Conditioned Intake and Fattening/Diabetes

Background: Obesity, diabetes, asthma, autism, birth defects, dyslexia, attention deficit-hyperactivity disorder, and schizophrenia have increased in children in the last half century. The will (decision) to eat develops often when previous energy intake has been incompletely exhausted. Objective: The will to eat develops after stimuli (often external) that do not correlate with energy availability in blood. Training a relation between hunger sensations (Initial Hunger, IH) and Blood Glucose (BG) as an index of energy availability allows an IH Meal Pattern that is associated with low mean BG and insulin sensitivity. Lack of any relation between the will to eat and the energy availability is a widespread error that may be responsible of health deterioration in children as well as in adults. Methods: After meal suspension and with synchronous blood glucose (BG) measurements, we taught patients to distinguish hunger sensations that are conditioned from those that arise after meal suspension (Initial Hunger, IH). This hunger (after meal suspension) signals a complete exhaustion of previous intake and is appropriate for meal onset to obtain meal-by-meal fasting nutrient levels and low BG prior to the next meal and establish an even balance. This pattern has been termed the Initial Hunger Meal Pattern (IHMP). Results: In contrast with untrained control subjects, trained subjects accurately recognized IH by synchronous BG measurements. We report here the identification of Initial Hunger (the subjective limit), the daily adjustments to three arousals for weeks and months, the diffusion of the error in untrained child and adult population, the validations of the IH and BG assessments and the improvements of 18 parameters by IHMP. Conclusion: The will to eat develops as a conditioned event and this conditioned will causes positive energy imbalance and insulin resistance/fattening. The imbalancing will to eat may be corrected by becoming aware of differences between the conditioned sensations of hunger and the sensations that develop after meal suspension.