Author Affiliations: Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York.
Short-term food deprivation of 18 to 24 hours is fairly common.1- 3 It can be medically imposed before blood draws or surgery, or it can be self-imposed in the case of serious dieting, religious fasts, and chaotic work schedules.4,5
Animal studies have examined only calorie levels rather than food types following deprivation.6,7 The question arises: when a food-deprived person finally eats, what foods do they eat first and most? The answer has implications for the precautions that patients, fasters, medical interns, and dieters should take when first serving and eating food after a short period of food deprivation.
A total of 128 participants were recruited from Cornell University for course credit, and they were randomly assigned to 2 experimental conditions: one group was instructed to avoid eating 18 hours prior to a lunchtime study (no food or beverages after 6:00 PM the night before the study), and the control group was not. The study was conducted during 12 weekday lunches involving 10 to 12 participants across both conditions and was approved by the institutional review board.
After arriving for lunch, participants were presented with a buffet of 2 starches (dinner rolls and French fries), 2 proteins (chicken and cheese), 2 vegetables (carrots and green beans), and a beverage. The order of the food on the tables was rotated across sessions to prevent an order bias. The amount of the foods participants served themselves was surreptitiously measured by scales embedded in the tables, and food consumption was unobtrusively videotaped.
After finishing the meal, participants completed a questionnaire in which they indicated if they had skipped breakfast and confirmed the order in which they had first tasted or eaten each of the foods they had for lunch. Intake was determined by deducting the amount left over from the amount served. Across both study groups, participants were similar with respect to BMI, age, and sex. All analyses were performed using SAS statistical software, version 9.2 (SAS Institute Inc). P < .05 was considered statistically significant.
We eliminated people who did not follow fasting instructions from analysis (n=43). However, those were still included in calculating correlations between first food served and calories eaten.
Participants in the control group started their meals with the high-calorie foods (starches and protein) less often than did participants in the fasting condition (44% [20 of 45] vs 75% [30 of 40]; χ2 = 6.83) (P = .01). Although this trend appeared stronger for women (36% [8 of 22] vs 80% [12 of 15]) than for men (50% [11 of 22] vs 66% [16 of 24]), the interaction with sex was not significant. The Table lists the types of foods served by study group consumption; compared with the control group, fasters were more likely to eat a starch first (13% [6 of 45] vs 35% [14 of 40]; χ2 = 5.53) (P = .02) and less likely to eat a vegetable first (56% [25 of 45] vs 25% [10 of 40]; χ2 = 8.16) (P = .005).
Importantly, starting their meal with a particular food led all participants to consume 46.7% more calories of it (128.57 vs 84.91 calories) (F1,122 = 3.89, P = .047). Indeed, in using choice as a binary variable, we found that the food that a person chose to eat first was correlated with how much was served (product-moment correlation coefficient, 0.24; P < .001), and it was correlated with how much of it the person ultimately ate during the entire meal (product-moment correlation coefficient, 0.21; P = .003) .
When a food-deprived patient, faster, medical intern, or dieter first encounters food, the first food they eat may well end up being the food of which they eat the most. In general, they will be most drawn to starches and will eat them instead of nutrient-dense vegetables. Even relatively mild food deprivation can alter the foods people choose to eat, potentially leading them to eat starches first and most.
Hospitals and cafeterias that deal with food-deprived individuals should make healthier foods—vegetables, salads, and fruit—much more convenient, visible, and enticing than starches to avoid such biasing of choices toward potentially less healthy choices. In addition, the serving size of starches can be reduced, or they can be offered in combo meals that balance the amount of starches with protein and vegetables.
Correspondence: Aner Tal, PhD, Cornell Food and Brand Lab, 14B Warren Hall, Ithaca, NY 14853-7801 (email@example.com).
Author Contributions:Study concept and design: Wansink. Acquisition of data: Wansink, Tal, and Shimizu. Analysis and interpretation of data: Tal. Drafting of the manuscript: Wansink and Tal. Critical revision of the manuscript for important intellectual content: Wansink and Shimizu. Statistical analysis: Tal. Obtained funding: Wansink. Study supervision: Wansink.
Financial Disclosure: None reported.
Funding/Support: This research was made possible by support from Cornell University.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
I read with interest the study by Wansink et al.  and the accompanying commentary by Yaroch and Pinard . While the study results are interesting, they are by no means novel and the conclusions the authors have drawn are inaccurate, in my opinion. That we crave starches in the setting of hunger is not a new concept. Rice, corn, potatoes, wheat, and other starches have fueled the human species for thousands of years. Positive selection for salivary amylase encoding genes supports the important role of starch digestion in human evolution . There is a large body of clinical and anthropologic evidence supporting the notion that humans thrive when the bulk of their calories are derived from starchy foods . More nutrient-dense vegetables and fruits are intended to complement the diet and cannot provide the majority of one’s required daily caloric intake all by themselves.
Starches are not always high in calorie-density as the authors imply. Starchy vegetables and intact whole grains, at approximately 450-500 calories per pound, are slenderizing food choices. One can safely consume an ad libitum diet centered on these foods without gaining weight . As a matter of fact, the Asian population centered their diet on rice for millennia and they were one of the trimmest civilizations in recorded history. Starches only become high in calorie-density when they are overly processed or when they are cooked and prepared with other more calorie-dense ingredients.
Oils, at approximately 4000 calories per pound, are the most calorie-dense food on the planet. French fries are not properly classified as starches. They are better classified as fats because the majority of their calories are often derived from the oil they are prepared with.
An appropriate conclusion for the study is to replace overly processed and fried starches with healthier ones that can safely be consumed to satiety without compromising health. Humans are going to crave starches. They always have and always will. The solution is to consume the right ones and not just to avoid the wrong ones.
1. Wansink B, Tal A, Shimizu M. First foods most: after 18-hour fast, people drawn to starches first and vegetables last. Arch Intern Med 2012;172(12):961-3.
2. Yaroch AL, Pinard CA. Are the hungry more at risk for eating calorie-dense nutrient-poor foods?: comment on “first foods most: after 18-hour fast, people drawn to starches first and vegetables last”. Arch Intern Med 2012;172(12):963-4.
3. Perry GH, Dominy NJ, Claw KG, Lee AS, Fiegler H, Redon R, Werner J, Villanea FA, Mountain JL, Misra R, Carter NP, Lee C, Stone AC. Diet and the evolution of human amylase gene copy number variation. Nat Genet 2007;39(10):1256-60.
4. McDougall JA, McDougall M. The starch solution: eat the foods you love, regain your health, and lose the weight for good! Rodale; New York: 2012.5. Bell EA, Castellanos VH, Pelkman CL, Thorwart ML, Rolls BJ. Energy density of foods affects energy intake in normal-weight women. Am J Clin Nutr 1998;67(3):412-20.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 5
Customize your page view by dragging & repositioning the boxes below.
Users' Guides to the Medical Literature
Clarifying Your Question
Users' Guides to the Medical Literature
The Structure: Patients, Exposures, Outcome
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.