People with stimulant use disorders are usually underweight. Current accepted knowledge is that they are skinny because stimulants suppress appetite - they eat less. But is it that simple? Here we review the relationship between stimulant use, food intake, metabolism and body weight, and highlight key points that may challenge current knowledge: 1) Stimulants interact with the hormonal signals that regulate appetite including ghrelin and leptin, and can produce long-term alterations in the ability to monitor and compensate energy deficits. 2) The diet of people with stimulant use disorders might be characterised by altered nutritional geometry, rather than overall reduction of food intake. 3) Long-term changes in homeostatic signals and nutrient intake can produce metabolic deficits that contribute to unhealthy low weight. Based on this knowledge we advocate for increasing awareness about the nuances of stimulant-related nutritional and metabolic deficits among addiction clinicians, and increased research on the interaction between stimulant use, appetite signaling, and metabolic deficits.

患有兴奋剂使用障碍的人通常体重不足。目前公认的知识是，它们很瘦，因为兴奋剂会抑制食欲-他们吃得更少。就是这么简单吗？在这里，我们回顾了兴奋剂使用，食物摄入，新陈代谢和体重之间的关系，并强调了可能挑战当前知识的要点：1）兴奋剂与调节食欲的激素信号相互作用，包括生长素释放肽和瘦素，并且可以产生长期变化监测和补偿能源短缺的能力。2）患有兴奋剂使用障碍的人的饮食特点可能是营养结构改变，而不是总体上食物摄入量减少。3）体内稳态信号和营养摄入的长期变化会产生代谢不足，从而导致不健康的低体重。