredness from lack of sleep
- Lack of interest in food due to changing taste buds, depression or loneliness
- Loss of appetite due to health conditions and dementia symptoms1
- Medication side effects
“I remind my clients often that a loss of appetite (and thirst) is a normal part of aging and doesn’t always mean something is wrong,” says Heather Schwartz, RD, at Stanford Hospital and Clinics. “However, minimizing the detrimental effects of poor nutrient intake is always important, no matter from where the low appetite stems.”2
It is also critical to rule out any underlying health problems or symptoms. If your loved ones aren’t eating well, a good first step is always to consult a physician.
What Should I Be Concerned About?
The aging process brings with it many perceptual, physiological and other changes that can lead to decreased appetite in the elderly patient, including:
- A lower metabolic rate and lessened physical activity mean seniors need fewer calories.
- Changes to the sense of smell and taste can affect the enjoyment of food.
- Dental problems or gastrointestinal changes (like lactose intolerance) that go along with age can affect the appetite.
However, if your parents or senior loved ones are making poor food choices because of their changing tastes, or if they aren’t getting enough to eat, then that’s cause for concern. Seniors must get the right nutrition for their changing dietary needs. Vitamin or nutrient deficiencies can cause significant health problems for vulnerable groups, especially the elderly.
Changes to taste or appetite also occur in conjunction with some serious illnesses, including:
- Alzheimer’s disease and dementia or Parkinson’s disease
- Head and neck cancers
- Mouth and throat infections or periodontal disease
- Salivary gland dysfunction
- Thyroid disorders
Any unexplained changes to your loved ones’ dietary health, including unexpected weight gain, loss or general malaise, should be checked out with a physician so you can rule out or confirm symptoms of dementia.
How Can I Stimulate an Appetite in the Elderly?
If you’re concerned about a lack of appetite in your elderly loved ones, whether or not dementia is a concern, there are a few practical things you can do to help them get enough nutrition:
Be aware of medication side effects.
If the problem is dry mouth, Schwartz says, “Chewing sugarless gum, brushing often or using an oral rinse before meals can improve taste sensation, and ultimately nutrient intake.” If meat is tasting “off” — and a common complaint is that some medications make foods taste metallic — then try other sources of protein like dairy or beans. If water doesn’t taste right, try adding herbs, or sliced fruits or veggies like lemon or cucumber.
Consider using an appetite stimulant.
Some seniors have had success with prescription appetite stimulants. A healthcare provider must be consulted to inform the patient and caregiver of the side effects of the stimulant and to also make sure it is appropriate for your loved one.
People of all ages may experience a reduced appetite when the thought of eating alone comes to mind. For seniors, accessibility and availability of social contact can be even more of a problem, especially if they suffer from dementia. Schwartz suggests checking out the meal options at senior centers, temples or churches, and community centers. Additionally, meal “dates” with friends, family or caregivers and even meal delivery services can help.
Increase nutrient density, not portion size.
“I ask caregivers not to increase the volume of food they serve to seniors who may have low appetites,” says Schwartz. “Rather, increase the nutrient density of the foods they serve.” In other words, don’t intimidate them with a huge helping. Alternatively, add healthy extra calories in the form of avocado, olive oil or a little peanut butter.
Set a regular eating schedule.
“Our bodies tend to thrive off regularity, as do our hunger and thirst signals, so when we stray from our usual patterns, so does our appetite,” says Schwartz. She suggests starting slowly by adding a small beverage and/or snack during a normal mealtime. This can help stimulate the body’s hunger signals.
Eating To Encourage a Good Night’s Sleep
In addition to experiencing serious changes in appetite, older adults and individuals with dementia often experience changes in their sleeping patterns. Such changes may be as a result of sleep disorders, such as insomnia or sleep apnea.3 They may also be related to pain or discomfort. It is not uncommon for people to be uncertain when addressing their elderly loved ones’ lack of eating and sleeping. However, both adequate sleep and nutrient consumption are critical for promoting optimal health.
Not eating during the day and feeling hungry at night can make sleeping even more difficult. Such unhealthy patterns increase the frequency of night awakenings. If dementia is involved, this can be very disorienting. Alternatively, chronic fatigue can make elderly adults less likely to finish meals. Consistent sleep deprivation can contribute to feelings of depression and a lack of physical activity, which can also negatively impact the senior’s appetite.
Foods To Eat for Better Sleep
In addition to getting enough to eat throughout the day, it is important that caregivers pay special attention to what is on a senior’s plate during the hours directly preceding bedtime. Try encouraging the following items for dinner and nighttime snacks:4
- Moderate Amounts of Lean Protein: While consuming too much protein can be hard on the digestive system late at night, adding some protein to a late-night snack can help promote sleep due to high levels of tryptophan.
- Warm Drinks: Drinking a glass of warm milk or a caffeine-free herbal tea at night can help relax seniors and boost the production of melatonin. Stay away from drinks with caffeine and avoid putting too much sugar in drinks right before bed. It’s also a good idea to finish drinking approximately 90 minutes before going to sleep to limit middle-of-the-night bathroom trips.
- Healthy, Complex Carbs: Carbohydrates paired with tryptophan-containing protein sources can help tryptophan make it into the brain where it is converted into serotonin. However, it’s a good idea to grab whole wheat toast or sweet potatoes over white bread, cookies, or other unhealthy carbs.
- Fruit: Some fruits such as cherries, kiwis, bananas, and pineapples contain melatonin, which can help seniors get to sleep sooner and stay that way longer.
Make sure to limit meal sizes late at night and avoid overly greasy or spicy foods. Such foods may irritate the stomach and cause difficulty falling asleep. As a result, the patient might avoid future evening meals. Also, older adults should avoid alcohol before bed since it affects normal sleeping patterns.5
Do you have any stories to share or questions to ask about a loss of appetite in the elderly? Share them with us in the comments below.
- How to Prevent Senior Malnutrition
- Senior Nutrition Resources
- The Cost and Health Benefits of Senior Living Nutrition
Telltale Signs It’s Time to Treat Your Depression
Depression is a serious illness with varying degrees. When it’s mild, it makes some areas of a person’s life challenging, according to Deborah Serani, PsyD, a clinical psychologist who specializes in treating mood disorders.
Mild depression typically doesn’t require professional help. It usually abates with holistic methods, such as exercise, meditation and light therapy, she said.
When it’s moderate, it significantly hampers daily life. When it’s severe, it becomes life threatening and requires immediate intervention, she said.
“Without oversimplifying things too much, I generally look at how much your symptoms are affecting your relationships, your daily activities, and how you think and feel,” said Lee H. Coleman, Ph.D., ABPP, a clinical psychologist and assistant director and director of training at the California Institute of Technology’s student counseling center.
Some people might not realize they’re dealing with depression, but they might notice that they just don’t feel like themselves, he said.
According to Serani, it’s time to seek treatment when your depression is moderate, and makes it difficult to function on a daily basis. You might have trouble getting to school or work and keeping up with tasks and assignments. You might want to isolate yourself from others, she said.
These are additional obvious and not-so obvious signs that it’s time to seek help:
- You have thoughts of suicide. “People may have a passing thought from time to time about death, but if you start dwelling on it or thinking about ways to die, it’s important to get help now,” said Coleman, also author of the book Depression: A Guide for the Newly Diagnosed.
- You feel an unshakeable sadness, Serani said. You’re feeling sad most of the time for over several weeks, and your sinking mood is affecting your work or relationships, Coleman said. You become uninterested or you’re too sad to concentrate, he said.
- You feel hopeless or helpless. According to Serani, your thoughts might sound something like this: “Why is everything so hard for me? How come I’m not feeling better?” You may worry that you’ll never feel good, again, and believe there’s no help for you, she said. “Often, helplessness is a negative circle. If you feel helpless, you get more depressed. When you get more depressed, you feel helpless.”
- You feel guilty, worthless or ashamed. Unfortunately, depression is sometimes misperceived as a character flaw (instead of a real, debilitating illness), said Serani, also author of the books Living with Depression and Depression and Your Child. “So many children and adults blame themselves for not being able to snap out of depressed episode.” They think: “I’m so stupid,” or “I can’t do anything right.”
- You experience extreme irritability, anger or impatience, Serani said. “These symptoms are often misunderstood and viewed as ‘burnout’ or
‘stress.’” However, when agitated individuals are further questioned, they “reveal more classical symptoms of depression like negative thinking, helplessness, sadness and hopelessness.”
- You don’t want to be around others. You might start taking time off from work, Coleman said. “Coworkers might ask if you’re feeling OK, or comment to you that you don’t seem like yourself.” (As he said, try not to let this upset you, but instead use it to check in with how you’re feeling.)
- You have a harder time concentrating on tasks, even ones you enjoy, Coleman said. “It’s common for people with depression to read, write and even think more slowly.”
- You’re tired, have less energy or don’t feel like getting out of bed, he said. “A lot of the time, the signs of depression show up in our bodies.”
- You have headaches or body aches, Serani said.
- Your sleeping patterns have changed. You might have trouble sleeping and wake up much earlier than you normally do, Coleman said. Or you start oversleeping. “The key is to look out for a major change in the way you sleep.”
- Your eating has changed. Some people with depression find food to be less appetizing and start to eat less, whereas others eat more than usual, Coleman said. Again, the factor to zero in on is change.
If you’ve noticed these signs, here are several suggestions on what to do next:
- See your family physician. “Getting a physical checkup is vital for diagnosing depression,” Serani said. If Coleman thinks a client may have depression, he also suggests they get a medical evaluation first. That’s because many medical illness mimic depressive symptoms. “Diabetes, anemia and hypothyroidism cause fatigue, irritability, difficulty concentrating, difficulty sleeping, changes in eating habits, listlessness and even depressed mood, just to name a few,” Serani said.
- Find a clinician who specializes in mood disorders. According to Serani, you can ask your physician for a recommendation, contact a nearby university, call the local mental health association or check out your insurance’s list of providers. “At your first appointment, you and your mental health therapist will evaluate your symptoms, create a treatment plan and immediately begin to work on ways to reduce your depression.” You can also consult an online directory, such as Psych Central’s Therapist Directory.
When considering if you need treatment, remember that, “you know yourself best,” Coleman said. So if you’ve been having a hard time with your day-to-day for more than several weeks, consider seeking help.
Also, remember that you’re not lazy or stupid or lacking somehow. Depression isn’t something you choose, Serani said. “This is a medical illness.” And while it’s a difficult and debilitating disorder, it is highly treatable. With proper treatment, you will feel better.
** If you’re having thoughts of suicide, please get help immediately. Call the National Suicide Prevention Lifeline at 1-800-273-TALK or 1-800-273-8255.
Telltale Signs It’s Time to Treat Your Depression
My appetite was disappearing again, but this time I wouldn’t let it go without a fight. I sought out a therapist and did some research on what it means to be depressed.
The first thing I did was look up the symptoms of depression. Seeing “lack of appetite” listed as a symptom on WebMD provided me no comfort. It made my problem feel clinical and distant, as if my problem could easily be fixed with a pill or a check-up. What I wanted was a virtual hug—for someone on the World Wide Web to tell me, “You’re not alone, because I feel this way too.” But as far as I could tell, there was little comfort to be found on the Internet. (I finally felt like someone understood me many years later when Chrissy Teigen detailed her experience with postpartum depression in a strikingly honest letter to Glamour. “I didn’t have an appetite,” Teigen wrote. “I would go two days without a bite of food, and you know how big of a deal food is for me.” I could relate.)
At that point, I had pretty much figured out that depression was at the root of my symptoms. When I met with the therapist, he confirmed the diagnosis and referred me to a psychiatrist who prescribed medication. Since then, I’ve been in counseling on and off.
In the years that followed, I learned many different ways to manage my depression. For me, part of recovery includes meal planning.
It’s now many years since my first depressive episode, and I’ve found ways to deal with my problem that work for me. I’ve taken medicine, seen doctors, practiced meditation, and dealt head-on with the beast that is depression. It’s been a long process (seven years and counting), and some days I still struggle. But I have measures in place to keep me regular. They aren’t the strictest measures, and they weren’t specifically prescribed to me by a doctor, but they are what I’ve found to be the most helpful through my years of recovery.
When I don’t have the drive to eat, I make a meal plan or have a snack. For people who struggle with a lack of appetite from depression, the best thing you can do is force yourself to eat, Rachel Goldman, Ph.D., fellow of the Obesity Society, clinical assistant professor of psychiatry at NYU School of Medicine, tells me. It’s important, she says, because eating something provides your body with nutrients, which will make you feel better. The more you skip meals, the worse you’re likely to feel.
My weekly meal-planning routine is helpful because during the week it allows me to mindlessly prepare the food I’ve already planned over the weekend. It makes it so I don’t need to think about what I need to do or find recipes to cook; I can just walk through the motions I already have set up for myself.
Two years into college, I found myself in another bout of depression. This time, I knew right away that I was depressed, and I attacked it with the things I already knew worked. I made an extensive meal plan that called for exciting, little-known ingredients—things that I could get only from shops outside of my normal stomping grounds. It pushed me out of my comfort zone and forced me to continue eating and adventuring. And it really helped. I was still depressed for a while after, but I knew I’d finally gained a better ability to fight my depression than I had ever had before.
If you or someone you know is struggling with depression and would like to seek assistance, you can visit the National Institute for Mental Health (NIMH) and National Alliance on Mental Illness (NAMI) websites for more information. If you believe you’re depressed, talk with your primary-care doctor or contact a mental-health professional. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255 for more immediate help.
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What to Eat When You’re Depressed
In September, writer Alexander Hardy put out a call on Twitter for “quick and uncomplicated ‘depression meals,’” to help a young relative who was struggling. Hardy — who is also a teacher and mental health advocate — said his relative wanted ideas “for when she needs to eat something more nutritious than jelly beans, chips, or packs of ramen but is too tired & spiritually ashy for great effort.”
The query resonated with Twitter users, who answered with over 1,000 suggestions. Top ideas were frozen meals from Trader Joe’s, a big pot of rice with frozen veggies, and either Asian- or Mexican-inspired toppings (miso, soy sauce, and Sriracha versus salsa, black beans, and cheese), protein-rich snacks like nuts or energy bars, bagged salads, a deconstructed sandwich (eat the meat, cheese, and bread separately), and eggs cooked any way. The key, many people said, was to get the biggest caloric impact with the least amount of effort.
“You helped me tonight when I needed someone to bring me up,” one person responded. “I’ve now had soup, a hard boiled egg, and chips and salsa.”
Hardy says he understood the need for simple meal options due to his own experience with depression and anxiety. “When I’m deep in it, actual meals and not just snacking or eating junk food or surviving off coffee and bubble gum, it can be a struggle,” he says. “When I get anxious, I forget to eat or I’m too anxious to eat or I feel like I don’t deserve to take a pause to eat.”
Straightforward, quick, nutritious meals are desirable to many people regardless of their mental health. But people with depression may be struggling with a clinical lack of energy, as well as deeper-set issues with self-worth.
“When you’re already depressed and you feel like garbage about yourself, you’re just like, ‘Well, I don’t deserve to eat a nice thing. It’s a lot of work, so why even bother?’”
“Mental illness is a spectrum, so for those who are maybe on the deeper end of that spectrum, you may be struggling not just with motivation to eat, but motivation to live, motivation to keep going,” says Hardy. “ to convince yourself that you’re worth saving, you’re worth investing in, you’re worth feeding, you’re worth nourishing and lifting up and pouring energy and time and effort into.”
A.A. Newton, a freelance health and food writer who struggles with depression, can relate. “The only person who benefits from you cooking at home is you. And when you’re already depressed and you kind of feel like garbage about yourself, then you’re just like, ‘Well, I don’t deserve to eat a nice thing,’” she says. “It’s a lot of work, so why even bother?”
To get around this feeling, Newton, who’s written about depression meals herself, keeps calorie-dense snacks like peanut butter and cheese in her refrigerator, and a stash of frozen ravioli and dumplings in the freezer. She says that having something easy on hand that puts a smile on her face can be a big boost. “There’s something about little filled pastas that is just the most comforting ,” she says. “I think that’s something really important for people who struggle with depression and feeding themselves to think about: What is the thing that is so delicious and makes you feel happy that you almost have no choice but to feed yourself.”
Depression’s impact on eating and hunger is well established, says Emily Deans, a psychiatrist practicing in Massachusetts. “Cardinal symptoms of depression will either be weight loss or weight gain,” she says. “Classic weight loss was much more common before we had lots of fast, easy food, but I think it’s the same process that’s going on with both of these.”
One reason is anhedonia, a hallmark symptom of depression where people lose interest in normally enjoyable tasks. To some, food doesn’t taste as good when they’re depressed, which can result in either a decreased appetite or cause people to eat junk food high in sugar, fat, and salt in an attempt to overcome their blunted sense of taste.
For others, the logistics of cooking can seem overwhelming, especially when meal planning, grocery shopping, chopping, and clean-up are factored in. “I find that it’s less the cooking and more grocery shopping that takes the majority of my energy,” says Shauna Morgan, who works in publishing and offered tips on Hardy’s thread. “When I go to the grocery store, if I’m in a depressive episode I sometimes wander around until I’m in tears.”
Deans says this logistical struggle is indicative of depression’s effect on the brain. “Depression affects the frontal lobe, and the frontal lobe is what helps us be motivated, prioritized, organized,” she says. “You actually are less able to do those things when you’re depressed.”
In anticipation of this feeling, Morgan says they keep “depression snacks” — typically protein-rich foods like energy bars, peanut butter pretzels, or almonds — by their bed for really bad days. They will also make a big batch of overnight oats with almond milk, brown sugar, chia seeds, and frozen fruit to keep in the refrigerator for the week.
There’s some evidence that what you eat when you’re depressed could actually help treat your symptoms. In one recent study published in the journal PLoS One, people who changed their diets for three weeks to follow a modified Mediterranean diet centered on fruit, vegetables, whole grains, fish, and nuts were able to improve their depression scores.
The researchers, from Macquarie University in Australia, write that a reduction in processed foods as a result of the diet change contributed the most to the improvement in symptoms. Exactly how diet influences people’s mood is unclear, but one theory is that processed foods cause inflammation in the body, which also affects the brain. Another possibility is that diet’s influence on the gut microbiome results in changes to the brain.
To take advantage of this gut-brain connection, try to keep an emergency supply of healthy, non-perishable foods in the pantry or freezer, such as brown rice, nuts, or frozen fruits and veggies. But if all else fails, don’t feel ashamed to order delivery. “The perfect meal for someone who’s depressed,” says Newton, “is the meal that they want to eat.”
There’s no doubt about it: Breakups can shake us to our core. Although we all deal with them differently, many people have experienced the phenomenon as the “breakup diet.” Why does heartbreak cause us to lose interest in food? We sat down with YourTango experts Marina Pearson and Debra Smouse to find out why loss of love causes a loss of appetite.
For starters, Pearson points out, “Considering that body and mind are connected, it makes sense that if you are upset that your body will be affected.” She explains what happens on a chemical level when we think stressful thoughts: “The first thing the body does is to create more adrenaline, which flows into the body; this increases our cortisol levels. Too much cortisol in the body on an ongoing basis can lead to sustained elevations of blood sugar, substantial loss of calcium from bones, depression of important immune responses, high blood pressure, loss of muscle mass, increased fat accumulation, and even loss of cognitive function. In short, it affects our immune system, and as our immune system is in the gut, is there any wonder that your appetite is affected by a breakup?”
How To Move On From A Painful Breakup
Smouse expands on the physical reactions we often have to food when dealing with breakup pains, explaining that although some people turn to comfort food like cupcakes, wine and ice cream, many others feel ill when attempting to eat: “It’s as if there is a connection between our stomachs and our hearts, and any food crossing our lips sends us into physical pain. We’re unable to swallow. We force ourselves to eat something, and it immediately comes back up. Though we aren’t quite ready to feel healing and hope, we don’t desire to feel any more pain, so we abstain from eating.”
When our hearts are hurting, Pearson says, it is logical that our bodies are, as well. “The body can only ever be in two states: either in a state of repair or a state of repose. If heartbreak is affecting you negatively, then your body will be in a state of repair. If it’s constantly in a state of repair your appetite will be affected, as your body will be working over time.”
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While dropping a few pounds can be encouraging or even feel great, Smouse warns against taking this into unhealthy territory. “My client Ann became almost skeletal after her divorce. Her doctor urged her to put some weight back on, but she was conflicted. She was convinced her husband had an affair because the other woman was ‘skinny’, so what began as a reaction to the anxiety of the breakup eventually became her way to prove to her ex that she could be thin, and therefore desirable. One of the best ways to recover from a breakup is by taking care of yourself both emotionally and physically.” Losing weight can be part of that equation but, as Smouse says, “starving yourself isn’t taking care of yourself…even if it is helping you to shed some extra pounds.”
So how can we move forward and engage in healthier behaviors toward food when we’re reeling from a breakup? Pearson suggests keeping your detrimental daydreaming to a minimum: “Terrifying thoughts about your breakup or ex may look really real to you in the moment, but they are not—just like when you go the movies and see the wonderful special effects, you know that the actors are not really acting on the screen in that moment. The same is true of our thoughts department. Thoughts are the special effects department of our minds, and even though they may look really real…they are not.”
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Once you accept that your emotional and mental demons are able to be conquered (you WILL find love again; you CAN heal), Smouse encourages you to indulge in some self-care. “First of all, allow yourself to feel everything. While numbing seems like a good solution, the longer you put off processing your feelings, the longer it’s going to take to recover. Remember that a breakup involves grieving the loss of the relationship, as well as the idea of what the relationship represented.”
Marina Pearson and Debra Smouse for YourTango.com Marina Pearson and Debra Smouse are columnists for YourTango.com
Has Anxiety Killed Your Appetite? Here’s What to Do About It.
Over the course of just one year, Claire Goodwin’s life turned completely upside down.
Her twin brother moved to Russia, her sister left home on bad terms, her father moved away and became unreachable, she and her partner broke up, and she lost her job.
From October to December 2012, she lost weight rapidly.
“Eating was an unnecessary expense, worry, and inconvenience,” says Goodwin. “My stomach had been in a knot and my heart in my throat for months.”
“I was so stressed, anxious, and preoccupied that I didn’t feel hunger. Swallowing food made me nauseous, and tasks like cooking or doing dishes seemed overwhelming and insignificant when compared to my bigger problems,” she shares with Healthline.
Though my weight loss has never been nearly as significant as Goodwin’s, I too struggle to maintain my appetite when I’m extremely stressed.
I have generalized anxiety disorder (GAD) and in moments of high stress — like when I was in a one-year accelerated master’s degree program and working part-time — my desire to eat vanishes.
It’s as though my brain can’t focus on anything except the thing causing me anxiety.
Although many people binge eat or indulge in rich foods when stressed, there’s a small group of people who lose their appetite during moments of high anxiety.
These people, according to Zhaoping Li, MD, director at the UCLA Center for Human Nutrition, are less common than people who respond to stress by binge eating.
But there are still a significant number of people who lose their appetite when they’re anxious. According to the American Psychological Association’s 2015 survey, 39 percent of people said they’ve overeaten or eaten unhealthy foods in the past month due to stress, while 31 percent said they’ve skipped a meal because of stress.
The fight-or-flight response shifts focus to the root of stress
Li says this problem can be traced all the way back to the origins of the fight-or-flight response.
Thousands of years ago, anxiety was the result of a response to an uncomfortable or stressful situation, such as being chased by a tiger. Some people’s response on seeing a tiger would be to run away as fast as they can. Other people might freeze or hide. Some might even charge the tiger.
This same principle applies to why certain people lose their appetite when anxious, while others overeat.
“There are people who respond to any stress with ‘the tiger’s on my tail’ ,” Li says. “I cannot do anything but run. Then there are other people who try to make themselves more relaxed or more in a pleasurable state — that’s actually the majority of people. Those people eat more food.”
People who lose their appetite are so consumed by the source of their stress or anxiety that they can’t do anything else, including necessary tasks like eating.
This feeling is all too real for me. I recently had a deadline looming for weeks on a long article I just couldn’t bring myself to write.
As my deadline approached and my anxiety skyrocketed, I began ferociously typing away. I found myself missing breakfast, then missing lunch, then realizing it was 3 p.m. and I still hadn’t eaten. I wasn’t hungry, but knew I should probably eat something since I often get migraines when my blood sugar is too low.
31 percent of people say they’ve skipped a meal in the last month because of stress.
Physical sensations from stress can suppress appetite
When Mindi Sue Black recently lost her father, she dropped a significant amount of weight. She forced herself to nibble here and there, but had no desire to eat.
“I knew I should eat, but I just couldn’t,” she tells Healthline. “The thought of chewing anything put me in a tailspin. It was a chore to drink water.”
Like Black, some people lose their appetite due to the physical sensations associated with anxiety that make the thought of eating unappetizing.
“Often times, stress manifests itself through physical sensations in the body, such as nausea, tense muscles, or a knot in the stomach,” says Christina Purkiss, a primary therapist at The Renfrew Center of Orlando, an eating disorder treatment facility.
“These sensations could lead to difficulty being in tune with hunger and fullness cues. If someone is feeling intensely nauseous due to stress, it will be challenging to accurately read when the body is experiencing hunger,” Purkiss explains.
Raul Perez-Vazquez, MD, says that some people also lose their appetite due to the increase in cortisol (the stress hormone) that can happen during times of high anxiety.
“In the acute or immediate setting, stress causes increased levels of cortisol, which in turn increases acid production in the stomach,” he says. “This process is meant to help the body quickly digest food in preparation for ‘fight-or-flight,’ which is mediated by adrenaline. This process also, for the same reasons, decreases appetite.”
This increase in stomach acid can also lead to ulcers, something Goodwin experienced from not eating. “I developed a stomach ulcer from the long stretches with only acid in my belly,” she says.
How to regain your appetite if you lose it
Black says she knows she should be eating, and has taken precautions to ensure her health is still a priority. She makes herself eat soup and tries to stay active.
“I make sure to go for a long walk twice a day with my dog to make sure my muscles aren’t atrophying from the weight loss, I do yoga to stay focused, and I play the occasional pick-up soccer game,” she says.
If you’ve lost your appetite due to anxiety or stress, try taking one of these steps to regain it:
1. Identify your stressors
Figuring out the stressors that are causing you to lose your appetite will help you get to the root of the problem. Once you identify these stressors, you can work with a therapist to figure out how to control them.
“Focusing on stress management will, in turn, lead to a decrease in physical symptoms associated with stress,” Purkiss says.
In addition, Purkiss recommends being aware of the physical sensations that can accompany stress, such as nausea. “When you’re able to determine that nausea is likely related to these feelings, it should be a cue that even though it may feel uncomfortable, it is still essential to eat for health,” she says.
2. Make sure you’re getting enough sleep
Li says that getting sufficient restful sleep is crucial for combating lack of appetite due to stress. Otherwise, the cycle of not eating will be more difficult to escape.
3. Consider eating on a schedule
Purkiss says a person’s hunger and fullness cues only regulate when someone’s eating consistently.
“Someone who has been eating less as a response to a decrease in appetite may need to eat ‘mechanically,’ in order for hunger cues to return,” she says. This can mean setting a timer for meal and snack times.
4. Find foods you can tolerate, and stick to them
When my anxiety is high, I often don’t feel like eating a big, indulgent meal. But I still know I need to eat. I’ll eat mild foods like brown rice with chicken broth, or white rice with a small piece of salmon, because I know my belly needs something in it.
Find something you can stomach during your most stressful periods — maybe a food bland in flavor or one dense in nutrients, so you don’t have to eat as much of it.
Jamie Friedlander is a freelance writer and editor with a passion for health. Her work has appeared in The Cut, Chicago Tribune, Racked, Business Insider, and Success Magazine. When she’s not writing, she can usually be found traveling, drinking copious amounts of green tea, or surfing Etsy. You can see more samples of her work on her website. Follow her on Twitter.
When Hurricane Maria hit Puerto Rico in 2017, Alexandra-Marie Figueroa, 26, was living in Boston and working at Amnesty USA. Following the hurricane’s aftermath, she says, she couldn’t shake the feeling that she needed to be back on the island with her family.
But doing so meant making certain sacrifices.
“When I moved back, it meant actively giving up a lifestyle full of privileges,” she says. “I had access to fresh foods and mobility, and paying for groceries was not an issue . I have a very restrictive diet because of food intolerances, and post-Maria Puerto Rico has made healthy eating even harder.”
However, access to fresher food isn’t the only thing making it difficult for Figueroa to eat a full meal most days. Between juggling a full-time job with law school and dealing with her grandfather’s imminent death, she says she’s found it difficult to take care of her mental health, which in turn makes it harder to feed herself.
“I’ve been running on Vienna canned sausages for the past week,” she says. “I realized it was becoming a problem when a friend found a single can in the back of my car, but I cannot do anything else but eat those while I deal at the moment.”
Figueroa, who has been diagnosed with bipolar disorder and depression, says that when she experiences periods of depression, she has a hard time feeling motivated to cook.
“When I’m high functioning, I’m always in the kitchen. I love to try new recipes,” she says. “When I’m deep in depression, I hardly think anything for myself is worth it.”
She isn’t alone in turning to low-effort meals when her mental health suffers. It’s a concept commonly referred to as “depression meals,” or meals people eat when their mental health makes it too taxing to cook. It’s something people who’ve experienced depression have discussed on social media, and deep Reddit threads, about what they eat when they feel like they just can’t. There’s even a Depression Meals Bingo meme, with things like “ramen noodles not fully cooked through” and “microwavable children’s food” filling in the squares, plus a “forgetting to eat free space,” a painful joke at how even basic self-care can go by the wayside when you’re struggling. While many of us can relate to the feeling of being too tired to do anything more than heat up frozen mac and cheese at the end of the day, depression meals happen when cooking — and any kind of self-care — feels impossible and even pointless.
Brooke Anderson, a 28-year-old living in Los Angeles, says pizza rolls have been her go-to when she’s feeling down ever since she had to start cooking for herself in college. Diagnosed with depression when she was 15, Anderson says she often finds herself neglecting food when she’s feeling low because depression makes it hard to put time into taking care of herself.
“It’s the same reason we don’t want to do our makeup or exercise,” she says. “You lose energy and focus and are literally just going through the motions, so with food, if you’re not going to enjoy it, you just want to make it and eat it as quickly as possible so you can get it over with and go back to depressive actions; in my case, sleep.” So she places the freezer food on a paper towel and microwaves it, eats just for the sole purpose of not starving, and goes straight back to bed.
According to the MayoClinic, low energy and a lack of focus are common symptoms for the estimated 16 million adults in the U.S. who experience depression — as are changes in appetite, and loss of interest in normal activities.
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“Most things feel daunting when you have depression, like brushing your teeth or even getting out of bed,” says Joy Bradford, PhD, an Atlanta-based psychologist who runs the podcast Therapy for Black Girls. “Everything feels like it is requiring you to exert more energy than is typical, so taking care of yourself feels more daunting. And because the added symptom can be a decreased appetite, if you don’t feel like eating, and you don’t feel like moving to do anything, then you just won’t.”
Still, you don’t have to have a diagnosed depressive disorder to be familiar with depression meals. Dr. Bradford says there’s a spectrum of what can be considered depression, from a major depressive disorder to a period of depressive symptoms, which you can experience as a one-off, while grieving someone’s death, or in the aftermath of a breakup, for example.
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“You can see depressive symptoms trigger for a lot of reasons, and they might not always meet the qualifications of having a full-blown diagnosis,” she says.
This can manifest itself in a person finding it extra hard to keep groceries stocked for a week or so; or retreating from friends and family for a while, but the feelings pass. A doctor can help work out potential treatment for phases like these — even if they feel sporadic and short — whether that’s medication, talk therapy, or both. Being too sad or wrung-out to eat shouldn’t be accepted as a normal part of life, and being unable to prioritize your own health even enough to make sure you’re eating is a red flag.
Just as people experience depression in different ways, how they feel about food during a depressive phase can vary wildly, too. Some find preparing a meal — even something bare-bones — to be therapeutic.
Maria Del Russo, a writer in New York City (who has written for InStyle), says that although she hasn’t been diagnosed with depression, she is prone to “depressive periods,” for which she goes to therapy. She says cooking is one of her coping mechanisms for these periods, though getting up to do it can be difficult.
“Caring for myself is admitting that something is wrong, and I think that in my most depressed moments, I’m trying to ignore everything that’s wrong with me,” she says.
Del Russo says her depression meal — pasta with a special tomato sauce —reminds her of home, where her mother would cook big bowls of pasta to make her feel better. Now, preparing it for herself is part of what makes it feel so good.
“Once I get into the groove of cooking, I start to feel better because I am doing something just for myself,” she says. “It’s nourishing and makes me feel like I’m being cared for. Just this time, I’m caring for myself.” Of course, what works for her won’t for everyone — and plenty of people experience depression symptoms so severely they can’t just get into the groove of cooking. But finding something, anything, to sustain during the hard times is important.
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No matter what your brain says, you have to eat — even if all you can manage is a few slices of buttered toast. For patients experiencing loss in appetite or not having enough energy for a meal, Dr. Bradford usually recommends smoothies, or Ensure or Boost shakes that can provide nutrients in a low-lift way.
Having easy-access food items like this on hand for times when you’re too sad, or too stressed, or too busy to eat something more involved is a good hack for making sure you stay fed. But when it feels like there’s something bigger going on with your mental health, self-care may mean making a call, rather than that go-to meal.
When I’m sad, I can’t eat at all. The past two years have been rough, and I’m afraid I’ll always be too thin because I’m never hungry. What can I do?
Sydney, 14, Los Angeles, CA
Emotions play a major part in your appetite, as you’ve discovered, Sydney! Some people can’t stop eating when they’re sad, while others feel like they can’t go near food when they’re upset. Your first step should be to pinpoint exactly why you’re unhappy. Write down everything in your life that is making you upset. Is there drama at home? Are your friends MIA? Is there a guy who hurt you? It might be bottled up inside, and that’s why you should talk with someone close to you (like your mom or a therapist) about whatever is bothering you. Venting and understanding your problems will help you fix what’s wrong or move forward.
Also, try to think of food as a representation of life — it supplies nutrients that will help you stay healthy (and happy!). If you still find yourself not eating at every meal or just having a scarce appetite, make an appointment to see your doctor. He can check if you have any medical problems that would cause you to lose your appetite, and he can help guide you to eating healthy again.
Appetite Changes Reflect Distinct Subgroups of Depression
By Will Boggs
NEW YORK—In patients with depression, appetite increases or decreases reflect pathophysiologically distinct endocrine, metabolic and immune subgroups of the disorder, researchers report.
“I was surprised that by simply asking individuals whether their appetite went up or down during the course of their depression, we were able to identify significant differences in stress hormones, metabolism, and inflammatory markers circulating in the body,” said Dr. W. Kyle Simmons from the Laureate Institute for Brain Research and The University of Tulsa, in Oklahoma.
“I was particularly intrigued, however, by the strong links we found between these changes that were happening in the body and the activity of brain regions that are important to sensing the body’s energy state and responding to rewards,” he told Reuters Health by email.
Changes in appetite and weight are important features of depression, with nearly half of patients experiencing depression-related decreases in appetite and approximately a third experiencing depression-related increases in appetite.
In an earlier functional MRI study, Dr. Simmons and colleagues found that depressed adults with appetite change showed marked differences in brain activity to food cues.
In the current study, they compared the relationships between peripheral endocrine, metabolic and immune signaling and brain activity to food cues between 23 depressed participants who experienced increased appetite and weight, 21 who experienced decreased appetite and weight, and 42 healthy controls.
The only significant relationship between bio-assay values and brain activity was a significant negative correlation between activity in the right posterior insula and the subjects’ ghrelin levels.
Compared with the decreased-appetite group, the increased-appetite group had significantly lower nighttime salivary cortisol levels, higher insulin levels, higher insulin resistance, higher leptin levels and lower ghrelin levels.
Increased-appetite participants had higher levels of C-reactive protein and interleukin (IL-)1RA than did decreased-appetite participants and healthy controls and higher IL-6 levels than healthy controls, the team reports in Molecular Psychiatry, online June 13.
The researchers identified four notable associations between brain activity to food cues and cortisol, metabolic and inflammatory factors: (1) a strong negative correlation between cortisol and ventral striatum activity in the decreased-appetite group; (2) a positive correlation between insulin resistance and insula activity in the increased-appetite group; (3) among participants with the highest IL-6 levels, weak responses to food cues in the decreased-appetite group but strong responses to food cues in the increased-appetite group in both insula regions; and (4) a negative correlation between insulin resistance and parahippocampal gyrus response to food pictures in the increased-appetite group.
“I think there are at least two important implications of this research,” Dr. Simmons said. “First, this work helps us understand how the endocrine, immune, and metabolic changes happening in the bodies of people with depression may lead to changes in brain activity that regulate appetite when they become depressed. Second, and perhaps most importantly, this work strongly supports the idea that there is more than one biological pathway into depression.”
“For some people, depression may be relatively more associated with increased stress hormones – and those folks may experience appetite loss,” he said. “For others with an increased appetite, depression may be associated with immune and metabolic dysregulation.”
“In future studies, scientists may be able to use an easily observable behavioral symptom like appetite change to quickly select among depressed research participants who have different depression biologies,” Dr. Simmons said. “Scientifically, this could be tremendously helpful.”
The researchers note, “Addressing the causality of the relationships reported here will require subsequent studies in which mood and appetite are measured in the presence of interventions that alter activity in basic signaling pathways underlying responses to stress, inflammation, and cellular energy regulation.”
Two of the nine authors of this report, including Dr. Simmons, are employees of Janssen Research and Development, LLC and are coinventors on a patent regarding appetite change and depression.
Mol Psychiatry 2018.
(c) Copyright Thomson Reuters 2018. Click For Restrictions – https://agency.reuters.com/en/copyright.html
The marked variability in the clinical course and symptomatology of depression suggests that this syndrome can arise from heterogeneous etiologies. This observation has motivated an expanding literature of studies using data-driven analytics to identify depression subtypes from behavioral symptom profiles (for example, see (7, 8, 24). Nevertheless, there are presently few examples of differential neural responses among subgroups of depressed patients defined a priori by their behavioral symptoms (but see (20, 21)). Depression-related increases and decreases in appetite and weight have long been codified as antipodal diagnostic markers in the Diagnostic and Statistical Manual (e.g., DSM-5). Yet while appetite changes have long been recognized as common diagnostic features of depression, and more recently as some of the most discriminating depressive symptoms in latent class analyses of depressive subtypes (6-8), there exist no data on differential brain activity among depressed subjects exhibiting increased versus decreased appetites. The present study thus investigated whether depression-related increases and decreases in appetite are associated with differential neural activity in response to food stimuli.
Within regions implicated in neurotypical responses to food stimuli (as defined by food-responsive regions mapped in healthy control subjects), the depressed appetite-increase group exhibited greater responses to food pictures than the depressed appetite-decrease group in the left orbitofrontal cortex and bilateral insula. In other areas, the depressed subjects with increased appetite also exhibited elevated activity relative to both healthy controls and depressed subjects with decreased appetite in the ventral striatum, putamen, ventral pallidum, and additional regions of the orbitofrontal cortex. Unexpectedly, we did not observe differences in hemodynamic activity between the depressed appetite-decrease and healthy control subjects in these regions. Rather, the depressed appetite-decrease group exhibited reduced activity relative to the depressed appetite-increase group in the bilateral anterior- and mid-insula. The most prominent effects were located bilaterally in the mid-insula, where the depressed appetite-decrease group exhibited significantly less activity than both the depressed appetite-increase and healthy control groups, neither of which differed from each other.
Consistent with our findings of greater activity in the depressed appetite-increase group, the neuroscience literature demonstrates that the orbitofrontal cortex, ventral striatum, and ventral pallidum contribute to various facets of reward processing, including stimulus valuation, motivation, and hedonic experience (11, 15, 17, 25, 26). Each of these regions has been previously implicated both in appetitive responses to food stimuli and in the pathophysiology of depression. For example, a large human and non-human primate research literature demonstrates that the orbitofrontal cortex dynamically encodes the value of stimuli with respect to an individual’s homeostatic needs (for reviews, see (25, 26)). This can be seen both in monkey and human studies of stimulus specific satiety, where orbitofrontal cortex activity is potentiated for stimuli that are novel and/or meet immediate homeostatic needs, but declines as the stimulus is repeatedly presented and the physiological need is reduced (27). Recent human neuroimaging evidence demonstrates that anterior orbitofrontal cortex may be particularly sensitive to secondary reinforcers, while posterior orbitofrontal cortex may be specific to primary reinforcers (28). In the present study, photographs (secondary reinforcers) of food (a primary reinforcer) elicited hyperactivation in the depressed increased appetite group in regions corresponding approximately to both Brodmann area 11 (anterior orbitofrontal cortex) and Brodmann area 13 (posterior orbitofrontal cortex). This suggests the depressed increased appetite subjects are excessively responsive to both food cues and food receipt, a possibility that warrants further research. Importantly, the orbitofrontal cortex has also often been implicated in major depressive disorder, as depressed patients exhibit abnormal orbitofrontal cortex volume and blood flow, and orbitofrontal cortex lesions increase the risk of developing depression (29, 30). These neuroanatomical and functional differences in depression may be associated with histological abnormalities, which have been demonstrated by postmortem neuropathological studies of the orbitofrontal cortex in depressed samples (31, 32). Likewise, both abnormal reward learning and anhedonia in depression are associated with attenuated activity and dopamine binding in the ventral striatum (18), a region known to underlie both food motivation (i.e., “wanting”) and hedonic perception (“liking”) (11). Finally, recent evidence from rodent electrophysiology and human neuroimaging demonstrates that the ventral pallidum is a key component in both the experience and anticipation of food hedonics (15), and is implicated in depression (33) (see Supplemental materials for a discussion of the relationship between findings in the present study and the subjects’ clinical ratings of anhedonia).
The anterior insula exhibited a pattern in which the depressed group with increased appetite exhibited significantly greater activity to food pictures than the decreased appetite group, while the hemodynamic response of the healthy group was intermediate between the two depressed groups (Figure 3). This pattern conceivably may reflect the anterior insula’s role as a center for integrating activity within reward and interoceptive circuitry. This account appears consistent with the anterior insula’s functional connectivity to multiple intrinsic networks in the brain, including reward and interoceptive regions (34). As such, the pattern of findings in the anterior insula is generally consistent with prior experimental evidence of altered anterior insula activity in depression. For example, both never-depressed adolescents at high familial risk of depression and currently remitted adults with a history of major depressive disorder exhibited weaker activity in the anterior insula and posterior orbitofrontal cortex to the sight and taste of chocolate (35, 36). Likewise, the anterior insula has emerged as a promising candidate for an imaging biomarker of treatment response in depression, with hypometabolism in this region associated with responsiveness to cognitive behavioral therapy, and hypermetabolism associated with responsiveness to pharmacotherapy using escitalopram (20, 21). In the present dataset we also find that activity in this region differentiates subgroups of depressed patients defined according to a behavioral phenotype (see Supplement for discussion of these findings in relation to the melancholic and atypical specifiers for major depressive disorder).
In contrast to both healthy controls and participants with depression-related increases in appetite, the subjects with depression-related appetite decreases exhibited abnormal activity in interoceptive cortex. The most pronounced differences were observed bilaterally in the dorsal mid-insula, near the location thought to be primary gustatory cortex in the human (37) and where vagal nerve afferent projections from the viscera first synapse in the cortex via connections in the brainstem and thalamus (38). The mid-insula has been repeatedly shown to play a role in interoception (i.e., a term referring broadly to the perception and integration of autonomic, humoral, and immune signals relating to the homeostatic state). Interestingly, the same region of the dorsal mid insula observed here also exhibited homeostatically sensitive category-specific responses to food pictures in an earlier study (16). Specifically, this region exhibited strong responses to food pictures when circulating peripheral glucose levels were low, but weak responses when glucose levels were high. This finding implicates the mid-insula both in interoception and in monitoring the body’s homeostatic energy needs. These links to the normative function of the dorsal mid-insula, when taken together with the results observed here in depressed subjects with altered appetite, accord well with recent reports demonstrating that depression is associated with both altered interoceptive activity in the dorsal mid-insula and abnormal functional connectivity between this region and other regions implicated in the pathophysiology of depression (e.g., the amygdala) (39). As most visceral interoceptive signals reach the brain via the vagus nerve, these findings also appear consistent with evidence for altered vagal function in depression, and the efficacy of vagal nerve stimulation for treating major depressive disorder (40). The accumulating evidence that interoception is compromised in some depressed patients has led to recent theoretical accounts pointing to its role as a central contributor in depression and anxiety (41, 42). Future research is needed to examine endocrine and peripheral vagal function in depression with appetite loss, as well as assess these subjects for altered interoceptive processing of homeostatic signals. This interoceptive region is also sensitive to oral somatosensation (43) and supports overlapping gustatory-interoceptive representations (44). Additionally, a similar pattern of activity across the groups was observed in the caudal anterior insula, near a region implicated in both taste representation and multimodal olfactory-taste integration (45, 46).
Importantly, activity of the dorsal mid-insula was not implicated only in depression with appetite loss. Compared to the other two groups, the depressed subjects with increased appetite inferred that foods depicted in photographs would be more pleasant to eat, and the activity of both left and right dorsal mid-insula to food images in the depressed increased appetite subjects was negatively correlated with these food pleasantness ratings (Figure 4). This negative association suggests the interesting possibility that interoceptive signals about the state of the body represented by increased activity of the mid-insula can act as a brake on food anticipation in those with over-active food reward signals (i.e., the depressed increased appetite group in the present study).
The findings here suggest that if, due to insula pathology, interoceptive representations are aberrant, a depressed individual may fail to make appropriate interoceptive predictions about the homeostatic consequences of encountered stimuli (e.g., sight or taste of food), resulting in the selection of behaviors that do not maintain homeostatic balance (i.e. either increased or decreased eating). These accounts would thus predict that depression-related appetite loss results from a failure to integrate afferent visceral interoceptive signals about the state of the body with external food cues. Conversely, depression-related appetite increases may result from a dysregulation of the balance between increased reward circuit activity (also observed in the present study) and interoceptive inferences in the insula about the homeostatic consequences of perceived foods.
An implicit assumption in this reward-interoception dysregulation hypothesis is the idea that one or more brain regions integrates both reward and interoceptive information. Based on the findings of both the present study and prior research, the ventral medial prefrontal cortex would seem to be a good candidate. Both the left and right dorsal mid-insula seed regions exhibited functional connectivity to the ventral medial prefrontal cortex that was positively correlated with inferred food pleasantness. Thus individuals with the strongest functional connectivity between the ventral medial prefrontal cortex and the mid-insula tended to report that that foods depicted in photographs would be more pleasant to eat, suggesting that the integrated activity of the two regions influences food judgments. Additionally, the ventral medial prefrontal cortex region observed herein has strong anatomical connectivity to the ventral striatum (47) (which also exhibited right mid-insula functional connectivity that was correlated with pleasantness ratings) and has been implicated in the integration of hedonic and non-hedonic information in the computation of food value (48).
Some strengths and limitations of the study design merit comment. Although the sample sizes were relatively low, thereby decreasing the likelihood of detecting less robust group differences, the depressed groups were composed of unmedicated participants, and the depressed subgroups of interest did not differ on BMI, depression severity ratings, or anxiety ratings. Moreover, they did not differ on the Snaith-Hamilton Pleasure Scale once food related items were removed, indicating that the depressed appetite-increase group was similarly anhedonic as the depressed appetite-decrease group (see Supplemental Materials for results after controlling for depression severity, anxiety severity, and anhedonia). One limitation, however, was that the groups were defined based on self-reported appetite changes, without corroborating evidence of associated weight change. An important next step is to examine whether and how these appetite changes translate into altered eating behavior per se. Relatedly, based on the decrease appetite depressed group’s average body mass index and exclusion of subjects with unhealthily low BMI, these subjects were not malnourished in the sense of excessively low caloric intake, and thus the observed functional changes are unlikely to be accounted for by malnourishment. Nevertheless, in future research it will be important to determine whether appetite changes in depression alter the specific macro- and micronutrient content of depressed individuals’ diets. It will also be important in future studies to attempt to recruit moderately/severely depressed subjects who do not exhibit appetite changes, and examine their neural response to food cues, relative to the other three groups described in the present study. Finally, it may also be important in futures studies to determine whether the activations observed in gustatory/interoceptive insula cortex reported here might result from autonomic changes or gustatory recall associated with seeing the food stimuli.
Here we report not only the first neuroimaging study to examine the responses of currently-depressed subjects to food stimuli, but also the first to examine differential brain activity in those who report depression-related appetite increases versus decreases. Our findings demonstrate that food cues elicit potentiated activity in reward circuitry of individuals whose depression is associated with increased appetite. In contrast, food cues elicit attenuated activity in the interoceptive circuitry of individuals whose depression is associated with decreased appetite. These differences in brain activity to food cues may thus serve as novel phenotypic biomarkers of depression subgroups with distinct pathophysiologies, and potentially illuminate the path toward new interventions targeting the development of depression-related obesity, and its concomitant illnesses.
How is Anxiety Linked to the Loss of Appetite?
Anxiety can send the human body into fight or flight mode, which enables a person to manage perceived threat. During fight or flight mode, various changes occur to the gastrointestinal system, as digestion becomes suppressed, elimination is quickened, and the stomach stops breaking down food. These responses are helpful if a person is truly in jeopardy, but can become problematic when the stress response is employed too frequently. When a person is experiencing prolonged anxiety, stomach and digestive issues can arise, including changes in appetite. Some people may experience an increase in hunger and cravings and will engage in binge eating behaviors. Other people may experience a decrease in appetite, although this is usually less common.
Loss of appetite is a symptom of stress and is never a presenting problem. Feelings of worry can distract a person from feeling hunger and bodily sensations can prompt nausea or stomach upset. Physical responses can also interfere with a person’s ability to correctly assess when they are hungry. A lack of appetite can be fleeting, can vary in intensity, and can change throughout the day.
It is hypothesized that a combination of factors causes a loss of appetite in relation to anxiety. Cortisol, stomach acid, hormones, neurotransmitters, and emotional factors are all deemed to be contributors to loss of appetite.
During heightened moments of anxiety, some individuals lose their appetite due to elevated levels of cortisol, the body’s stress hormone. Increased cortisol can boost the production of stomach acids, which speeds up digestion and creates a sensation of fullness. This sensation halts signals to the brain that initiate hunger. Increased acid production can also result in the formation of stomach ulcers.
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Several hormones and neurotransmitters in the brain are correlated with emotion and hunger. Individuals with anxiety often have irregular levels of the neurotransmitter serotonin. Serotonin impacts feelings of fullness and controls the intensity of anxiety. If serotonin levels are unbalanced, anxiety and appetite can become irregular. Hormones and neurotransmitters can impact communication with the brain, as the brain may be alerted that the body does not need to eat when in fact it does.
Emotional factors can play an important role in a person’s loss of appetite. Eating may not be the main focus when a person is worried about other things. If a person ignores the brain’s hunger messages, the body may eventually stop transmitting them.
Appetite loss can have a negative impact on the body and on a person’s functioning. A lack of appetite can deprive the body of important nutrients, thus harmfully impacting a person’s energy levels, sleep patterns, heart rate, metabolism, and immune system. Fatigue and lack of energy can result if a person does not ingest the appropriate amounts of vitamins and minerals. These symptoms can put the body at a disadvantage in coping with stress and reducing anxiety.
A person experiencing a lack of appetite in response to anxiety can utilize behavioral interventions to increase food intake. A person can set an alarm to go off during mealtimes as a reminder to eat. An individual can also eat several small meals per day instead of ingesting larger meals.
While the fight or flight mode is necessary during moments of danger, it can be debilitating if employed too frequently in response to anxiety and stress. The stress response causes changes to a person’s digestive system, which impacts a person’s appetite. A decrease in appetite is believed to be caused by a variety of factors. Appetite loss can have an overall negative impact on the body and on a person’s level of anxiety. Behavioral interventions can assist a person to monitor their food intake during times of stress.