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Nighttime Noshing

When is it something serious?

As far back as 1955, night eating syndrome (NES) has been identified as a disorder characterized by insomnia, evening hyperphagia and morning anorexia.1 My own interest in this subject was sparked by an article in a specialty dietetics newsletter published in spring 2010. I had received questions from patients about NES, and it seemed like a good idea to gather some evidence-based information. Knowing the difference between eating too many calories late at night and having NES is helpful in making decisions about treatment and plans of care.

What does research show?

In their literature review published in 2010, Allison, et al. cited 100 papers with varying levels of information about NES, all published between 1999 and 2009.2 A separate article by Allison stated that since NES was first described, many definitions have been used. This makes it difficult to generalize across the spectrum of studies and provide an integrated categorization of NES.3

In 2008, experts proposed criteria for NES that were later published in the International Journal of Eating Disorders.4 The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by consumption of at least 25% of intake after the evening meal and/or nocturnal awakenings with ingestions at least twice per week. Awareness of the eating episodes is required, as is distress or impairment in functioning. Three of five modifiers must also be endorsed. These criteria must be met for a minimum duration of 3 months.

What about simple nighttime eating?

In my nutrition practice and in my public speaking, I am often asked whether eating late at night or after dinner causes weight gain. My answer is always twofold. If we eat more than we need or expend day after day, we will gain weight or not be able to maintain a healthy weight. Limiting after-dinner snacking to a portion well within a person's daily caloric needs is the best course of action. This can be done by using portioned bowls or cups or by doling out the appropriate serving size for the selected food, as stated on the nutrition label.

Patients often find portioning challenging when they are not ready to make changes. However, when asked to eat an appropriately portioned snack for weight maintenance or weight loss, a motivated patient will likely follow through. Another strategy is to simply stop eating after a certain time each night. For example, after 7 p.m., consider the kitchen closed.

One study looked at NES and nocturnal snacking and their association with obesity, binge eating and psychological distress. Colles, et al. characterized NES by a time-delayed pattern of eating relative to sleep, in which most food is consumed in the evening and at night (specifically 50% of daily kcals after 9 p.m.).5 NES was positively associated with patients whose BMI was greater than 34.8 (+/- 10.8), those who qualified as binge eaters, and being male. Participants with elevated psychological distress were more likely to consume nocturnal snacks but had not been diagnosed with NES.

Recommendations

Allison describes NES as a syndrome of a delayed circadian pattern of eating that is disruptive to sleep patterns, shameful and embarrassing, and often leads to weight gain.2 Some experts estimate that NES is as prevalent or more so than bulimia nervosa, binge eating disorder, and anorexia nervosa.2 Antidepressants and cognitive behavioral therapy can be helpful in treating this syndrome.2

For patients who do not meet NES criteria but have a problem with nighttime eating, find out exactly they are consuming at night. Often, eating later at night coincides with sedentary behavior such as television watching or computer activities, which can promote mindless consumption of particularly low-nutrient calories. Asking patients to plan a healthy snack within their calorie range for the day can aid in weight loss and weight management when NES is not the primary diagnosis.

What role for circadian rhythms?

In closing, I'd like to direct you to an interesting article that describes the conclusions of a study published in 2011 in the journal Obesity (http://www.appforhealth.com/2011/05/night-eating-linked-to-obesity/).6 Through their research, scientists at Northwestern University concluded that circadian rhythms of eating and sleep are usually synchronized so that humans and animals do not eat nocturnally. "Night eating causes a disruption in hormones that regulate appetite and hunger and makes the body more likely to store calories as fat," they wrote.

Robyn Kievit is a family nurse practitioner, a registered dietitian and a certified specialist in sports dietetics. She operates a private nutrition practice in Boston and is on staff at Emerson College. E-mail your nutrition and weight loss questions to robyn@robynkievit.com or visit her website at www.robynkievit.com. On Facebook and Twitter, search for nutritionmentor.

References

1.      Stunkard AJ, et al. The night-eating syndrome: a pattern of food intake among certain obese patients. Am J Med. 1955;19(1):78-86.

2.      Allison KC, et al. Night eating syndrome: overview and treatment. Pulse. 2010;29:8-11. http://www.scandpg.org/local/resources/files/SCANs_PULSE-Spring_2010-final2.pdf. Accessed Oct. 18, 2011.

3.      Allison KC, et al. What is night eating syndrome? New directions toward a unified definition. Int J Child Adolesc Health. 2009;2(2):175-184.

4.      Allison KC, et al. Proposed diagnostic criteria for night eating syndrome. Int J Eat Disord. 2010;43(3):2414-247.

5.      Colles SL et al. Night eating syndrome and nocturnal snacking: association with obesity, binge eating and psychological distress. Int J Obes. 2007;31(11):1722-1730.

6.      Baron KG, et al. Role of sleep timing in caloric intake and BMI. Obesity. 2011;19(7):1374-1381.


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