Stephanie Fein MD [00:00:00]:
Hello, fabulous. Dr. Stephanie Fein here with Weight Loss for Fertility. And today we are talking about the hunger scale, specifically positive 2, which is satisfied, not full. And the nuance I'm going to call pre-positive 2. That's what we're talking about. I have not spoken specifically about the hunger scale in quite a little while. And so I'm going to point you back to the Hunger Scale series we did.
Stephanie Fein MD [00:00:31]:
That's episode 148 through 154. And that was actually a year ago in September of 2025. So if you're looking for it, look for September 2025. You will see Hunger Scale series as the titles. And there's 6 episodes, 7 episodes. And I don't think there's numbers anywhere, but if there were, 148 through 154 would be the numbers. So, So that, those episodes will get you familiar, very familiar with the hunger scale in general. I definitely have talked about that in the last year and I'll go over it here, but those were deep dives into certain numbers.
Stephanie Fein MD [00:01:06]:
Like positive 2 had its own episode, negative 2 had its own episode, the extremes have an episode. It's just a really good place to get all you need to know about the hunger scale. It just gets you familiar with it. And to be brief here with what the hunger scale is, it's a scale that goes from -5, which is completely empty of food, feeling faint, to +5, which is unbelievably full, painfully full, like having to undo your pants, like at Thanksgiving, having to lie down. Those are the extremes. We don't want to be at those extremes. What we want is to learn the numbers 5, 4, 3, 2, 1, 0 for ourselves, and we want to eat at -2 when we're just hungry, not the first whiff of hunger, that's -1, but -2 is just hungry, not overhungry, which would be -3. And we want to stop eating at +2, which is satisfied, not full.
Stephanie Fein MD [00:02:09]:
Full is +3. We want to stop at +2. So Satisfied, not full. Getting familiar, knowing, learning what your cues are for your own body is the process. When we do that, we can eat any foods we want and we can lose weight because we're eating them when we're hungry, we're stopping when we're satisfied, not full. The key too is not to get overhungry because then it's very hard to stop at positive 2. If you eat at negative 2, It's much easier to stop at positive 2. That's the whole premise.
Stephanie Fein MD [00:02:45]:
That's how we lose weight. The great thing about it is you can eat anything you want. The other great thing about it is you start to notice so much about your body and food. What foods actually feel good? Which ones energize you? Which ones feel terrible? Knowing that makes it easy to pick foods that energize you. And that keep you full longer. Because as we're using our hunger scale, we're noticing how hungry we get and how frequently that is. And it's just a pain in the patootie to have to eat all the time if we keep getting hungry. So we want to eat foods that last and that give us the energy we need to do our day.
Stephanie Fein MD [00:03:29]:
That's general hunger scale. Dive into the hunger scale series from a year ago, September 2025, episodes 148 to 149. 154. That's the gist of it. So positive 2 is where we're going to be discussing today. We're talking today about a nuance of the hunger scale. So it's not one of the— we're not going to only talk about positive 2. We're going to talk about a nuance.
Stephanie Fein MD [00:03:55]:
Now remember, as I was saying, positive 2 is satisfied, not full. That feeling is something we're not used to. Many of us are not used to Feeling that or stopping eating at that. We usually, a lot of us, stop at full. And full, positive 3 on the hunger scale, is slightly uncomfortable, I would say. You may need to rest, take a breath. You're not feeling totally energized. You feel fed and you're not hungry anymore, but you're also a little Dragged down.
Stephanie Fein MD [00:04:32]:
My, one of my very favorite ways of describing this is one that my client said to me. It was so smart. She said, oh, you mean it's like you could have sex afterwards? Yes. You feel unencumbered. You feel great after you eat. No problem. You could do any physical activity you want because you're not Uncomfortable in any way. So that's positive 2.
Stephanie Fein MD [00:04:59]:
Now that's a big goal that we go for where we're trying to learn our positive 2. When I'm working with people, that's a big part of what we do. So a beautiful client was noticing that her feeling of satisfaction actually progressed over time. So if she started to eat at negative 2, when she was just hungry and she ate the food until she reached a positive 2, which is satisfied, not full. She She was eating the food until she felt that, but 30 or so minutes later, she was at a positive 3 or positive 4 even. That was such good noticing. Super impressed by it. And this is an issue because we want to be at positive 2 at the end of the whole meal process.
Stephanie Fein MD [00:05:50]:
So we don't ever want to be in the position to feel full or overfull or uncomfortable in any way. So we don't want to get to positive 3 or positive 4, even if that's 30 or 60 minutes later. And that is such a perfect, important concept to notice. And I love that my client brought this up. Now, why might this happen? Because in general, that isn't something that I run into a whole lot. Very often people are, they eat when they're just hungry at -2 and they are finding their positive 2. They stop eating, feel great. But there are some people where this happens.
Stephanie Fein MD [00:06:32]:
And why might that be the case? First of all, I'm always remembering that each body is different. Every body is different. Is put together with its own combo of hormones and muscles and bones and experiences. And every body is a miracle. And it can't be that each one is exactly the same. So every body has its own experience with this. So some people, when you hear this, you may be like, oh yeah, that happens to me all the time. I just have figured out how to Stop eating before I need to, or that kind of thing.
Stephanie Fein MD [00:07:09]:
Or some people might be like, "Ooh, I've never experienced that." Each body is different, and noticing is always going to be our best friend and our best teacher. When we notice it, we can be curious about it and then decide what to do about it. So that's number one. Number two is there's a real thing. The one of the main things genetics can be in this medications can cause this kind of thing. There's other reasons, but one of the main ones to me. Would be the hunger hormone sensitivities. So insulin resistance and leptin resistance would be 2 big ones that could be going on.
Stephanie Fein MD [00:07:49]:
And as why the— it's slow for the body to recognize when there's food in the stomach. That a lot of that can be hormone related. And when I say hormone related, hormones are just the mess of the chemical messengers. They work sometimes in the brain, they work in cells, they work in organs, they're sending messages all over. But to me, the main concept of that is that it works differently in some people's bodies. And resistance could be one of the reasons. So insulin resistance is when there's more insulin needed To get the same effect. That's resistance in general.
Stephanie Fein MD [00:08:36]:
So if we needed— I'm just going to— a thimbleful of insulin to take care of a normal meal, if we have insulin resistance, it might take 2 thimblefuls. And there's implications for that. Our pancreas has to work overtime. There's more insulin in our bloodstream. The sugar— Because insulin moves glucose from the bloodstream into the blood cells. If it's not able to do that, we will have sugar variability in our bloodstream. So it's an— there are consequences to having insulin resistance. And same with leptin resistance.
Stephanie Fein MD [00:09:21]:
So leptin is the satisfaction hormone that tells us when we've had enough. So leptin would be something that I'd be curious about in people who have this phenomenon where they feel they're more full 30 to 60 minutes later. There may be some leptin resistance there. And that means that it takes more leptin. There's still a lot of leptin in the body. Leptin is actually made from fat cells. to tell us that we've had enough, we're satisfied. But there's leptin resistance, meaning there's a lot of leptin in the system, but the brain is not registering it.
Stephanie Fein MD [00:10:02]:
And the contributors to that are— these won't surprise you— things like chronic inflammation, high insulin levels will also impact leptin. And you can see if you have insulin resistance, then you— that can impact the leptin. Poor sleep. And that's usually modulated through cortisol. So stress would impact it and also high sugar diets. The diets and carbs. And when I say carbs here, processed flours, like that kind of thing. I'm not talking about vegetables and fruits.
Stephanie Fein MD [00:10:37]:
That can impact leptin and insulin resistance. It has to do with the small chains, how Fast glucose gets into the bloodstream and the demand then for insulin. And therefore, it's a timing issue. If it dumps a lot of glucose in, you need a lot of insulin immediately. Same with the leptin, I would imagine. And this is actually with this idea that the signal is too big, too fast, and the leptin doesn't have time to catch up. So these are just 2 of the Hunger hormone sort of pathways, the hormones that can impact hunger and satisfaction. There are more that are in the works to be understood.
Stephanie Fein MD [00:11:23]:
These are 2 of the main ones. I'm sure there are much more. And so how those are impacted, I don't know. What I do know is that we can impact it with weight loss, which of course, this is a cycle, right? We want to lose weight, it's harder to lose weight. But if we lose weight, it will help. It's one of those things. Which is not a problem because we just keep experimenting and learning what will work for our body. It can feel challenging, but we just do what we can.
Stephanie Fein MD [00:11:59]:
We listen to our body and we figure out what works for our body. That is what we're doing with the hunger scale, and that works for weight loss. So in terms of why this might happen with stopping eating as a positive 2, and then 30 to 60 minutes later feeling overfull, we talked about everybody being different. We talked about hunger hormone sensitivities, but also the speed at which we eat. For fast eaters, we may not catch it. It may take a minute. There may be a lag. And also if we're eating with distractions, if we're watching TV, if we're doing that sort of mindless where we're not Tuned into our hunger cues.
Stephanie Fein MD [00:12:39]:
That can be another way that there would be a lag. So these are all things just to keep in mind. Some of them we have more control over than others. It's— they've actually done studies on speed at which people eat, and it's possible to slow it down, but sometimes that's pretty difficult. If we can just use this nuance of a pre-positive 2, that may solve the problem if it's too hard to— Change the speed at which we eat. The distraction we definitely can do something about. And if we're eating, only focusing on our eating and how our body's feeling and how the food tastes and relaxing and looking at our environment, if we're doing that and cluing into our body, that we have more control over. And that works really well too.
Stephanie Fein MD [00:13:30]:
Now, what do we do? If we're having this issue where there's a lag time between eating and feeling our positive 2, we want to eat the amount of food that gets us to the positive 2 at the end of our body's whole process. So in this example, it might be 60 minutes later, but we want at the 60-minute mark to be at positive 2, not at positive 3. And it's something we can only learn by experimenting. There's literally no other way of doing this. So we experiment, we play how much food, which kinds of food, what works so that at the end of my entire process, first I can find out how long is my process. Maybe I can eat differently so that it, I shorten that process. All of this is going to be play and experiment. Maybe if I'm paying attention, maybe if I don't eat as fast, it shortens the process.
Stephanie Fein MD [00:14:27]:
Like, I don't know. The only way we could know is experiment and play. We want the positive 2 to be at the end of our body's process. So we'll be identifying for ourselves a pre-positive 2 feeling. We will stop eating at that feeling. Knowing that it will get us to a feeling of positive 2 at the end of the process. So that's what we're talking about, the pre-positive 2 feeling. For some of us, if there's a lag to our positive 2, we want to stop eating at our pre-positive 2 feeling so that we can be satisfied, not full at the end of the process.
Stephanie Fein MD [00:15:13]:
Pre-positive 2 is the feeling at the End of the meal when you stop eating. Pre-positive 2 is the feeling at the end of the eating process that is not the positive 2 feeling, but a feeling that you know will lead to a positive 2 feeling within the hour. Not everyone will need this. It's just one variant of what can happen as we get to know our body and its hunger cues. It's so important because we want to know our body. We want to know how it works. We want to know these feelings. So if you need a pre-positive 2, no problem at all.
Stephanie Fein MD [00:15:55]:
We just need to identify it because at the end of the whole process of your body handling that meal, we want to feel a positive 2, not a positive 3, positive 4. Remember, you'll be able to identify yourself if you're feeling a positive 3 or positive 4 soon after your meal. We want that ending feeling to be a positive 2. So you'll be stopping chewing and swallowing at a pre-positive 2 feeling that only you will know what that is. You may not need this forever because this may resolve if— we'll just say if leptin resistance is part of the equation, and as you're losing weight, you may not have leptin resistance anymore. Same with insulin resistance. As you lose weight, that may dissolve, evaporate, no longer have it. And so you may not have as long of a lag time.
Stephanie Fein MD [00:16:52]:
It may go away completely. It may be shorter. You'll know as you're losing weight and as you're paying attention to your hunger scale, which you'll be doing all the time. So you will notice when there's a change. Or it could stay the same and you're losing weight and it's still the same, but it's not a problem because you've figured it out. This is all normal variance. All our bodies are different. Amazing.
Stephanie Fein MD [00:17:17]:
We just have to find what works for us. That's what I've got for you today. Be aware of this hunger scale nuance pre-positive 2. You may need to identify this feeling if you notice that you feel full, positive 3 or positive 4, after your meal is over. The goal is a feeling of satisfied, not full, which is positive too, at the end of your whole meal process. You may not need this, but it's good to know about if you do. For all things hunger scale and weight loss for fertility, follow me on Instagram. I'm @StephanieFeinMD.
Stephanie Fein MD [00:17:57]:
And if you'd like to lose weight with me, go to my website and click the Lose Weight with Me button. It's stephaniefeinmd.com. I would love to help you. You can also ask me any questions there too. There's a contact me page. I'd be happy to. I am sending you so much love until next time. Mm.
