Magazine article Clinical Psychiatry News

Night Eating Syndrome: Common, 'Neglected': Prevalence Rises with Obesity

Magazine article Clinical Psychiatry News

Night Eating Syndrome: Common, 'Neglected': Prevalence Rises with Obesity

Article excerpt

DENVER -- Night eating syndrome may yet have its day in the sun.

This common but underappreciated condition was first described by Dr. Albert J. Stunkard, professor of psychiatry at the University 9f Pennsylvania, Philadelphia, in 1955. Four years later he offered the first description of binge eating disorder.

Since its debut in the DSM-IV under the heading "Eating Disorders Not Otherwise Specified," binge eating disorder has become far and away the most commonly diagnosed eating disorder, accounting for nearly two-thirds of all such diagnoses.

Meanwhile, night eating syndrome remains unfamiliar even to many who specialize in eating disorders, and the few investigators studying the syndrome labor in relative obscurity. "For some reason, the night eating syndrome hasn't caught on yet, but I'm optimistic," Allan Geliebter, Ph.D., said at an international conference of the Academy for Eating Disorders.

He presented a study showing night eating syndrome (NES) entails overactivity of the hypothalamic-pituitary-adrenal axis with distinct psychopathology.

Affected individuals display an increased cortisol response to stress. One current speculation holds that patients with NES eat carbohydrate-laden foods during the night in an attempt to self-medicate and thereby reduce their cortisol level and diminish their experience of stress, according to Dr. Geliebter, a research scientist at Columbia University, New York.

NES is characterized by a shift in eating that involves morning anorexia and evening hyperphagia along with insomnia and / or awakening from sleep to eat. Its prevalence increases with degree of obesity. Studies suggest a prevalence of 12% in moderately obese individuals and 58% with severe obesity.

The typical NES eating pattern doesn't involve bingeing. Rather, affected individuals graze steadily after dinner through the evening hours.

"Instead of having three square meals, they tend to skip breakfast, have a light lunch, and then consume a lot at night. Some patients report taking their tray with them and actually eating in their bed," he noted.

Dr. Geliebter reported on a study of 10 obese women with NES and 18 equally obese women without it. Mean body mass index was 35 kg/m2 in each group.

NES was diagnosed based on consumption of more than 50% of daily calories after 7 p.m. along with either awakening from sleep to eat, or skipping breakfast four or more days per week coupled with difficulty in falling asleep at least four nights per week.

All participants completed the Beck Anxiety Inventory, the Zung Self-Rating Depression Scale, the Rosenberg Self-Esteem Scale, a questionnaire on night eating, and a measure of perceived global stress. …

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