Yesterday we looked at the 6 month semi-starvation phase of the experiment and the changes it caused both mentally and physically in the subjects.  Today let's look at the refeeding phase which occurred after the subjects had been restricted food. 

They divided in to 4 groups at varying calorie levels for the first 12 weeks and for the duration of the study they were allowed unrestricted amounts of calories. 

Progression during refeeding phase:

• Initial increase in depression and irritability, even aggressiveness
• Intense hunger pangs, insatiable appetites, hard to stop eating – some even started binging and stealing food
• Ongoing preoccupation with food
• Physical discomfort from eating (e.g. digestive issues, edema)
• Rapid gain in adipose tissue, especially in abdomen
• Gradual regain of muscle
• When calorie limit was lifted they ate an average of 5,218 calories per day (more than double their pre-study intake)
• Eventual resolution of physical issues (dizziness, lethargy, edema, etc)
• Continued to lick their plates clean after as long as 15 weeks, despite unlimited access to food
• Preoccupation with food eventually diminished after 20+ weeks
• Some returned to normal eating over time, but a few continued to perpetually overeat

This also mimics the refeeding effects we see in individuals with eating disorders.  As the body recovers from starvation it goes through a lot of uncomfortable changes and eventually returns to its normal state.  This period of intense discomfort (physically and emotionally) is difficult to get through, but the good news is that things to eventually get better.  Educating patients about this ahead of time helps them to know that this phase is temporary if they can just push through it.  

This experiment told us so much about eating disorders even though that wasn't its intent.  I'm grateful to Ancel Keys for this amazing body of work and will continue to put it to good use in clinical practice.