The Neurobiological Lag: Neuroendocrine and Neural Adaptations During Recovery From Anorexia Nervosa and Their Potential Role in Post-Restoration Eating Behaviour

Abstract

The Neurobiological Lag: Neuroendocrine and Neural Adaptations During Recovery From Anorexia Nervosa and Their Potential Role in Post-Restoration Eating Behaviour Author: Haleema SadiaAffiliation: PMAS-Arid Agriculture University Rawalpindi, PakistanDocument type: Narrative Review Description Recovery from anorexia nervosa (AN) involves more than the restoration of body weight. Although nutritional rehabilitation reverses many consequences of prolonged energy deficiency, neuroendocrine, neural, cognitive, interoceptive, and behavioural processes may recover at different rates. This narrative review synthesizes human evidence concerning neurobiological adaptations during nutritional rehabilitation and following weight restoration in anorexia nervosa. It examines hypothalamic and endocrine regulation, appetite-related hormones including leptin and ghrelin, neural systems involved in reward processing and cognitive control, and the distinction between physiological hyperphagia and binge eating during recovery. The review introduces the concept of a neurobiological recovery lag to describe the potential asynchrony between anthropometric restoration and the normalization of other biological and behavioural processes. This framework is conceptual and does not imply a universal biological delay or establish a direct causal relationship between neurobiological adaptations and post-restoration binge eating. By integrating evidence across multiple domains, this review highlights the importance of understanding recovery as a multidimensional process rather than relying on body weight alone as an indicator of recovery. It also identifies research priorities, particularly the need for longitudinal human studies that assess endocrine function, neural processes, interoception, cognition, and eating behaviour within the same individuals over time. This work aims to contribute to the scientific discussion surrounding nutritional rehabilitation, recovery trajectories, and the interpretation of eating behaviour following prolonged energy restriction. Keywords: Anorexia nervosa; weight restoration; nutritional rehabilitation; neuroendocrinology; leptin; ghrelin; neuroimaging; eating behaviour; interoception; cognitive control; recovery.