Night eating syndrome

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Night eating syndrome (NES) is an eating disorder, which is primarily characterized as an ongoing, persistent pattern of late-night binge eating.[1][2] It was originally described by Dr. Albert Stunkard in 1955 [3] and is currently included in the “Other Specified Feeding or Eating Disorder” category of the DSM-5.[4] Research diagnostic criteria have been proposed [5] and include evening hyperphagia (consumption of 25% or more of the total daily calories after the evening meal) and/or nocturnal awakening and ingestion of food two or more times per week.  The person must have awareness of the night eating to differentiate it from the parasomnia sleep-related eating disorder (SRED).  Three of five associated symptoms must also be present: lack of morning hunger, urges to eat in the evening/at night, belief that one must eat in order to fall back to sleep at night, depressed mood, and/or difficulty sleeping.  NES affects both men and women,[6] between 1 and 2% of the general population,[7] and approximately 10% of obese individuals.[8] The age of onset is typically in adulthood, with children rarely reporting NES.[9]  People with NES have been shown to have higher scores for depression and low self-esteem, and it has been demonstrated that nocturnal levels of the hormones melatonin and leptin are decreased.[10]  The relationship between NES and the parasomnia SRED is in need of further clarification.  There is debate as to whether these should be viewed as separate diseases, or part of a continuum.[11]

Symptoms and behavior

The research diagnostic criteria for NES [5] include:

  1. The daily pattern of eating demonstrates a significantly increased intake in the evening and/or nighttime, as manifested by one or both of the following:
    1. At least 25% of food intake is consumed after the evening meal
    2. At least two episodes of nocturnal eating per week
  2. Awareness and recall of evening and nocturnal eating episodes are present.
  3. The clinical picture is characterized by at least three of the following features:
    1. Lack of desire to eat in the morning and/or breakfast is omitted on four or more mornings per week
    2. Presence of a strong urge to eat between dinner and sleep onset and/or during the night
    3. Sleep onset and/or sleep maintenance insomnia are present four or more nights per week
    4. Presence of a belief that one must eat in order to initiate or return to sleep
    5. Mood is frequently depressed and/or mood worsens in the evening
  4. The disorder is associated with significant distress and/or impairment in functioning.
  5. The disordered pattern of eating has been maintained for at least 3 months.
  6. The disorder is not secondary to substance abuse or dependence, medical disorder, medication, or another psychiatric disorder.

The DSM-5 diagnostic criteria for NES [4] are as follows:

  • Repeated occurrences of night eating, demonstrated by eating after waking from sleep or by an excess in food intake after the evening meal.
  • The individual is aware of and can recall the eating.
  • Other influences such as changes in the individual’s sleep-wake cycle or social norms cannot better explain the night eating.
  • Significant distress and/or impairment in functioning results from the night eating.
  • The disordered pattern of eating is not caused by binge-eating disorder, a mental disorder, a medical disorder, or the effect of medication.


Treatment for NES includes the selective serotonin reuptake inhibitors, Cognitive-Behavioral Therapy, progressive muscle relaxation, and behavioral weight loss.[12][13][14]  Bright light therapy might also be a treatment option. No other therapies have been tested.  There is no support for therapies that affect melatonin or leptin. Several years ago there was a belief that night eating was associated with carbohydrate craving, but research has failed to support this theory.


NES is sometimes associated with excess weight; as many as 28% of individuals seeking gastric bypass surgery were found to suffer from NES in one study.[15]  However, not all individuals with NES are overweight.[10][16]  Night eating has been associated with diabetic complications.[17]  Many people with NES also experience depressed mood [10][18][19][20][21][22][23][24][25] and anxiety disorders.[23][24][26][27]

See also


  1. ^ “Night bingeing recognised as a disorder”. BBC News. April 20, 1999. Retrieved May 20, 2010. 
  2. ^ eMedicine – Parasomnias : Article Excerpt by Sat Sharma
  3. ^ Stunkard, A.J., Grace, W.J., & Wolff, H.G. (1955). The night-eating syndrome; a pattern of food intake among certain obese patients. The American Journal of Medicine, 19, 78-86.
  4. ^ a b American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  5. ^ a b Allison, K.C., Lundgren, J.D., O’Reardon, J.P., Geliebterm A., Gluck, M.E., Vinai, P., et al. (2010). Proposed diagnostic criteria for night eating syndrome. International Journal of Eating Disorders, 43, 241-247.
  6. ^ Striegel-Moore, R.H., Franko, D.L., Thompson, D., Affenito, S., & Kraemer, H.C. (2006). Night eating: Prevalence and demographic correlates. Obesity, 14, 139–147.
  7. ^ Rand, C.S.W., Macgregor, M.D., Stunkard, A.J. (1997). The night eating syndrome in the general population and amongst post-operative obesity surgery patients. International Journal of Eating Disorders, 22, 65–69.
  8. ^ Stunkard, A.J., Berkowitz, R., Wadden, T., Tanrikut, C., Reiss, E., & Young, L. (1996). Binge eating disorder and the night-eating syndrome. International Journal of Obesity, 20, 1–6.
  9. ^ Lundgren, J.D., Drapeau, V., Allison, K.C., Gallant, A.R., Tremblay, A., Lambert, M.A., . . . Stunkard, A.J. (2012). Prevalence and familial patterns of night eating in the Quebec adipose and lifestyle investigation in youth (QUALITY) study. Obesity, 20, 1598-1603.
  10. ^ a b c Birketvedt, G., Florholmen, J., Sundsfjord, J., Østerud, B., Dinges, D., Bilker, W., & Stunkard, A.J. (1999). Behavioral and neuroendocrine characteristics of the night-eating syndrome. Journal of the American Medical Association, 282, 657-663.
  11. ^ Auger, R.R. (2006). Sleep-related eating disorders. Psychiatry, 3, 64-70.
  12. ^ Patel, K.R., O’Reardon, J.P., & Cristancho, M.A. (2012). Pharmacological treatment of night eating syndrome. In J.D. Lundgren, K.C. Allison, & A.J. Stunkard (Eds.), Night eating syndrome (pp. 221-230). New York, NY: The Guilford Press.
  13. ^ Allison, K.C. (2012). Cognitive-behavioral therapy and night eating syndrome. In J.D. Lundgren, K.C. Allison, & A.J. Stunkard (Eds.), Night eating syndrome (pp. 231-245). New York, NY: The Guilford Press.
  14. ^ Pawlow, L. (2012). Other approaches to the treatment on night eating syndrome. In J.D. Lundgren, K.C. Allison, & A.J. Stunkard (Eds.), Night eating syndrome (pp. 266-281). New York, NY: The Guilford Press.
  15. ^ O’Reardon, J.P.,  Stunkard, A.J., & Allison, K.C. (2004). Clinical trial of sertraline in the treatment of night eating syndrome. International Journal of Eating Disorders, 35, 16-26.
  16. ^ Lundgren, J.D., Shapiro, J.R., & Bulik, C.M. (2008). Night eating patterns of patients with bulimia nervosa: a preliminary report. Eating and Weight Disorders: Studies on Anorexia, Bulimia, and Obesity, 13, 171–175.
  17. ^ Morse, S.A., Ciechanowski, P.S., Katon, W.J., & Hirsch, I.B. (2006). Isn’t this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes. Diabetes Care, 29, 1800–1804.
  18. ^ Gluck, M.E., Geliebter, A., & Satoy, T. (2001). Night eating syndrome is associated with depression, low self-esteem, reduced daytime hunger, and less weight loss in obese patients. Obesity Research, 9, 264-267.
  19. ^ Calugi, S., Grave, R.D., & Marchesini, G. (2009). Night eating syndrome in class II-III obesity: Metabolic and psychopathological features. International Journal of Obesity, 33, 899-904.
  20. ^ Boseck, J.J., Engel, S.G., Allison, K.C., Crosby,R.D., Mitchell, J.E., & de Zwaan, M. (2007). The application of ecological momentary assessment to the study of night eating. International Journal of Eating Disorders, 40, 271–276.
  21. ^ Allison, K.C., Ahima, R.S., O’Reardon, J.P., Dinges, D.F.,Sharma, V., Cummings, D.E., . . . Stunkard, A.J. (2005). Neuroendocrine profiles associated with energy intake, sleep, and stress in the night eating syndrome. Journal of Clinical Endocrinology and Metabolism, 9, 6214-6217.
  22. ^ Striegel-Moore, R.H., Franko, D.L., Thompson, D., Affenito, S., May, A., & Kraemer, H.C. (2008). Exploring the typology of night eating syndrome. International Journal of Eating Disorders, 41, 411–418.
  23. ^ a b de Zwaan, M., Roerig, D.B., Crosby, R.D., Karaz, S., & Mitchell, J.E. (2006). Nighttime eating: a descriptive study. International Journal of Eating Disorders, 39, 224–232. 
  24. ^ a b Lundgren, J.D., Allison, K.C., O’Reardon, J.P., & Stunkard, A.J. (2008). A descriptive study of non-obese persons with night eating syndrome and a weight-matched comparison group. Eating Behaviors, 9, 343–351.
  25. ^ Thompson, S.H., & DeBate, R.D. (2010). An exploratory study of the relationship between night eating syndrome and depression among college students. Journal of College Student Psychotherapy, 24, 39-48.
  26. ^ Sassaroli, S., Ruggiero, G.M., Vinai, P., Cardetti, S.,Carpegna, G., Ferrato, N., . . . Sampietro, S. (2009). Daily and nightly anxiety amongst patients affected by night eating syndrome and binge eating disorder. Eating Disorders, 17, 140–145.
  27. ^ Napolitano, M.A., Head, S., Babyak, M.A., & Blumenthal, J.A. (2001). Binge eating disorder and night eating syndrome: psychological and behavioral characteristics. International Journal of Eating Disorders, 30, 193–203. 


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