Effects of Semi-Starvation
The Effects of Starvation on Behavior: Implications for Eating Disorders
by David M. Garner, Ph.D.
The following is an adaptation of a portion of a book chapter: Garner, D.M. (1997). Psychoeducational principles in
the treatment of eating disorders. In: Handbook for Treatment of Eating Disorders. (145-177). D.M. Garner & P.E.
Garfinkel (Eds). New York, NY: Guilford Press.
One of the most important advancements in the understanding of eating disorders is the recognition that severe and
prolonged dietary restriction can lead to serious physical and psychological complications (Garner, 1997). Many of
the symptoms once thought to be primary features of anorexia nervosa are actually symptoms of starvation. Given
what we know about the biology of weight regulation, what is the impact of weight suppression on the individual?
This is particularly relevant for those with anorexia nervosa, but is also important for people with eating disorders
who have lost significant amounts of body weight. Perhaps the most powerful illustration of the effects of restrictive
dieting and weight loss on behavior is an experimental study conducted almost 50 years ago and published in 1950
by Ancel Keys and his colleagues at the University of Minnesota (Keys et al., 1950). The experiment involved
carefully studying 36 young, healthy, psychologically normal men while restricting their caloric intake for 6 months.
More than 100 men volunteered for the study as an alternative to military service; the 36 selected had the highest
levels of physical and psychological health, as well as the most commitment to the objectives of the experiment.
What makes the "starvation study" (as it is commonly known) so important is that many of the experiences observed
in the volunteers are the same as those experienced by patients with eating disorders. This section of this chapter is a
summary of the changes observed in the Minnesota study.
During the first 3 months of the semistarvation experiment, the volunteers ate normally while their behavior,
personality, and eating patterns were studied in detail. During the next 6 months, the men were restricted to
approximately half of their former food intake and lost, on average, approximately 25% of their former weight.
Although this was described as a study of "semistarvation," it is important to keep in mind that cutting the men's
rations to half of their former intake is precisely the level of caloric deficit used to define "conservative" treatments
for obesity (Stunkard, 1993). The 6 months of weight loss were followed by 3 months of rehabilitation, during
which the men were gradually refed. A subgroup was followed for almost 9 months after the re-feeding began. Most
of the results were reported for only 32 men, since 4 men were withdrawn either during or at the end of the
semistarvation phase. Although the individual responses to weight loss varied considerably, the men experienced
dramatic physical, psychological, and social changes. In most cases, these changes persisted during the rehabilitation