Overweight and Waking Up Hungry: What to Tell Patients

“Why am I always waking up hungry?” is a recurring theme on social media platforms like TikTok. People ask, “What does it mean if you wake up really hungry?” and may get answers like this one on YouTube, “Hunger in the morning is a sign of health. If you’re not hungry in the morning, it means you’re running out of stress hormones.”

What’s the real deal on this topic, particularly for patients with overweight or obesity, and what makes sense to tell them? There’s little evidence to support specific mechanisms or interventions, so Medscape Medical News asked two experts to share their thoughts.

Why Do Some Individuals With Overweight/Obesity Wake Up Hungry?

“Several factors contribute” to the problem, said Peter Goulden, MD, chief of the Division of Endocrinology, Diabetes and Bone Diseases at Mount Sinai Morningside and Mount Sinai West in New York City. These may include dysregulated appetite hormones such as leptin and ghrelin, disrupted sleep architecture, and insulin resistance.

Furthermore, he added, “Sleep apnea, common in obesity, can fragment sleep and alter circadian rhythms, increasing morning hunger.”

“Weight is not necessarily a risk factor for waking up hungry. It can happen to anyone,” said Deena Adimoolam, MD, a specialist in endocrinology, diabetes and metabolism based in New York City. Blood glucose levels tend to drop in the early morning hours, which stimulates hunger for some people, she said. Some may be at higher risk for low blood glucose in the morning — like those taking medications for diabetes, liver or kidney diseases, and other chronic illnesses. Alcohol can also trigger lower blood sugar in the morning.

Why Is Waking Up Hungry Not a Good Thing?

“Waking up hungry may drive early-day overeating, often with high-calorie, low-nutrient foods, reinforcing metabolic dysfunction and weight gain,” Goulden said. “It may also reflect poor sleep quality, which is independently associated with cardiometabolic risk.”

“Low blood sugar can lead not only to hunger in the morning but also irritability, lightheadedness, dizziness, nausea, increased perspiration, and tremor,” Adimoolam said.

What Tips Can Clinicians Give to Help Patients?

Goulden advises encouraging patients to avoid late-night eating, ensure adequate protein and fiber intake at dinner, and address sleep hygiene. “Managing underlying sleep disorders such as obstructive sleep apnea is critical,” he said.

Adimoolam advises patients who wake up hungry to consider having a healthy snack at bedtime, such as fruits, yogurt, nuts, cheese, nut butter, or a protein drink. They should ensure they are eating three balanced meals daily that provide adequate nutrition.

What Else Should Clinicians Be Aware Of?

“Look for signs of nocturnal eating or nighttime hypoglycemia in patients with diabetes,” Goulden said. “Also, assess for mood- or stress-related eating patterns, which often manifest during the night or early morning hours.”

“Patients taking GLP-1 analogs for weight loss may be at a higher risk for low blood glucose in the morning that can result in hunger,” Adimoolam added.

Goulden and Adimoolam reported having no relevant conflicts of interest.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.