Insulin was triggering the appetite and physically driving the women to eat. A psychological craving had been transformed into physical hunger. Insulin can be produced whenever you smell food, prepare a meal, or even think about food.
This insulin reaction, which increases hunger and craving, occurs with greater intensity in people who are overweight and in people who are dieting. Since the body interprets very low-calorie dieting as starvation, the insulin reaction may represent the body's attempt to entice a chronic dieter to eat for survival. The insulin reaction is also due to the repeated association of the sight, smell, and thought of food with binge eating. Because of the frequency of these associations, the binge eater's body becomes conditioned to anticipate food in response to external food cues.
Merely seeing food sets off an anticipatory response that, in the past, only occurred after eating.
This pre-eating insulin response is more pronounced in the overweight because of their heightened sensitivity to the sight and smell of food (mentioned in the previous chapter). This is why one of the main goals of my treatment program is to teach you to become more aware of your internal hunger and less reactive to external food cues.