How could long-term appetite suppression affect muscle, bone, and mental health?

How severity and duration shape the risks to muscle, bone, and mental health

The most severe and prolonged appetite suppression, as seen in anorexia nervosa, carries the highest risks. In a 29-year study of over 5,000 women hospitalized for anorexia, the risk of death was 9 times higher at 5 years and remained elevated for up to 20 years [1]. This was driven by suicide (nearly 5 times the risk), pneumonia (over 8 times the risk), and diabetes (over 7 times the risk) [1]. These findings show that long-term, severe calorie restriction can damage multiple organ systems, including the immune system (leading to fatal infections) and mental health (through suicide).

For less severe suppression, the risks are more nuanced. A 2023 study of nearly 6,000 adults found that a higher weight-adjusted waist index (WWI) — a simple measure that reflects low muscle and bone mass relative to body weight — was strongly linked to unhealthy body composition. People in the highest WWI quartile had 18 times the odds of having high fat, low muscle, and low bone mass in men, and over 6 times the odds in women [2]. This suggests that even without a diagnosed eating disorder, long-term appetite changes that lead to weight loss can erode muscle and bone health.

The mental health double-edged sword: suppression can harm or help

The relationship between appetite suppression and mental health is not one-directional. On one hand, severe suppression in anorexia is linked to a 4.9-fold increased risk of suicide death, even after accounting for depression and anxiety [1]. This indicates that the malnutrition itself may directly impair brain function and emotional regulation, independent of pre-existing mental illness.

On the other hand, a 2023 study of 120 adults from 16 countries found that training people to suppress unwanted thoughts — a form of mental suppression — actually reduced anxiety, negative affect, and depression, with benefits lasting at least 3 months [3]. This benefit was strongest in those with high trait anxiety or pandemic-related posttraumatic stress [3]. This suggests that the "suppression" of appetite and the suppression of thoughts are fundamentally different processes, and that blanket statements about suppression being harmful are oversimplified.

Further complicating the picture, a systematic review protocol (not yet completed) aims to investigate whether sarcopenia (low muscle mass and function) is linked to anxiety disorders [4]. This highlights that the muscle loss from appetite suppression may itself contribute to mental health problems, creating a vicious cycle.

Bone health: a hidden victim of chronic stress and malnutrition

Long-term appetite suppression can harm bones through both direct nutritional deficiencies and the chronic stress that often accompanies it. The same study linking high WWI to low bone mineral density found that higher WWI quartiles correlated with significantly lower bone density at the lumbar spine, femoral neck, and total hip [2]. This means that as people lose weight from appetite suppression, they are also losing bone, increasing fracture risk.

Animal research provides additional insight: chronic stress during different life stages (pregnancy, childhood, adulthood) caused sex-dependent bone loss and impaired bone healing in mice [5]. For example, stress during pregnancy led to weaker bones in male offspring only, while early-life stress caused bone loss in female mice only [5]. This suggests that the timing and sex of the individual matter greatly for how appetite suppression and its associated stress affect bone.

The mechanism appears to involve the immune system: chronic stress dysregulates immune responses, leading to chronic low-grade inflammation that interferes with bone regeneration [5]. This is relevant to appetite suppression because malnutrition itself also impairs immune function, as seen in the elevated pneumonia mortality in anorexia [1].

About These Sources

This answer is built on 5 peer-reviewed studies — published from 2021 to 2025, 1 from 2024 or later, 3 in Q1 journals, collectively cited 286 times — selected as the most relevant from 5 studies that passed quality screening, drawn from 33 papers retrieved from a database of over 500 million.

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