Eating to live or living to eat: The meaning of hunger following gastric surgery

This paper is based upon interviews with twenty-seven women and men who have an inherited risk of developing gastric cancer and have had their stomach removed as a preventative measure. We describe what happens when bodily processes – digestion - are disrupted by the removal of the stomach. Interviewees' who had undergone prophylactic total gastrectomy experienced changes to the lived experience of hunger and appetite. The interviewees' accounts of life post-surgery suggested that private sensations of hunger (i.e. internalised feelings of hunger) disappeared following gastrectomy and in most cases never reappeared. The majority of interviewees described an alternative sense of hunger as developing over time. This externalised or disembodied hunger was described as triggered by a range of extracorporeal or external bodily criteria rather than internal sensations. We argue that this externally motivated desire for food, generated from without rather than within, serves the same purpose as internally generated feelings of hunger - it encourages eating, which sustains the body. Interviewees reported not only having to learn when to consume food following PTG, but also what to eat by adapting to what they perceived as their body's food tolerances and changing tastes. We argue that these changes in the lived experience of hunger and appetite may affect individuals' ability to participate in commensal relationships following gastrectomy, and that this may have negative consequences for identity.