Night eating syndrome (NES), also known as “midnight hunger”, is an unusual type of eating disorder characterized by an ongoing, persistent pattern of late-night binge eating. NES, which has not been formally defined as an eating disorder, was originally described by Dr Albert Stunkard in 1955. The underlying causes are currently being identified and treatment plans are being developed. It appears that NES caused by a combination of biological, genetic, and emotional factors. The following are signs and symptoms of NES:
- The person has little or no appetite for breakfast. Delays first meal for several hours after waking up. Is not hungry or is upset about how much was eaten the night before.
- Eats more food after dinner than during that meal.
- Eats more than half of daily food intake during and after dinner but before breakfast. May wake up and leave the bed to snack at night. May not be aware at the time of what they are doing.
- This pattern has persisted for at least two months.
- Person feels tense, anxious, upset, or guilty while eating.
- NES is thought to be stress related and is often accompanied by depression and anxiety. Especially at night the person may be moody, tense, anxious, nervous, agitated, etc.
- Has trouble falling asleep or staying asleep. Wakes frequently and then often eats.
- Foods ingested are often carbohydrates: sugary and starchy.
- Behavior is not like binge eating which is done in relatively short episodes. NES involves continual eating throughout evening hours.
- This eating produces guilt and shame, not enjoyment.
Approximately one to two percent (1-2%) of adults in the general population have this problem, but research at the University of Pennsylvania School of Medicine suggests that about six percent of people who seek treatment for obesity have NES. Another study suggests that more than a quarter (27%) of people who are overweight by at least 100 pounds have the problem.
One theory postulates that people with this condition are under stress, either recognized or hidden. Their bodies are flooded with cortisol, a stress hormone. Eating may be the body’s attempt to neutralize cortisol or slow down its production. More research needs to be done before this explanation can be accepted or rejected. In any event, stress appears to be a cause or trigger of NES, and stress-reduction programs, including mental health therapy, seem to help.
If you are seeking help for NES, you would be wise to schedule a complete physical exam with your physician and also an evaluation with a counselor experienced in the treatment of eating disorders and also sleep disorders. In addition, a dietitian can help develop meal plans that distribute intake more evenly throughout the day so that you are not so vulnerable to caloric loading in the evening.
Evaluation in a sleep laboratory could be worthwhile. Most large hospitals have such facilities. It is not yet clear whether night eating is an eating disorder or sleep disorder or both. The more information available to the person and treatment team, the greater the chances are of developing an effective treatment plan.