What is Night Eating Syndrome?
Night eating syndrome (NES) is an eating disorder that involves eating after dinner and during the night. It was originally identified by researchers Wolff, Stunkard, and Grace in a group of people who were seeking help with weight loss. They noticed that these individuals were consuming a quarter or more of their daily calories during the night, a time when people without obesity weren’t eating.
Night eating syndrome is recognized when a person experiences at least three of the following symptoms:
- A strong desire to eat between dinner and bedtime.
- Not feeling hungry in the morning or during the night (also known as anorexia).
- Difficulty falling asleep or staying asleep.
- Feeling sad or depressed.
- Feeling worse in the evening.
- Believing that they can’t sleep without eating.
What Causes Night Eating Syndrome?
Researchers are still trying to figure out what causes night eating syndrome. Recent studies suggest that it could be a combination of factors related to the mind, brain, and genetics. One study conducted in Germany found that children were more likely to have night eating syndrome if their mothers also had this habit. The researchers compared these children with others whose mothers didn’t have night eating habits.
In another recent study, scientists compared family eating habits between families with a person who had night eating syndrome and families without. The results revealed that the condition was more common in families with the syndrome, suggesting it might be passed down through family members.
Stress also seems to play a role in this syndrome. It can make the symptoms worse, while reducing stress can help alleviate them. Some researchers believe that the syndrome might start and continue due to stress and other mental health issues like depression.
Risk Factors and Frequency for Night Eating Syndrome
In the US, about 1.5% of the population experiences night eating syndrome, which is in line with the prevalence rates of other eating disorders like bulimia nervosa and anorexia nervosa. This condition commonly occurs in people who are overweight or obese, but it’s worth noting that not everyone with night eating syndrome is overweight. Interestingly, research from Sweden indicates that both obese men and women are about 2.5 times more likely to have night eating syndrome compared to those who are not obese.
In studies of people seeking weight loss surgery, up to 64% displayed signs of night eating syndrome. This syndrome often starts in late adolescence or early adulthood, and it usually continues over a long period. Its frequency can increase or decrease in response to stress. Surprisingly, one study reported that women are more likely to meet all the criteria for night eating syndrome, suggesting that even though both genders may experience the symptoms, women are tend to be more affected.
People with night eating syndrome are also more likely to have another eating disorder, with prevalence rates ranging from 5% to 44%. In fact, between 15% and 20% of night eating syndrome sufferers are also found to have binge eating disorder. However, the two conditions are not the same. They differ in the amount of food consumed at each meal, the reasons for eating, and concerns about weight and shape. In a study that screened for night eating syndrome, 12.3% of the participants met the criteria, and these individuals also tended to be obese.
Signs and Symptoms of Night Eating Syndrome
Nocturnal eating syndrome is a condition characterized by certain criteria. Some notable ones include consuming a significant portion of daily calories after dinner, usually 25% or more, and waking up at least twice a week to eat during the night. There’s also an awareness of, and recollection of, these nighttime eating habits.
The condition can generally be described by three main characteristics:
- Missing breakfast and morning meals due to a lack of appetite
- Feeling a strong urge to eat between dinner and bedtime
- Difficulty falling asleep or staying asleep for 4 or more nights per week, often associated with a belief that eating will help return to sleep
- Experiencing a worsening mood at night or frequent episodes of depression.
Testing for Night Eating Syndrome
According to a controlled study conducted by Look AHEAD (Action for Health in Diabetes), Night Eating Syndrome (NES) was found to be more common among patients who were feeling down or depressed. This study also revealed that people with diabetes who are also overweight tend to have a higher body mass index and face weight problems at a younger age compared to those without eating disorders.
Past studies have found that amongst individuals with both type 1 and type 2 diabetes, those who reported excessive eating in the evenings (a condition known as evening hyperphagia), along with having two or more diabetes-related complications and being obese, were more likely to have a hemoglobin A1c level greater than 7. Hemoglobin A1c is a blood test that measures the three-month average of your blood sugar levels; a level above 7 is considered high and can indicate uncontrolled diabetes.
Treatment Options for Night Eating Syndrome
Psychotherapy, specifically cognitive behavioral therapy, has been demonstrated to reduce symptoms of night-eating. A study on 25 patients occurred over 12 weeks. Throughout the course of the study, the researchers provided education, encouraged the patients to keep track of their sleeping and eating habits, nurtured coping skills, and helped manage their eating, sleep patterns and weight. By the end of the study, patients experienced less weight gain, consumed fewer calories in the evenings, had fewer awakenings during the night and fewer instances of eating during the night. These patients also reported improved mood and quality of life.
Serotonin, a chemical found in the human body, plays a role in managing eating habits, mood, and sleep. Some experts believe that low serotonin levels might lead to increased eating and disturbances in sleep patterns at night. Seventeen patients participated in a 12-week clinical trial where they were treated with the medication, sertraline. Alongside this study coupled with a couple more others, there was a marked reduction in how often the patients woke up at night, instances of overeating in the evening, and calorie consumption after evening meals.
In these studies, around 29% of patients showed no symptoms of night-eating after the trial and 67% showed a positive response to the treatment. Another trial tested the effectiveness of the medication escitalopram, which also showed a significant reduction in symptoms of night-eating. However, compared to a placebo (a substance with no therapeutic effect), there were no distinctive differences.
In another study, 44 patients were divided into three groups: one group receiving education, the second group receiving education plus progressive muscle relaxation, and the third group receiving progressive muscle relaxation plus exercise. It was found that the group who practiced progressive muscle relaxation showed the most notable reduction in the amount of food consumed.
Boosting serotonin levels in the body using phototherapy (a treatment that uses light) has been explored. Two individual case studies used phototherapy for treating symptoms of both night-eating and depression. A study on a 51-year-old woman who had both depression and night-eating syndrome used medication called paroxetine alongside bright light therapy. When she stopped the light therapy, her symptoms of night-eating returned. Another study using phototherapy on 15 patients showed a great reduction in symptoms of night-eating, as well as improvements in mood and sleep disturbances.
What else can Night Eating Syndrome be?
Night eating syndrome and sleep-related eating disorders are often mixed up. The differences are in the details of the person’s nighttime eating. Night eating syndrome includes excessive eating and nighttime food intake, combined with awareness. Sleep-related eating disorders primarily involve repeated involuntary eating during sleep. Eating during sleep is considered a type of sleep disorder because it’s automatic and often not well remembered. Sometimes, people with this disorder even eat non-food items, similar to sleepwalking.
Night eating syndrome is considered an insomnia-related disorder because patients are awake, aware, and remember their eating. Typically, patients with night eating syndrome don’t report having other sleep disorders. However, some patients might suffer from both conditions.
Even though night eating syndrome and binge eating disorder both involve excessive eating in the evening, that doesn’t necessarily mean they have the same underlying causes. Unlike binge eating disorder, the excessive evening eating seen in night eating syndrome is mainly linked to nighttime anxiety. Also, the amount of food eaten in the evening by patients with night eating syndrome isn’t as large as the amount consumed by patients with binge eating disorders.
What to expect with Night Eating Syndrome
People who have undergone treatment for NES, including medication, cognitive therapy and lifestyle changes, have reported a substantial improvement in their symptoms. Without treatment, many health and emotional problems can arise due to being overweight or obese. These issues include high cholesterol, diabetes and high blood pressure.
Possible Complications When Diagnosed with Night Eating Syndrome
People with Night Eating Syndrome (NES) often gain weight because they consume more calories before bed. This extra calorie intake can lead to health problems such as diabetes, high blood pressure, heart disease, and obesity. If not treated with therapies like counseling, it can also lead to mental health issues.
Research has shown that NES might be linked to different psychological disorders, especially depression. It’s been observed that many people with NES also show symptoms of major depressive disorders, substance abuse issues, and anxiety disorders.
Common Problems Faced by NES Patients:
- Weight gain due to increased calorie intake before bedtime
- Potential health issues such as diabetes, high blood pressure, heart disease, and obesity
- Without proper therapy, potential psychological issues can develop
- Possible association with psychological disorders like depression
- Indications of major depressive disorders, substance abuse, and anxiety disorders
Preventing Night Eating Syndrome
Night Eating Syndrome (NES) is a condition where a person eats excessively at night, either after dinner or upon waking up from sleep. There are a few symptoms that commonly occur alongside this including feeling the need to eat between dinner and sleep, not feeling hungry in the morning, having trouble sleeping or falling asleep, feeling down or having one’s mood worsen in the evening, and believing that one won’t be able to fall asleep again without eating.
This condition is seen in around 1.5% of people in the United States, which is roughly the same number of people who have binge eating disorder. The occurrence of symptoms can come and go, often related to the stressors in a person’s life, and typically starts during early adulthood.
Treatment options include both medication and non-drug-based therapies. An example of a non-drug-based therapy is cognitive behavioral therapy, which helps one learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions.
