The impact of both internal (eg, hunger) and external (eg, food salience) factors on eating is frequently mediated by cognition; people may decide to eat (or not eat) upon consideration of (or despite) the allure of such pressures. Because such internal and external factors have seemingly direct effects on eating (ie, because these factors can be interpreted as affecting eating directly, without the mediation of decisions that add little in the way of explanation) most analyses of eating do not bother to include deliberation or conscious choice as important elements. When we find that people eat in a manner opposed to both internal and external pressures, however, some sort of deliberative element seems necessary to account for the behavior. If someone were to continue eating an unpalatable food despite being sated, it would probably be necessary to have access to that individual's phenomenology to help provide an explanation. More commonly, people fail to eat despite their evident hunger and the availability of palatable food. Such dietary restraint demands an analysis that adds a set of mental factors to the control of eating in addition to physiological and environmental stimuli to which the person responds more or less reflexively (40). Such cognitive dietary calculations do not arise spontaneously, of course; they themselves are learned and may be reinforced or extinguished. But the prevalence (in humans, at least) of eating patterns that depart radically from the straightforward application of our knowledge of physiology and environmental stimulus control requires that attention be paid to willful opposition to such signals. One of the most serious problems arising from dieting is that the chronic overriding of normal controls on eating renders the dieter confused about whether or when she or he is feeling hunger or appetite. This problem is exacerbated in the recognized eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder).
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