During my residency more than 20 years ago, I was sleep deprived and gained a lot of weight. After rounding in the hospital well past midnight on a Sunday, I shuffled slowly into the breakroom between the surgical and medical ICUs. A large tub of fried chicken sat unattended on the table, no doubt purchased by a well-meaning member of the night team trying to support their shift-worker colleagues. They hadn't accounted for me, the overworked, sleep-deprived third-year medical resident struggling through the backstretch of a 36-hour marathon call.
The more basic areas of my brain leapt into action. The precious effort required for higher-order cortical processing couldn't be wasted or simply wasn't possible at that point in the night. This would be a System 1 decision. In a flash, I bellied up to the table. A breast and two drumsticks vanished faster than a post-call psychiatry intern working the ICU. I quickly fled the area and beat a shameful retreat to my call room to wallow in a sweat of grease and guilt.
Maybe my leptin and ghrelin levels were off. Perhaps my brain mistook sleep deprivation for a caloric deficit, and I was "eating to stay awake." Maybe fatigue had eliminated my willpower and I fell prey to hedonistic behavior. Whatever the reason, I ate that chicken without pausing to consider whether I was hungry. That moment was emblematic of my entire residency. The synergy of sleep deprivation, fatigue, and unhealthy eating led to a 20-lb (give or take 5 lb) weight gain.
