Hunger/fullness scaling is a realistic strategy for long-term weight management. The process involves the following:
1) becoming very aware of how physically hungry or full you are before, during and after eating;
2) becoming very sensitive to subtle differences in hunger and fullness; and
3) responding appropriately to different levels of hunger and fullness.
To measure your level of hunger or fullness, use the 0 to 10 scale described in Table 9-1.
On the hunger-fullness scale, 5 is noted to be comfortable, neither hungry nor full. Increasing hunger is represented by increasingly lower numbers on the scale. A 4 on the scale is when you first become aware that you are less than comfortably full, but you are still comfortable. At 2 you are very hungry, your stomach feels empty and may be growling. A 1 on the scale may be associated with a headache, feeling fatigued or shaky hands. Finally at 0, you are starving, and feelings of fatigue, light-headedness and shakiness are more intense. Higher numbers are associated with fullness. Fullness is a bit trickier to judge than hunger. This is because your stomach has to send chemical signals to your brain so that you recognize fullness. These chemical signals need about 20 to 30 minutes to travel through your bloodstream to your brain. Therefore, for about a half hour after you stop eating you continue to feel increasingly full. Just above comfortable, 6 on the hunger-fullness scale indicates that you are just beginning to feel full. A 7 represents being comfortably full. Eight is when your clothes start to feel tight, and 9 is when you feel uncomfortably full. At 10 you are completely stuffed, and may experience burping or reflux from your stomach up your esophagus. Everybody experiences hunger and fullness differently, so you should consider the descriptors above as guidelines. Modify the scale to reflect you personal signals of hunger and fullness.
Now, to start becoming aware of your own levels of hunger and fullness, as well as of subtle differences in levels of hunger and fullness, use the hunger-fullness scaling worksheet presented in Table 9-1. In the first row, you are encouraged to generally plan to have healthy foods available for meals and snacks. This will prevent stopping off at the deli or the hot truck when hunger cues begin and you do not have a plan or easy access to healthy foods. Following your plan saves hundreds of Calories. If you know you will be out of the house or at work when you get hungry in the afternoon, give some thought as to what choices you will have for lunch. Will there be a place with a healthy salad bar – lean meat, fish or chicken, beans, lots of vegetables, olive oil-based salad dressing and whole grains? Or will your only choices be a high-fat deli sandwich, burgers, hot dogs, pizza or fries? If healthy options will be limited, plan to bring lunch.
Sometimes you will not follow through on your plan. Therefore in the next row of the worksheet shown in Table 9-1, write in the foods you actually do eat at each meal and snack soon after eating. Take time to reflect how often and under what circumstances you deviate from your plan. Does it happen more often when you are stressed or with certain people? How about when you are tired or lonely? Increasing your awareness of these types of patterns is the first step to exploring your relationship with food and improving your eating habits.
Although you are not recording amounts of food, you will be recording levels of hunger and fullness as a means to re-connect the amount of food you eat to internal physiological signals. As an infant, this connection was intact, and you ate when you were hungry and stopped eating when you were full. However, as you grew you were probably encouraged to finish bottles, take one more bite or clean your plate. As you grew even older, you were increasingly exposed to advertisements luring you to eat, eat, eat! Re-establishing this connection takes practice and effort. On the hunger-fullness worksheet, there are gray bubbles in the actual intake row. In the first bubble highest in the box record your level of hunger before you start eating, and in the second bubble record your level of fullness after you are done eating. At first you may find it difficult to assign a number to your level of hunger and fullness, but as you practice you will become increasingly confident in your ability to do so.
Finally in the last notes cell, write how you were feeling, whom you ate with and where you ate, as well as other factors that may affect what or how much you eat. The goal is to stay between a 2 or 3 on the hunger side and 7 on the fullness side. When your hunger gets to a level 2 or 3, you should begin to eat. If you let yourself get too hungry, such as a level 0 or 1, you are more likely to make poor choices, eat quickly and eat too much in response. You should stop eating at a level 7, and about a half hour after eating you may bounce up to an 8. If you eat beyond this level, you are eating for reasons other than physiological hunger. You should keep hunger-fullness records for a few days or weeks, and look for patterns and trends.
Continue this process until the urge to eat dissipates or until you become legitimately hungry and eat. At first it may be difficult to delay eating, but by practicing this process you will be increasingly aware of your hunger and fullness and of subtle differences in the level of hunger and fullness. You will also become increasingly confident in your ability to respond appropriately – to delay non-hunger eating and to eat when you are hungry. Mastering the hunger-fullness scaling process is one of the keys to long-term success.
