How can I manage constant hunger and overeating?

Managing Constant Hunger and Overeating

You need a comprehensive evaluation to determine if your constant hunger and overeating represents binge-eating disorder, bulimia nervosa, medication-induced hunger, or physiologically-driven disrupted eating, as the treatment approach differs substantially based on the underlying cause.

Initial Assessment Required

Your evaluation should include:

• Quantification of eating behaviors including frequency and intensity of overeating episodes, whether you experience a sense of loss of control during eating, and any compensatory behaviors like purging, laxative use, or excessive exercise 1
• Screening for binge-eating disorder if you have frequent recurrent episodes of consuming large amounts of food with loss of control 1
• Assessment for bulimia nervosa if overeating is accompanied by compensatory purging behaviors 1
• Review of all medications to identify drugs that may increase hunger or caloric intake, as certain medications (particularly atypical antipsychotics, insulin, and some diabetes medications) can drive uncontrollable hunger 1
• Screening for depression and anxiety using validated measures, as these commonly co-occur with disordered eating patterns 1
• Medical workup including complete blood count, comprehensive metabolic panel with electrolytes, and assessment of vital signs to rule out metabolic causes and identify complications 1

Treatment Based on Diagnosis

If You Have Binge-Eating Disorder

The American Psychiatric Association recommends eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy as first-line treatment 1. This can be delivered in individual or group formats.

If you prefer medication or don't respond to psychotherapy alone within 6 weeks:

• Consider lisdexamfetamine as a medication option 1
• Consider antidepressant medication as an alternative 1

If You Have Bulimia Nervosa

The American Psychiatric Association recommends starting both eating disorder-focused CBT and fluoxetine 60 mg daily 1. You can start fluoxetine either:

• Initially alongside psychotherapy, OR
• After 6 weeks if there is minimal or no response to psychotherapy alone 1

If Hunger is Medication-Related

Review your medication regimen with your physician to identify drugs affecting hunger and caloric intake 1. Common culprits include:

• Atypical antipsychotic medications (particularly olanzapine) which require careful monitoring and potential reassessment of the treatment regimen 1
• Insulin or other diabetes medications that may need dose adjustments 1

Consider GLP-1 receptor agonists (like semaglutide or liraglutide) if you have diabetes or obesity, as these medications can help regulate hunger and food intake, potentially reducing uncontrollable hunger 1. These work in appetite and reward circuitries to modulate food intake and may improve control over eating behaviors 1.

If This Represents Disrupted Eating Without a Formal Eating Disorder

Many people experience physiologically-driven hunger that appears psychological but stems from metabolic disruptions, insulin resistance, or treatment effects 1. In this case:

• Time-restricted feeding to a 6-10 hour eating window can help mitigate the tendency to eat unnecessary meals throughout the day 2
• Address insulin resistance through appropriate macronutrient choices and timing of exercise with respect to meals 2
• Avoid energy-dense, highly palatable foods that promote passive overconsumption, as hunger and satiation depend on the volume of food processed by the gastrointestinal tract, not circulating metabolites 2, 3
• Consider incretin therapies (GLP-1 agonists) which can reduce uncontrollable hunger and overeating behaviors even without a formal eating disorder diagnosis 1

Multidisciplinary Treatment Plan

All eating-related concerns require a coordinated treatment plan incorporating medical, psychiatric, psychological, and nutritional expertise 1. This should include:

• Regular monitoring of weight and vital signs 1
• Ongoing assessment of eating behaviors using validated measures 1
• Treatment of any co-occurring psychiatric conditions like depression or anxiety 1
• Nutritional counseling to establish normalized eating patterns 1

Critical Pitfalls to Avoid

• Do not use phentermine or other appetite suppressants for binge-eating or bulimia, as these are only indicated for short-term weight reduction in obesity and are contraindicated in patients with agitated states or history of drug abuse 4
• Do not assume this is simply a willpower problem - constant hunger can result from complex interactions of genetic, physiological, chemical, environmental, and psychosocial processes 5, 2
• Do not ignore potential medication causes - many psychotropic medications and diabetes treatments can induce hyperphagia 1
• Do not delay seeking specialized eating disorder treatment if you have loss of control over eating, as early intervention prevents symptoms from becoming ingrained 6