NES prevalence would increase with increasing BMI Associations between NES and binge eating, symptoms of depression, body image/appearance dissatisfaction (AD), mental health-related quality of life (MHQoL) and eating behavior were investigated. Three groups differing in body weight and treatment-seeking status (bariatric surgery candidates, weight loss support group members and general community respondents) were recruited. The aim of this study was to investigate the clinical significance of NES by exploring the relationship between NES and (1) BMI, (2) BED and (3) psychological distress. 21, 25, 26 NES could simply constitute a variant of normal eating behavior that may be linked to weight gain and obesity. It is currently unclear whether NES, as a discrete condition, is associated with emotional distress, impairment or disability, and thereby represents an eating disorder of clinical significance. 21 In obese populations, BED has been linked with NES 6, 9, 10, 22 and nocturnal snacking 23, 24 however, the nature of the association is uncertain. BED involves regular episodes of excessive, uncontrolled overeating, and is strongly associated with psychological distress. 20 Symptoms of depression are more consistently associated with NES, 1, 4, 7 but may be influenced by the concurrence of binge eating disorder (BED). 19 Despite this, only one cross-sectional study has shown a positive relationship between NES and body mass index (BMI).
NES prevalence estimates are low in community samples (range: 0.4–1.6%), 5, 17, 18 but markedly higher among groups of obese persons seeking medical or surgical weight loss (range: 6–64%). 16 At present, NES is not formally listed as an eating or sleep disorder, and no agreed diagnostic criteria exist.
11, 12, 13, 14, 15 Individuals with NES, who report nocturnal snacking may constitute a group with more severe symptoms than those who do not wake to eat. 2 Features of the syndrome have generally included morning anorexia, evening hyperphagia and insomnia, 3, 4, 5, 6, 7, 8, 9, 10 and more recent research criteria have stipulated the consumption of nocturnal snacks, where individuals wake from sleep to eat.
Individuals with NES are characterized by a time-delayed pattern of eating relative to sleep, where most food is consumed late in the day and into the evening and night. 1 in 1955, awareness of NES as a behavioral entity has only emerged in the last decade. Night eating syndrome (NES) is such a condition, observed most frequently among groups of overweight and obese individuals. The escalating worldwide prevalence of obesity has drawn attention to the association between ‘non-normative’ eating patterns, weight gain and obesity. Further characterization and understanding of the clinical significance of NES and nocturnal snacking is required. Elevated psychological distress was only apparent in those who consumed nocturnal snacks. In this study, NES was positively associated with BMI, BE and male gender. Low MHQoL ( P=0.007) and male gender ( P=0.022) explained 27% of the variance in the nocturnal snacking group. Those with NES who consumed nocturnal snacks reported poorer MHQoL ( P=0.007) and greater depressive symptoms ( P=0.039) and hunger ( P=0.013) than others with NES. NES alone was not associated with psychological distress. Individuals with co-morbid NES and BE reported similarly elevated psychological distress as other binge eaters. Across all groups, BE ( P=0.001), BMI ( P=0.003) and male gender ( P=0.013) explained 10% of NES variance. NES criteria were met by 11.1% of the total cohort. NES and binge eating (BE) ( ⩾1 episode/week) were confirmed by interview. Validated questionnaires assessed BED, symptoms of depression, appearance dissatisfaction (AD) and mental health-related quality of life (MHQoL). Nocturnal snacking (awakening to eat) was recorded. NES diagnosis required within the previous 3 months: (1) no appetite for breakfast, (2) consumption of ⩾50% of daily energy after 1900 hours and (3) sleep difficulties ⩾3 nights/week. One hundred and eighty bariatric surgery candidates, 93 members of a non-surgical weight loss support group and 158 general community respondents (81 males/350 females, mean age: 45.8☑3.3 years, mean body mass index (BMI): 34.8☑0.8 and BMI range: 17.7–66.7). This study aimed to investigate the clinical significance of NES and nocturnal snacking by exploring the relationship between NES and (1) obesity, (2) binge eating disorder (BED) and (3) psychological distress. Night eating syndrome (NES) is characterized by a time-delayed pattern of eating relative to sleep, where most food is consumed in the evening and night.
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