by Wilson, Bee
Teachers report children fainting on the playground; or those who come to school wired on a breakfast of sweets and fizzy drinks, or leftover scraps of fried takeout; in rare cases, boys’ and girls’ stomachs are distended, as with the African children on the TV news during famines. The UK charity Magic Breakfast tries to address the problem. Former businesswoman Carmel McConnell founded the organization in 2001 after visiting London’s inner-city schools as part of her research for a book. Shocked to hear of pupils complaining of hunger, she immediately got to work. Now, Magic Breakfast supplies more than 8,000 children with healthy breakfasts through morning “clubs.” The breakfast usually consists of cold cereals and milk, fresh fruit, and special protein-enriched bagels served with butter and jam; sometimes there is porridge, which fills the children up if only they can be persuaded to eat it.
On a bright July morning, I eat a “Magic Breakfast” at Keyworth primary, an “outstanding” school in a deprived area of South London. The children—aged four to eleven—are eating buttered bagels and wedges of apples and oranges. There’s a good, toasty smell in the room. The atmosphere is calm, with a group of soccer-mad boys at one end of the table and a gaggle of girls chattering away at the other end. The school’s head teacher, Susi Whittome, remembers that before the “breakfast club” was introduced, children often arrived at school either sleepy or “upset,” with many kids going wild or zoning out in class, which turned out to be a response to hunger. Both behavior and educational results at the school have greatly improved now that the children are not hungry. Whittome wants children to leave her school as “ambassadors for social justice”—not easily done on an empty stomach.
The symptoms of long-term hunger are horrible and complex, all the more so in a child. Apart from loss of weight, the child may feel tired and cold all the time, and worried, depressed, or disengaged. She bruises easily and lacks focus. Her skin is dull, and she may have permanent goosebumps and cracked lips. “White lips on black children” was one of the signs of hunger observed by Marvin Davies, a social worker and teacher working with agricultural laborers and their families in Florida in the 1960s. Prolonged chronic malnutrition affects children for the rest of their lives, because it affects both brain development and growth. One in four children in the world is stunted by hunger, and many of the consequences are irreversible. Yet in the short term, food has a power to reverse the symptoms of malnutrition very quickly. After just three or four weeks of adequate feeding, a child’s body may get back in sync: anti-hunger charities in the developing world cite similarly quick rates of recovery from feeding interventions. Magic Breakfast workers say they see children perked up by the very first bagel, which may give them enough energy to stay awake for that morning’s lessons. The psychological consequences of hunger, needless to say, last longer.
When I sit and eat with the children at Keyworth primary and ask them what they like about the breakfast, I expect them to talk mainly about the food. Certainly they are chewing their bagels with gusto. But what most of the children bring up is the social aspect. “It’s fun,” says one. “The best bit is playing games,” says another. When the children have finished eating and cleared their dishes, they are allowed to catch up with homework or play board games like Monopoly and Connect Four. Three sisters are sitting in a row, laughing.
Many of these children live in housing so small that there is no room to eat together around a table. When I ask one of the girls what she eats for breakfast on weekends, she says, “Anything random.” It isn’t just food that is lacking in their lives; it’s the space to share it in and the mood of relaxation and security that comes from a structured communal meal. In 2011, a study of more than 22,000 low-income families with young children found that those who lived in crowded housing were more likely to suffer from food insecurity. Likewise, a hundred years ago in Glasgow, investigators found that there was a direct correlation between the housing where a child lived and the extent to which they were underfed. Whereas a thirteen-year-old from a house with four rooms weighed, on average, nearly eighty pounds, a child of the same age from a one-room dwelling weighed just seventy pounds. It may be that the size of the home and the child’s weight had a common cause in poverty: those families who could only afford one room were also those with the least money to spare for food. Either way, cramped accommodation is still one of the biggest obstacles to feeding a family well, because whether a meal is satisfying depends on the setting and the company as well as the food.
A breakfast club gives these children something their hard-pressed families couldn’t provide them no matter how hard they tried: the chance to sit at a spacious table and eat with friends. Food—the right food—is clearly essential to preventing hunger. High-protein bagels are good, especially when the alternative is a growling tummy and a fuzzy head. But talking to these children at Keyworth primary, it’s clear that the craving that they needed to satisfy was for something more than just toast. What makes breakfast clubs such as this one so effective is that they feed the hunger for social interaction as well as the hunger for food.
Hunger runs deep. Before you can fully cancel it out, you need to learn what it is you are truly hungry for.
Being able to regulate the amount of food we eat according to our needs is perhaps the single most important skill when it comes to eating—and the one that we least often master. In contrast to its close relation, appetite, hunger looks like a basic impulse: an expression of the body’s biological need for food. Yet the more you examine it, the more you see that hunger is not a simple drive at all. Hunger is always a kind of emptiness—an absence of nourishment—but what it will take to replenish it is far from obvious. Back when we were children, we learned to respond to hunger in ways that were only partly about our body’s need for food. Maybe we suppressed our hunger so that we could eat less and lose weight, or we feigned it so we could eat more. Or we ignored it because we would rather carry on playing. Very little of the eating that happens in the modern world is as simple as feel hungry, eat food. The great challenge for most people is learning how to recognize when we have had enough.
“The cry of the newborn for food,” says physiologist Anton J. Carlson, is hunger in its “purest form,” a pain that is immediately quieted with feeding. For the rest of our lives, hunger will never be quite so pure again. With animals, the main test for hunger is eagerness for food, but it’s one of our quirks as humans that we sometimes remain eager to eat even when our bellies are full to bursting. The existence of anorexia proves that it is possible to be hungry and yet not eager for food. Children will declare that they are stuffed and couldn’t eat another morsel, pushing their main course aside, only to discover that they are, in fact, “starving” when a tray of cupcakes appears. Many are quick to learn that “hunger” is the ultimate justification for eating. As a teenager, I remember often claiming I was peckish when really I was just lonely and bored. It’s far harder to refuse a child’s request for snacks when he pleads an empty stomach. Maybe grown-ups are not so different. I’ve lost track of the number of times I’ve heard waiters—hoping to sell something from the dessert menu—claim with an endearing smile that we have two separate stomachs, one for savory, one for sweet.
Even discounting the little lies we tell ourselves to justify a slice of cheesecake, hunger is not easy to measure or define. The feeling of nausea or stomachache—which ought to be the exact opposite of hunger—is remarkably similar to it in the early stages: rumbling in the gastrointestinal tract, stabbing pain in the abdomen, a restless feeling that your body is out of kilter and needs to be given something to fix it. Equally, it is possible to be so hungry that you do not feel hunger anymore. Aid workers helping acutely malnourished children perform an “appetite test.” If a child is so weakened that she refuses a small amount of food offered by a parent, she is in imminent danger and must be admitted to a hospital. Among nutritionists, there is no universally recognized standard for measuring the sensatio
n of hunger. Common sense might say that hunger could be gauged by the amount of time since you last ate. If food is a fuel, we should feel that the tank is emptiest when the longest time has elapsed since it was filled—usually, in the morning. Unless you dabble in midnight feasts, the longest gap between meals is the overnight stretch before breakfast. Yet numerous trials have shown that people do not tend to be hungriest in the morning, despite the gap.
Most people do not feel their peak hunger at weekday breakfast time (though they are more likely to be hungry for a weekend breakfast, another sign that hunger is a social drive). Some—mystifyingly, to me—have to be coaxed to nibble anything much in the morning. One of the great regrets of my life was pretending to be such a person when I was seventeen and on a language exchange with a family in France. On the first morning, they asked what I liked for breakfast. In my stilted French, I said I preferred just to drink black coffee, thinking this would make me look sophisticated (and yes, probably kidding myself that I’d come home as skinny as a French girl). Day after day, I watched in silent envy as the family devoured crusty baguettes with fresh white butter and apricot jam along with bowls of milky coffee and hot chocolate. I sipped my acrid black coffee. My pride would not allow me to admit how famished I was.
Apart from the gap between meals, another way to measure hunger is through various hormonal “biomarkers.” These seem to promise a more objective, scientific way to determine whether a person is hungry, though in practice they confirm that hunger is never fully objective. In the 1950s, low blood glucose levels were supposed to be the main cause of hunger (this was the “glucostatic” theory of the late Dr. Jean Mayer, a Harvard nutritionist who became president of Tufts University). When spending the afternoon with a toddler, sometimes it feels as if you can see the child’s blood sugar levels dropping by the second. If you catch them in time with a banana, all will be fine. If not, they will flatline into a tantrum.
Sure enough, there is a link between blood glucose and hunger. As we know from people with diabetes, our bodies react severely when blood sugar is too low: shakiness, nausea, and sweating often result. But this does not mean that blood glucose can be used as a simple measure of hunger. It transpires that absolute glucose levels in the blood are actually a very weak indication of hunger and fullness. Glucose injections do not tend to reduce appetite, at least not much. High glucose in the blood, strangely enough, does not translate to high glucose in the small intestine. What does induce hunger is when blood sugar rapidly drops. In a lab situation, a decline in blood glucose over a short time frame—a few minutes—will fairly reliably prompt human subjects to ask for a meal. Yet this is still not the whole story. In one study, fifteen overweight men were asked to stay in an isolated room free of clocks or any other indication of when mealtimes might be; meanwhile, their blood sugar was continuously monitored. They were free to ask for a meal whenever they liked. Among them, they asked for forty meals when they were in a “postabsorptive state,” meaning the point at which all the food they had eaten at their last meal had been absorbed from the digestive tract. Yet, in these men, the hungry moments never coincided with a drop in blood sugar.
Another “biomarker” for hunger is a hormone in the gut called CCK (for cholecystokinin), which is released into the blood when the body detects fat or protein. At least sixteen separate scholarly studies have shown that the presence of CCK suppresses hunger, but since it works primarily when the stomach is full, it hardly represents much progress as a measure for hunger. After twelve healthy men were given slow intravenous doses of CCK, they spontaneously reduced the amount of food they ate (including strawberry jelly on Ritz crackers) by an average of 122 grams. But that average conceals great variation. Three of the twelve men actually ate more food when they were dosed with CCK. A 2003 study found that the appetite-suppressing effects of CCK are greatly increased when the stomach is distended. But we already knew that people with distended stomachs tend to feel full, CCK or not.
There has been much excitement in scientific circles over two other hormones, leptin and ghrelin, that appear to work in tandem to influence our hunger. The theory is that leptin reduces hunger and ghrelin increases it. Leptin is what tells the brain how much body fat is being stored and is available for use. Certainly, a high level of it causes laboratory animals to eat less. With humans, though, it’s complicated. There have been rare cases of hugely obese children whose bodies lacked leptin and who were crazed with hunger, scavenging rotting food from rubbish bins or uncooked fish fingers from the freezer. Leptin injections got them back to normal levels of both hunger and weight. Among those of average weight, however, leptin concentrations do not change markedly after a meal; it is only after starving for longer periods, twenty-four hours or so, that leptin concentrations in the body fall significantly.
Given that leptin sends information about how much fat is available to the brain, its usefulness as a measure of hunger depends on what else is happening in the body. Binge eaters often have relatively high levels of leptin circulating in their systems, as do obese people, but this does not mean that they never experience hunger. It has been suggested that obesity may trigger leptin resistance in the body, such that it no longer works as a signal for reducing appetite.
Ghrelin—a hunger stimulant—may be a more promising biomarker for hunger. People who suffer from a rare condition called Prader-Willi syndrome, characterized by extreme and unassuageable hunger, have four and a half times more ghrelin in their systems than others who do not have the condition. But the absence or presence of ghrelin is not enough to cause hunger. In people with regular mealtimes, the feeling of hunger appears to arrive before the amounts of ghrelin in your system increase.
The most common way scientists measure whether someone is hungry or not remains simply asking them. Your answers are then mapped on a scale. For example, you might be asked “How hungry are you?” and prompted to mark your answer on a line somewhere between “Not at all” and “As hungry as I have ever felt.” Our bodies give us some pretty clear signs that they want food, including tightness in the stomach, loud rumbling of the digestive tract, a feeling of hollowness, lightheadedness, dryness in the mouth or throat, and sometimes a weird excitability. In pigeons that have had the cerebrums removed from their brains, hunger leads to an intense, restless running about, which instantly stops with just a few grains of wheat. Humans are not pigeons. The problem with subjective reports of hunger is that different people experience lack of food in such vastly different ways.
My mother was a wartime baby—born in 1941—and many times told me and my sister of the hunger of the late 1940s, after the war, when rationing was still in force in England. She attributed her lifelong fear of small portions to this austerity. Rationing had taught her that no portion could ever be too big. Years later, on long family car journeys, she could not bring herself to stop at the motorway restaurants called Little Chef, not because she thought the food was bad—which it was—but because the adjective “little” convinced her there wouldn’t be enough of it. A story she told repeatedly to illustrate the hunger of rationing was of the day as a child when she felt so ravenous that she burst into the larder and ate a whole block of margarine. Such hunger! But one day, her older brother, my uncle, was having lunch at our house when she told the margarine story again. Did he remember feeling terribly hungry, too, during those wartime years? she asked. Not particularly, no, he said, and changed the subject.
The most famous attempt to measure what hunger actually does to the human body was the Minnesota Starvation Experiment, conducted in 1944–1945 at the University of Minnesota. For twenty-four weeks, thirty-six strapping and healthy young men were put on a reduced diet of 1,560 calories, a similar amount to what many weight-loss diets now recommend. As well as losing, on average, a quarter of their bodyweight, they suffered intense psychological and physical distress. Some became obsessed with reading cookbooks. Many found that their sex drive declined, and they
withdrew socially. It was common to feel dizzy, moody, and nervous. They bit their nails, chewed gum, and drank coffee in profusion. A few became paranoid that they were being given less food than others, or engaged in bizarre behavior, such as dousing their meals in water and spices. But while they all ate the same amount of food, they varied in the degree and quality of the hunger pains they felt. Two-thirds reported feeling hungry all the time, but another third did not. For some, hunger felt like a mild discomfort in the abdomen; for others it was a sharp and intolerable shooting sensation. In the months after the experiment ended, their ability to gauge hunger went haywire. They might eat as many as 6,000 calories, gorging until they were uncomfortably full and gassy, yet still feel unsatisfied.
Hunger—this mechanism that we suppose to be so basic—turns out to be one of the more intricate bodily impulses. Feeding it is not like putting petrol in a car. There is nothing straightforward about gauging its extent, either from the inside or from the outside. Nor is it an easy thing to terminate. The mere fact that we speak of hunger as simple may be a sign of how little we have understood what it would mean to master it.