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Night Eating Syndrome

Do you find yourself constantly struggling to lose weight? Does it seem like the more you try to control your eating and restrict your calories the more weight you seem to gain? Does the thought of needing to lose weight seem to occupy more space in your mind now then ever before? Have you tried to lose weight by skipping meals, particularly breakfast and/or lunch? Do you find you have difficulty stopping eating once dinner starts in the evening? Do you plot strategic attacks to “raid the refrigerator” before bedtime or sometimes even after going to bed?

If you answered, “yes” to these questions, you may be someone suffering from the “night eating syndrome”. This condition affects up to 27% of obese people, and roughly 1.5% of the general population. The classical syndrome includes loss of appetite in the morning and during the day, and insomnia at night. Mood is also affected, with stress, depression, and anxiety being common amongst those with the condition. Night eaters most commonly have little or no appetite upon awakening in the morning, and may not feel hungry for the first time of the day until afternoon. They then would tend to overeat from dinnertime onward throughout the night, frequently consuming an excess of calories after dinner. This pattern of pattern of deprivation during the day, and over consumption of calories at night leads to weight gain and eventually obesity.

Night eating syndrome is now recognized as a specific type of eating disorder. Not only is this syndrome an eating disorder, but one of mood and sleep as well. Night eaters are much more likely to suffer from insomnia, and wake up on the average 10-12 times more often than a control group without the condition (average 3.6 times per night, compared with 0.3 times nightly in non-affected individuals). About half of the time, night eaters actually get up and eat something after waking up at night.

Recent studies (JAMA 1999;282:657-663) have also shed some light on the hormonal changes associated with this condition. In this study, affected individuals were found to have lower levels of the hormone melatonin, and higher levels of the hormone cortisol. Melatonin is known to play a critical role in the body’s internal clock, which helps to maintain the rhythmic cycle of sleeping and wakening. Lower melatonin levels may interfere with the sleep patterns of these people, leading to insomnia and frequent wakening through the night. Higher cortisol levels are also found in mood disorders such as depression, anxiety, and under conditions of stress. Cortisol is produced by our adrenal glands, which are considered our stress glands. A high level of cortisol increases appetite, and is associated with obesity, type II diabetes, high blood pressure, and high cholesterol. An excess of cortisol is also known to increase the risk of heart attack, stroke, and osteoporosis. These important and potentially serious health concerns make night eating syndrome more than just a weight-control problem; night eaters are at higher risk for serious health problems.

To make matters worse, it has also been found, that night eaters generally show lower levels of the hormone leptin. Leptin is felt to be responsible for turning off one’s appetite through the night during sleep. Lower levels of the hormone leptin in night eaters may increase their nighttime appetites, leading to consumption of even more calories, thereby magnifying the problem. According to Albert Stunkard, MD of the University of Pennsylvania's Weight and Eating Disorders Program, "Not only is night-eating syndrome an eating disorder, but one of mood and sleep as well. People who fall prey to this syndrome are not simply indulging in a bad habit. They have a real clinical illness, reflected by changes in hormone levels."

Dr. Stunkard feels that nighttime eating may be a way that people with an underlying mood disorder such as stress, anxiety or depression, may be trying to medicate themselves with food. "This snacking may be a way for these persons to medicate themselves," speculates Stunkard, "because they eat a lot of carbohydrates, increasing serotonin in the brain, which in turn, leads to sleep." "People with this syndrome start out daily with morning anorexia-- or not eating anything all morning -- and consume fewer than average calories throughout the day. As the day wears on, their mood worsens and they become more and more depressed," said Stunkard. Then comes the night, when victims raid the refrigerator and cupboards for high-carbohydrate snacks, sometimes up to four times a night. If anxiety and depression increase throughout the night, so does eating.

Night eating, therefore, becomes a self-perpetuating cycle that can be difficult to break.

If you feel you may be a “night eater”, we would recommend the following approach to help control this condition:

• First, begin by eating breakfast, even though you may not feel hungry. Try to include a source of protein in your breakfast, such as eggs, whole grains, a protein “smoothie” or salmon or a lean breakfast meat. Try to avoid eating just cereal, toast, a bagel, a muffin, or a donut.
• Next, you’re likely to find that you are hungry for lunch around 11:30 or noon. This will be a surprise because, before when you were skipping breakfast, you often would not notice being hungry until 4 or 5 PM. You should go ahead and eat a healthy lunch that satisfies your hunger. Choose high fiber, filling foods such as salads, beans, nuts, lean meats, and whole grains.
• When dinnertime rolls around, you will notice something interesting happening. Instead of being famished with a voracious appetite just looking for anything to put in your mouth, you’re likely to find that you’re not particularly hungry for dinner; in fact, you could easily pass it by altogether. Rather than skipping dinner, however, try to have a small, but healthy meal such as soup and salad, or a bean salad and a slice of whole grain bread.
• Night eaters should refrain from desserts after dinner as much as possible, since this may restart the cycle of late night eating. Instead try to choose fruit or herbal tea after dinner if you’re still looking for something with a little sweetness.
• After following this pattern of eating for just a few days, you are likely to find improvement in your level of energy during the day, the quality of your sleep, your mood, and finally your weight.
• Finally, if you have feelings of depression, anxiety, or overwhelming stress, you should seek professional help; without addressing these important feelings it may be difficult to fully overcome the pattern of night eating syndrome.

Be healthy – be mindful…stay tuned