This morning at 4am, I woke up to a bowl hitting the floor.
Our food-obsessed lab had climbed onto the buffet and eaten Ukrainian Easter eggs. Real eggs that my kids had decorated and we’d been saving for years.
He met me in the hallway with half an egg hanging out of his mouth. Totally empty.
I was pissed. Still am. He’s getting kenneled while we’re at work today because he’s made his choices and now has consequences.
But here’s the thing about the dog – he’s pretty in touch with his hunger signals. You’ll never catch him standing in front of the fridge at 3pm having an existential crisis about whether he’s actually hungry.
Unlike us physicians.
The Question That Haunts Every Meal Decision
“Am I actually hungry? Or am I just stressed? Should I eat this? What if I’m eating when I’m not really hungry?”
If you’ve ever stood there questioning yourself like this, you’re not alone. This comes up constantly inside Thrive Academy for Physicians.
And it makes total sense. The scale’s not moving. You’re wondering if maybe you’re overeating without realizing it. Maybe you’re eating when you’re not hungry. It creates this whole cloud of confusion and stress around every food decision.
Why We Lost Our Hunger Signals
Two big reasons.
Diet culture taught us to stop trusting ourselves.
Eat less, less, less. Cut out more. Don’t eat if you’ve already had your points or calories. Override your hunger. Suppress it. Ignore it.
After years of being told your hunger signals are wrong, of course you don’t trust them anymore.
Medical training taught us to live from our neck up.
We were trained to ignore bodily signals. All of them.
Suppress the urge to pee during a long case. Skip meals when your double-booked clinic runs two hours late. Not just be up when you’re sleepy, but be up and alert and functioning at a very high level making critical decisions on zero sleep.
All of this we learned in medical training.
So it makes total sense that you may not understand your own hunger signals anymore. When you couple medical training’s disconnect with diet culture’s override – we may have no awareness of our hunger and satiety signals at all.
They seem foreign to us.
Why This Is So Hard to Figure Out
Stress eating doesn’t announce itself.
It doesn’t jump up and down waving its arms yelling “Hey! We’re stress eating! I’m stressed! Let’s eat!”
If it does sound like that, your stress level is probably at such a high level that your brain’s like “Oh my God, I can’t handle it anymore.”
But most of the time, stress eating is way quieter.
Your brain gives you a different reason for reaching for food:
“I’m just hungry.” “That looks so good.” “It might go away.” “Somebody else might have it.” “This might be my only opportunity.” “I just need a break.” “I just need a reward.”
When we dig into these thoughts, they’re usually related to stress eating.
And here’s what’s really tricky: You might not even realize you’re stressed when this is happening.
That’s why it’s so hard to tell the difference.
Physical Hunger: What It Actually Feels Like
Physical hunger is a physiological sensation. It happens in your body.
Your stomach feels empty. Maybe it’s growling. That hollow feeling. You haven’t eaten in a while.
You have low energy. You feel like you need fuel.
You might get shaky. Light-headed. Irritable.
Your focus drops. You’re more distractible. Tasks feel harder than they should be.
Here’s a helpful distinction: If you’re hungry for a specific food, it’s probably not physical hunger.
If you would eat an apple or a piece of chicken breast, you’re probably hungry.
If you only want that specific cookie or bag of chips? Probably not physical hunger.
Physical hunger is “I need food.” Not “I need THAT food.”
Stress Eating: When It’s Above Your Neck
Stress eating is eating as a response to a negative emotion.
It generally comes on suddenly. It’s urgent. You need it now.
It’s for specific foods – usually carbs, crunchy stuff, sweet stuff.
It happens above the neck. It’s a thought-driven urge. You may not feel physically hungry in your body (but you also can have overlap between physical hunger and stress eating- both can happen at the same time)
What to do about it:
First, recognize that you might not even realize you’re stressed. Get curious about what you’re actually feeling.
Ask yourself: What emotion am I experiencing right now? Am I frustrated? Overwhelmed? Exhausted? Anxious?
Sometimes just naming the emotion takes some of the urgency away.
Then you get to decide: Do I want to address the emotion a different way? Or am I choosing to eat right now knowing I’m stressed?
Both are okay. The difference is awareness versus autopilot.
Avoiding Emotions Eating
This is eating to avoid feeling certain emotions.
You’re feeling sad or lonely or anxious. And eating helps you not feel those feelings as intensely. It numbs them out.
What to do about it:
Get curious about what emotion you’re trying to avoid.
Sometimes we’re afraid that if we let ourselves feel the emotion, it’ll be overwhelming. It’ll consume us.
But emotions are just sensations in your body. They come and they go.
Try this: Name the emotion. Then ask yourself – where do I feel this in my body? What does it actually feel like physically?
When you stop avoiding it and just let yourself feel it, it usually isn’t as bad as you thought it would be.
You don’t have to fix the emotion. You don’t have to make it go away. Just acknowledge it’s there.
Sometimes eating is still the choice you make. But when you’re aware of what you’re avoiding, you can also choose other ways to cope. Calling a friend. Going for a walk. Just sitting with it for a few minutes.
Procrastination Eating
You have a task you don’t want to do. So you eat instead.
You know you need to finish your notes from clinic. Or call that difficult family member back. Or deal with that insurance denial that’s been sitting in your inbox. And suddenly you’re in the break room eating chips.
What to do about it:
Recognize the pattern. “Oh, I’m reaching for food because I don’t want to do this task.”
Then you have choices:
You can do the task anyway. Often once you start, it’s not as bad as you thought.
Or you can consciously choose to procrastinate without the food. Take a real break. Go for a walk. Scroll your phone for five minutes. Whatever.
Or you can eat knowing that’s what you’re doing. But do it consciously.
The key is noticing: I’m procrastinating. Not: I’m just hungry.
When you’re aware of it, you can problem-solve. Why don’t I want to do this task? Is there a way to make it easier? Can I break it into smaller pieces? Can I ask for help?
Reward Eating
After you finish a hard day you reward yourself with food.
Got through a brutal 30-patient clinic day? You deserve that pizza. Finally finished charting at 10pm? Time for ice cream.
What to do about it:
This one’s tricky because rewards aren’t bad. We need them (and you deserve them 100%).
The question is: Do you want food to be your only reward? Or your main reward?
Get creative about other rewards. Things that feel good and replenish you.
Taking a bath. Buying yourself flowers. Watching your favorite show. Reading for pleasure. Having a good nap. Saying no to something you don’t want to do.
Food can still be a reward sometimes. But when it’s your only reward, you end up using it constantly. And it honestly isn’t super effective.
Build a list of non-food rewards. Things that actually feel rewarding to you. Not things you think should be rewarding.
You also can be intentional about the types of foods you use for rewards. Often there are some healthier foods that still have that “treat” feel to them. Brainstorm what those might be for you and plan to have them on days where you know you’ll want a reward.
Then when you’ve accomplished something, you have options.
Physical Fatigue Eating
You’re just tired. Physically exhausted. And you’re using food to try to give yourself energy. To try to feel less tired.
What to do about it:
The real answer? You need rest. Sleep. Actual recovery.
But I know that’s not always possible in the moment.
So short-term: Yes, food can give you energy. Especially protein and some carbs. Choose foods that will actually fuel you rather than just giving you a sugar spike and crash.
Longer-term: Look at your sleep. Are you chronically not getting enough? What can you do to prioritize it?
Also look at your schedule. Are you constantly running on empty? What needs to change?
Sometimes the eating is just a symptom of a bigger problem – you’re asking your body to do too much on too little rest.
Post-Call Fatigue Specifically
Post-call is a whole different level of fatigue.
You drag yourself home after 24 hours. Exhausted. Sleep-deprived. Your body’s been in fight-or-flight mode.
And you have this desperate, urgent hunger.
Yeah, you probably need food. You probably didn’t eat well on call.
But let’s talk about what’s actually happening physiologically:
Ghrelin increases. That’s your hunger hormone. When you’re sleep-deprived, it goes up.
Leptin decreases. That’s your satiety hormone. When you’re sleep-deprived, it goes down.
Your frontal lobe is impaired. That’s your impulse control. Your decision-making. When you’re exhausted, it doesn’t work as well.
Your cravings increase for high-reward food.
So that urgency and desperation you feel? That’s not just “I’m hungry.”
That’s your exhausted, depleted, stressed-out body wanting to eat to feel better fast.
Your body wants high-reward food because you feel like crap. That makes total sense.
What helps:
Have foods ready BEFORE you go on call. Foods that are both satiating AND feel like a reward.
Not diet food. Not sad desk salad. Food you actually enjoy that also works for your body.
Choose food that supports your energy on post call days (hint- it’s probably not the highly processed stuff). Hydrate well because hospitals are like desiccation chambers.
Set yourself up to succeed when you’re most vulnerable.
Also recognize that some of this is just going to happen. You’re human. You’re exhausted. Give yourself grace.
Emotional Eating (Positive Emotions)
This is eating in response to positive emotions.
Celebration. Excitement. Anticipation. Novelty.
What to do about it:
This one’s actually fine most of the time. Food is part of celebrations. That’s human. That’s culture.
But you also can get curious about whether the food you eat actually adds to the celebration for you. Sometimes, you end up eating as default when you really were there to celebrate the friends and family you were with.
PMS Eating
Lots of physicians struggle with eating during their PMS week. And it makes sense.
There is a biological component. Your estrogen and progesterone shift. Your metabolic rate increases slightly. You might genuinely need 100 to 300 more calories.
But I think a lot of PMS eating is also stress-driven. You’re crampy, tired, maybe hemorrhaging. And yet everything else has to stay the same. Same work pace. Same patient load. Same demands.
What to do about it:
Write out your perfect PMS week (pretend you have a magic wand for this) What would it look like if you honored what your body needs?
More sleep? Lighter schedule? Rest time when you get home?
Then ask: What elements could I actually put into my life?
Create a protocol for those weeks. Go to bed early. Give yourself quiet time. Go for walks if that helps your cramps.
Acknowledge your needs that week.
Also focus on foods that are satiating but also feel rewarding. You might be seeking treats because you don’t feel well. Find foods that satisfy both needs.
Learning Your Body’s Hunger Language
It’s normal to struggle with interpreting your hunger and satiety signals. But you also can learn them – but it will take some time (just like learning any other language)
The biggest thing is compassion and curiosity instead of judgment.
Not: “I should know this. Why can’t I do it.”
But: “It makes sense I don’t know this. I’m learning a language I was never taught.”
Start paying attention to your hunger signals. Learn what your body feels like.
Notice patterns. What time of day do you get hungry? What does it feel like in your body? What situations trigger eating that’s not related to hunger?
This is learning the language of your own hunger and satiety signals.
Not a failure. Not something wrong with you. Just learning something new.
You’re Allowed to Eat When You’re Not Hungry
I want to make one thing clear: You have the right to eat when you’re not hungry.
Food means more than just food energy. It’s connection, culture, comfort.
Sometimes it’s okay to use food for things that aren’t strictly related to hunger. That’s our human nature, our society, our cultures. That’s often how we connect.
The goal isn’t to only eat when you’re physically hungry.
The goal is to eat when you’re not hungry with awareness. Knowing why you’re doing it.
Not on autopilot. Not out of control. But as a conscious choice.
That’s what makes all the difference.
Why This Actually Matters
Trying to go through life managing your eating and weight long-term while not trusting yourself around it?
Almost impossible. And not fair.
It takes away enjoyment from food. It makes everything harder. It keeps you in this constant state of second-guessing.
But when you start learning your body’s language? When you can tell the difference between these types of eating?
You can make conscious choices. You’re not fighting yourself. You’re not questioning every hunger signal.
That’s food freedom.
Listen to the full episode of the Thriving As A Physician podcast wherever you get your shows to hear all of this in more detail – the specific sensations, more strategies for each type of eating, and how to start trusting yourself again.
Because you deserve to stop questioning yourself at every meal.
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