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November 16, 2004

BehindTheMedspeak: Night Eating Syndrome

Ones

Nanci Hellmich wrote an interesting article for yesterday's USA Today about this disorder, difficult to diagnose amidst a plethora of related problems.

It's very problematic, differentiating a normal behavior from one that tips into pathology when it comes to food.

Zoloft seems to help in night eating disorder, as it seems to help almost anything with a behavioral component.

"Listening to Zoloft" could well turn out to be Peter Kramer's next book, what with the drug's increasingly ubiquitous use.

Here's the story.
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The Loneliness of the Nighttime Snacker


When Carlo Porreca's three children were babies, he frequently got up at night to check on them.

Years later, when they were teenagers, he was still getting up at night, but by then he was going down to the kitchen and eating.

At first he nibbled on a few crackers, but then he began gobbling cookies and milk and sandwiches.

For more than 20 years, he ate three or four times between midnight and 4 a.m.

"It took on a life of its own, and my body started waking me up for the food," says Porreca, now 62, a computer manager in Philadelphia. One night he even cooked himself a steak.

He put on 50 pounds before he was diagnosed with a disorder called night eating syndrome.

Like Porreca, people who have this condition consume a third or more of their daily calories after dinner, either before going to bed or during the night, says psychologist Kelly Allison of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine in Philadelphia.

They aren't sleepwalking; they're aware of what they're doing.

"But there is a feeling of compulsion and anxiety associated with it."

She and her colleagues at the university are presenting new research on the syndrome today in Las Vegas at the annual meeting of the North American Association for the Study of Obesity, a conference being held in partnership with the American Diabetes Association.

They've found that the antidepressant Zoloft is effective in controlling night eating, and Allison also has explored treating it with behavior modification strategies.

Allison has written a new book, "Overcoming Night Eating Syndrome," with Sara Thier and Albert Stunkard.

Stunkard is the University of Pennsylvania psychiatrist who discovered the syndrome in the early 1950s.

Estimates vary on how many people have this problem, but research suggests that it affects 6% to 8% of people treated in obesity clinics and about 1.5% of the general population, Stunkard says.

People of normal weight sometimes are affected, too, and it may be a pathway to the development of obesity, he says.

Penn researchers have studied more than 100 patients with the condition and also have gathered data from more than 2,000 others who've visited their Web site at www.uphs.upenn.edu/weight.

Night eaters are different from those who get up occasionally to snack or who consume a lot of food several times a week before bed.

Stunkard says night eaters often eat sparingly early in the day.

"The disorder represents a shift of the biological rhythm of eating to later in the day," he says.

People with the syndrome may, for example, eat 700 to 800 of their 2,200 daily calories at night.

They may eat peanut butter right out of a jar or chocolate cake or leftovers from dinner, Allison says.

The emotional and physical impact is circular.

"The eating helps soothe people and makes them feel better for a short time, but it also increases their weight, which makes them feel worse," she says.

Some are frustrated.

"They feel like even though they are eating well during the day, they can't lose weight because they feel so compelled to eat during the night."

Allison worked with one woman who got up and ate more often at night after her third child was born with a serious brain abnormality.

The increasing weight left her feeling depressed and hopeless.

Another patient woke nearly every hour on the hour and tried to do other activities but usually ended up giving in and eating.

"Then I sleep like a baby," he reported.

The syndrome often seems to be triggered by a stressful or emotional event.

About 75% of people can link its start to a specific event like a divorce, pregnancy or loss of job, Allison says.

"About 50% of our sample have had a major depressive episode in their lifetime."

Porreca didn't have a history of depression.

He believes he had a sleeping disorder that became an eating disorder.

"Between the two of them, it took hold and I couldn't control it," he says. When Penn doctors studied his eating patterns, they found he ate 34% of his calories between midnight and 4 a.m.

Key behaviors observed in people with night eating syndrome:

• Overeating in the evening. They may feel hungry and eat to relax before bedtime.

• Difficulty falling asleep. They may toss and turn for half an hour or longer. They may need to eat something just before going to bed.

• Waking at night and eating at least three times a week. After falling asleep, they often wake up at least once and need to eat before being able to fall asleep again.

• Not feeling hungry in the morning. They don't have any appetite and will often go without food until lunchtime or later in the afternoon. They may wake up "feeling kind of gross, nauseated, like they're really full," Allison says.

For some people, the syndrome becomes part of their daily lives for years, she says.

"We see people who are 60 and have had it since they were 30," she says.

David Neubauer, an associate director of the Sleep Disorders Center at Johns Hopkins Medical School in Baltimore, says doctors at sleep clinics treat a range of sleep-related eating issues.

In the 1980s, researchers wrote about a problem called nocturnal sleep-related eating disorder.

People suffering with this go to sleep, then get up and may not be fully aware that they are eating.

Some know what they've done only after being observed or by noticing missing food, crumbs and empty wrappers, he says.

They are different from people who actually wake up and get a snack, but they may share some of the characteristics of people with the night eating syndrome, he says.

For some with the syndrome the delayed pattern in eating disrupts sleep, Allison says.

"This can impact people's ability to concentrate and feel rested the next day."

Experts are researching treatments, including recommending basic behavioral changes in eating and exercise habits.

In three different studies, University of Pennsylvania researchers are prescribing the antidepressant Zoloft to patients with the disorder.

"We do get good results, but of course it's not a magic bullet for everyone," Allison says.

"Other drug treatments may work; they just haven't been studied yet."

After enrolling in a university study, Porreca started taking Zoloft.

"Within two weeks, I was sleeping through the night."

He also lost 25 pounds and his cholesterol dropped.

Then he started walking and doing other physical activities, eating healthier and quit smoking.

"I can't believe how well I feel. I didn't realize how wonderful it is to sleep through the night. I feel peppier. I feel tremendous."
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How the pounds add up

Here's a sample food diary of someone with night eating syndrome.

Note that just over 30% of the day's calories are consumed after dinner.

Food and beverage consumed; Quantity; Calories

• 10 a.m. - (Breakfast); Average; 176

• 1 p.m. - (Lunch); Average; 808

• 6 p.m. - Pepperoni pizza; 3 slices; 930; Iced tea, sweetened; 12 oz.; 150

• 8 p.m. - Vanilla ice cream; 1 cup; 300

• 11 p.m. - Chocolate chip cookies; 3;180

1 a.m. - Potato chips; 1 oz.; 150

3 a.m - Peanut butter; 3 tbs.; 315

Total calories: 3,009
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Eight ways to break the cycle

Keep a journal of thoughts and emotions.

Keep a detailed food journal, recording each meal and snack immediately after eating it and the time it was eaten.

Try to shift some caloric intake to earlier in the day.

Exercise at least three times a week. It helps physically and physiologically by activating certain chemicals in the body.

Consult a mental health professional or physician if suffering from depression, anxiety, obsessions or compulsions.

Examine sleep habits and possibly cut back on caffeine, alcohol or smoking, especially in the afternoon and evening.

Keep only healthful foods in the house to limit cravings for high-calorie foods.

If you eat food to help you fall back to sleep, reduce the amount.

November 16, 2004 at 02:01 PM | Permalink


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