Hunger is almost like two books in a small (180 page) package. There's the paranormal fantasy with a somewhat unusual premise, and then there's the YA issue novel. They only barely come together as a whole, and it's the issue aspect that makes this book worth reading.
Lisa is anorexic, and in denial. Her turning point comes when Death (here cast as essentially Kurt Cobain) gives her the job of Famine. Yes, the Horseman of the Apocalypse. It was this fantasy aspect that I felt was a little weak. It's a great premise (and it isn't overdone!) but so much isn't explained at all. The ending is hurried and isn't properly explained enough to be consistent with what went before. This is aside from how uncomfortable it is to see a privileged white girl get her enlightenment in third world countries. (Also, unnecessary. Hunger is a major problem in America, too.) If I were just judging this book based on the fantasty storyline, it'd be three stars, at best.
But that isn't the whole of the story. The real meat here is Lisa's experience (she isn't struggling, not really. she's given up) with anorexia. She calls it the Thin Voice, the running commentary on how many calories she's consumed, how long it'll take her to work it off, and just how worthless she really is. (Hershey's Kisses, it whispered. Twenty-five calories each.
) It's suffocating enough to read, and it doesn't take long to see what it does to her. There's also a painfully graphic scene of a bulimic purging. (In a note at the end, the author mentions her own struggles with bulimia.) It's all terribly real. I also appreciated that the end made it very clear that Lisa's recovery was ongoing and wouldn't be easy.
As a book about an eating disorder, Hunger is realistic and effective. 4.5 stars, easily. It's the fantasy aspects that are a little weak. I'll be reading the rest of the series, and hoping for more in that department.