Night Eating Explore the Individuals

Night Eating

Explore The Individuals Experience Of Night Eating Syndrome And How It Affects Their Life

Night Eating Syndrome

The Individual's Experience of Night Eating Syndrome and how it Affects Their Life

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The problem of night eating syndrome has become a focus of research in recent years largely due to the debate about its relationship to various eating disorders and obesity. This syndrome has also been linked to aspects of the individual's life experience with regard to the prevalence of anxiety and stress in many cases. Recent research has found a possible causative link between stress and tension as well as psychological factors such as depression, and the onset of night eating syndrome. This has led to a research concern with the experiences of those who suffer for this syndrome and to the way that it impacts and affects their daily lived. It is also clear for a survey of the literature that there is as relative paucity of research in this area. This proposal will therefore focus on this concern and will attempt to explore and interrogate the individuals' experience of night eating syndrome and the way it affects their lives.

Introduction

The condition known as night eating syndrome is a comparative newcomer to the arena of research in eating disorders and obesity. There has in the last decade been an increased research interest in this syndrome as it has been linked by many experts to other eating disorders and obesity. Its prevalence is also as matter of medical concern. One study notes that, "Perhaps as many as 6 million Americans suffer night eating syndrome, or NES…. (Overcoming Night Eating Syndrome: A Step-by-step Guide to Breaking the Cycle).

The present proposed study of night eating syndrome is not only intended to provide an overview of the cardinal aspects of this condition but also to explore the experiences of those who suffer from this syndrome and the impact that it has on their lives. One of the central aspects that will be a focus of attention is this study is the predominance of stress and anxiety in these individuals -- which is an aspect that is in need of further research in order to ascertain the underlying causative features of the syndrome. A second important focus and one that contributes to the life experience of the individual, is the close link of this condition and obesity.

Overview

Night Eating Syndrome is generally described as a condition that is characterized by the compulsion to consume more than half of one's daily calorie intake after the evening meal. This is usually accompanied by 'morning anorexia' or a lack of any appetite for the breakfast meal. This condition is also associated with insomnia and waking up during the night to eat. Furthermore, this condition has become a focus of recent research because of its link to obesity and other health issues. For instance, it is noted that "Foods eaten during the nighttime binge are often high caloric in content and unhealthy." There are a number of comorbid aspects to this condition. One of the most significant in terms of the main theme of this study is depression and anxiety conditions that are also seen as contributory and causative factors in this condition. Other causative features of this condition include the finding that there is a reduction of certain hormones in sufferers. This includes a decrease in melatonin that has been attributed to sleep disturbances.

An accepted definition of this condition is as follows:

Night eating syndrome (NES)… occurs when the normally synchronous patterns of energy intake and sleep become disrupted; the result of this dysynchrony is a relative phase delay between the disordered eating patterns and the normal sleep-wake cycles ( Townsend, 2007, p. 217).

This definition places emphasis on the disruption of normal sleeping and eating cycles. This dysynchrony raises the question of causation and is also related to the experiential situation of the patient who has this condition.

The term Night Eating Syndrome was coined by Strunkard in 1955 and was described as a disorder that composed "….the triad of morning anorexia, evening or nocturnal hyperphagia (in full con- sciousness), and insomnia" (Fairburn & Brownell, 2002, p. 183). An important early finding that has significance for modern research is that "… it occurred disproportionately among obese persons" (Fairburn & Brownell, 2002, p. 183). This is an important factor that is often debated in the literature. As one study notes, "More significant is the further finding that more than 33% of morbidly obese individuals -- persons who are 100 or more pounds overweight -- are affected by this disorder" (Night Eating).

Even more significant in terms of the present study, is that Strunkard found that this condition was associated with periods of stress and that it also responds well to the alleviation of stress (Fairburn & Brownell, 2002, p. 183). This is an extremely important facet of the disorder, as it tends to suggest the role that stress and anxiety play in the life experience of the individual who suffers from the disorder. Furthermore, Strunkard found that, "The night eating syndrome appeared to be a special circadian stress response characteristic of some obese persons" (Fairburn & Brownell, 2002, p. 183).

The significance of stress and tension in the life of the individual with this condition is well documented in the literature. As a study by Thayer ( 2003) states,

Overeating as a way of seeking energy and feeling better when faced with unpleasant anxiety or tension is most likely to occur when resources drop -- for example, late in the afternoon or at night. One pattern of this type of overeating, first observed in the 1950s by Albert Stunkard, has been the subject of numerous scientific papers. ( Thayer, 2003, p. 119)

Thayer also notes that night-eating syndrome is not currently classified in DSM-IV as an eating disorder. This is an area of debate that will also be explored in the present study as the condition has been closely associated with obesity (Thayer, 2003, p. 118).

Thayer also refers to the experience of the individual and to the importance of stress and tension as a factor in the life experience of the individual. "Several researchers have identified stress and evening tension as influences on night-eating syndrome" (Thayer, 2003, p. 119).

A central approach in the present study will be to adopt a holistic view of this condition. In order to understand the life situation and the experience of the person who suffers from the syndrome one has to understand the comorbid and concomitant features of the condition. It also becomes clear from the literature that this is an extremely debilitating condition.

Prevalence and Demographics

In recent years, research has indicted that this disorder is more prevalent than was previously thought. There are however many different reports on the issue of prevalence and on demographic issues. In one study, for example, the researcher states that;

The prevalence of NES varies widely, depending on the population under study and on the diagnostic criteria used to classify it. The best prevalence estimate of NES in the general population is 1,5%."The prevalence of NES rises dramatically among the obese, with prevalence rates of about 9%.8 Prevalence does not appear to differ by gender or ethnicity and, although rarer, NES does occur among nonobese persons

(Lundgren, 2006)

The debate on this issue will be dealt with in more detail in proposed study.

Literature Review

The literature on this topic began proliferating in the 1900s, when the association between night eating syndrome and eating disorders and obesity were investigated. In order to understand the impact that this syndrome has on the individual it is firstly necessary to investigate the development, background and the various theoretical stances that have been attributed to this syndrome. Therefore, this literature review was divided into two sections; the background and overview to this condition and literature that reflected the living experience of the individual suffering from this condition. However, it should also be borne in mind that these two aspects invariably overlap and there are many books and articles that include both of these dimensions.

The literature for this project was sourced from a wide array of databases and online as well as offline resource areas. These included databases such as Ebscohost, Questia, Google Scholar and many others. An attempt was made cover the field as widely as possible to include aspects such causative factors, as well as comorbid factors such as depression and stress.

General Background and Overview

One of the more useful general studies of this subject is Logue (2004), the Psychology of Eating and Drinking. This study provides a comprehensive overview of the origins of the term night eating syndrome and insight into some of the more recent studies and research. Importantly, the study deals with the psychological dimensions of this condition and refers in particular to depression as a consequence of anxiety in the life experience of the individual. The study also differentiates between the psychological effects of night eating syndrome in comparison to obesity. "…people with NES tend to be more depressed than obese people without NES, and the mood of those with NES tends to worsen during the evening, something not seen in other obese people"(Logue, 2004, p. 185).

Among the many studies that provide insight into the background and origins of this syndrome, one of the most enlightening was Obesity by Stunkard, in Fairburn and Brownell (2002). This provides an in-depth analysis of night eating syndrome as well as a concise overview of the background of this condition. Stunkard also refers to a detailed overview of this condition.

Studies using the above criteria estimate that the prevalence of the night eating syndrome in the general population is approximately 1.5% and that prevalence increases with increasing weight, from about 10% of persons enrolling in obesity clinics to as high as 25% of patients undergoing surgical treatment for obesity…it occurs among about 5% of those presenting for the treatment of insomnia (although other sleep-related eating disturbances are also seen in which patients are either partially or totally unconscious). (Fairburn & Brownell, 2002, p. 183)

Of particular interest to the topic of this proposal are the behavioral characteristics of those who suffer from this syndrome. Stunkard refers to the different behavioral patterns in NES or night eating syndrome patients and those suffering from obesity.

The more striking difference between the two groups was in the temporal pattern of their food in- take….the cumulative caloric intake of the night eaters lagged behind that of the control subjects so that, by 6:00 P.M., they had consumed only 37% of their daily intake compared to 74% by the controls. The food intake of the controls slowed during the evening, while that of the night eaters continued at a rapid pace until after midnight. During the period from 8:00 P.M. To 6:00 A.M., the night eaters consumed 56% of their caloric intake, compared to 15% for the control subjects. (Fairburn & Brownell, 2002, p. 184)

As the above quotation suggests, another concern that is often noted in the literature on this subject is the complex and often controversial intersection between this condition and other eating disorders and obesity. Fairburn & Brownell ( 2002) note that researchers and experts are in agreement that, "NES shares characteristic of not only eating disorders but also sleep and mood disorders" (Fairburn & Brownell, 2002, p. 183). This is an important point as it views night eating syndrome in a holistic light which attempts to link it to other conditions and especially to stress and anxiety that the individual may experience. "Sufferers tend to exhibit symptoms such as feelings of anxiety and guilt, insomnia or interrupted sleep" (Fairburn & Brownell, 2002, p. 183).

Fairburn & Brownell ( 2002) also refer to the importance of a renewal of interest in the link between eating disorders and obesity. The authors of this study state that the view that obesity was believed to be due to an eating disorder is simplistic and does not take other factors such as disturbed eating patterns into consideration.

This simplistic view is no longer held and, as a result, for some time little attention was paid to the possibility that disturbed eating might contribute to obesity. This situation is changing, and two eating disorders have now been linked to obesity. The first is binge eating disorder & #8230;and the second is the night eating syndrome. (Fairburn & Brownell, 2002, p. 183)

This study therefore stresses the link between night eating disorder and obesity and this in turn has direct consequence for the cycle of stress and depression that the individual may experience.

The issue of prevalence and the demographics of this syndrome have also been a focus of research. A study by Lundgren (2006) conducted between University of Pennsylvania and the University of Minnesota, estimates that "… the prevalence of NES among patients seeking psychiatric services in university-based outpatient treatment clinics… NES was surprisingly high, with 12.3% of the sample meeting criteria based on a comprehensive telephone interview "(Lundgren, 2006, p.156). Importantly, this study also found a high correlation between obesity and night easting syndrome (Lundgren, 2006, p.156).

Another study by de Zwaan et al. ( 2003) suggest that while NES appears to be more common among obese individuals, "… within the obese, the lack of consistency in criteria used to diagnose NES, differences in patient populations and differences in methodology to assess NES, have contributed to a wide range of prevalence estimates" (de Zwaan et al., 2003, p.12). What is of special significance in the findings from the study by Lundgren is that; " These findings not only confirmed our hypothesis that night eating is associated with greater psychiatric comorbidity, but once again showed that night eating is associated with obesity" (Lundgren, 2006). This study therefore points to two aspects that have an impact on the life experience and the quality of life of individuals that suffer from this syndrome; namely, obesity and psychological disorders such as depression.

There are also various studies on strategies to overcome the disorder; for example, relaxation and visualization exercises are stressed as an important part of dealing with the syndrome -- which again sheds light on the issue of life experience (Overcoming Night Eating Syndrome: A Step-by-step Guide to Breaking the Cycle). Insight into some of the most recent research findings and developments is dealt with by Lundgren (2006).

Life Experience and Impact of the Condition

The above study by Lundgren (2006 emphasizes the comorbid aspects of this condition. Besides the issue of obesity, Lundgren refers to the association of night easting syndrome with" depressed mood and life stress" (Lundgren, 2006). "NES was more likely to occur among patients with a lifetime history of substance use disorders but not more likely to occur among patients diagnosed with mood disorders, anxiety disorders, psychotic disorders, or personality disorders" (Lundgren, 2006). This is an association that is encountered in various degrees and forms in the literature and which plays a significant role in ascertaining life experience and the impact of the syndrome.

The central factor of stress and tension in the lives of individuals who suffer from this condition is explored in an article by Theyer (2003) entitled Calm Energy: How People Regulate Mood with Food and Exercise. This study refers to research on behavior patterns of the individual who indulges in night-eating. The study explores the link between obesity, night-eating and anxiety or depression. As Thayer states in the study; "One researcher described personal interviews with obese night eaters who said they felt distressed and hopeless by their inability to stop eating at night, although they could maintain their diet during the day" (Thayer, 2003, p. 119).

This quotation emphasizes the feeling of helplessness and hopelessness that many individuals experience in their daily lives. This is added to by the inability to control excessive night eating. This also points to a cyclical situation where night easting leads to obesity, which in turn leads to further anxiety and depression. The study suggests that the underlying causative factors in this condition must be addressed to prevent a cycle of this nature from becoming self-perpetuating. As Stunkard has stated, "Not only is night eating syndrome an eating disorder, but one of mood & sleep as well…" (Night Eating). This has important implications that will be explored in this study in terms of the experience and situation of the individual.

The link between mood, feelings of anxiety and depression are emphasized by Stunkard. "Dr. Stunkard feels that night eating may be a way that people with an underlying mood disorder such as stress, anxiety or depression, may be trying to medicate themselves with food" (Night Eating).

The issue of mood in patients with this disorder is also discussed in Fairburn & Brownell ( 2002). "Changes in the mood of the night eaters were also distinctive" (Fairburn & Brownell, 2002, p. 184).

An important aspect referred to in the above study by Fairburn and Brownell, (2002) is the neuroendocrinology of the night eating syndrome. Research by Birketvedt et al. is referred to. This research found"… highly significant differences between night eaters and control subjects in plasma levels of melatonin, leptin, and cortisol… melatonin levels at night in the night eaters were significantly lower than those of controls" (Fairburn & Brownell, 2002, p. 185). The research also noted that, "The big difference between the night eaters and control subjects lay in their nighttime responses" (Fairburn & Brownell, 2002, p. 185).

Importantly, a study by Stunkard found that, "Thus, night eating syndrome appears to be a unique combination of eating disorder, sleep disorder, and mood disorder. A distinctive neuroendocrine pattern helps to link these three dimensions" (Fairburn & Brownell, 2002, p. 186). Furthermore, it has been found that lower levels of melatonin have been linked to depression and may be as factor in the mood structure of those who suffer from night eating disorder.

The issue of stress and tension in the lifestyles of those affected is seen as a central component of this syndrome in many studies. For example, "Experts agree that NES shares characteristic of not only eating disorders but also sleep and mood disorders. Sufferers tend to exhibit symptoms such as feelings of anxiety and guilt, insomnia or interrupted sleep…" (Overcoming Night Eating Syndrome: A Step-by-step Guide to Breaking the Cycle). It is suggested that the importance of factors like guilt should not be underestimated in playing a role in what is often a secret and clandestine activity. An article entitled Binge eating disorder and night eating syndrome: psychological and behavioral characteristics ( 2001) was also useful in this regard and one of the central findings was that anxiety was a factor in this condition.

Stunkard also makes the link clear between night easting syndromes and life circumstances which may result in stress and anxiety.

This syndrome seems to be precipitated by stressful life circumstances and, once present, tends to recur daily until the stress is alleviated. Attempts at weight reduction when the syndrome is present have an unusually poor outcome and may even precipitate a more severe psychological disturbance. (Stunkard, 1981, p. 464)

There above quotation clearly suggests a link between this condition and life situation. It therefore follows that there would most likely be a situation of stress and anxiety in the life of the individual who experiences this syndrome. As the above quotation also intimates, these stressful factors can lead to psychological disturbances that can further exacerbate the situation.

Another study that adds to this debate is Night eating syndrome and nocturnal snacking: association with obesity, binge eating and psychological distress ( 2007). This study found that, "Elevated psychological distress was only apparent in those who consumed nocturnal snacks. Further characterization and understanding of the clinical significance of NES and nocturnal snacking is required" (Colles et al. 2007, p. 1722).

An interesting study that sheds light on the issues at stake in this proposal is Night Eating Syndrome Is Associated with Depression, Low Self-Esteem, Reduced Daytime Hunger, and Less Weight Loss in Obese Outpatients ( 2001). The results of this study also tend to confirm the link between psychological issues and night eating."Night eaters had higher depression (p = 0.04), lower self-esteem (p = 0.003), and less hunger (p = 0.005), and a trend for more fullness (p = 0.06) before the daytime test meal than the others" (Gluck, Geliebter and Satov, 2001, p. 264) Thayer (2003) also notes a causal link between depressive mood, anxiety and night eating disorder.

They awaken frequently and have other kinds of troubled sleep patterns, indicating the strong possibility that they are experiencing heightened tension. Sleep problems often are caused by tension or anxiety, and when this condition is reduced, more normal sleeping occurs. Similarly, when sleep problems are reduced among those with night-eating syndrome, the eating problems can abate. (Thayer, 2003)

Another study by Gluck ( 2007) states that "Night eating syndrome has been associated with life stress, low self-esteem, adverse reactions to weight loss, anxiety, and depression" (Gluck, 2007, P.27) Gluck also states that, "These psychological characteristics are more prominent, even when compared with those of other equally overweight participants, suggesting a distinct pattern of psychopathology"(Gluck, 2007, P.27).

The above studies therefore suggest that this disorder goes hand in hand with a lifestyle or life situation that is characterized by deep levels of stress and anxiety. This leads to feelings of distress and hopelessness (Thayer, 2003) which can also lead to negative self-perceptions and to feeling of guilt and low self-efficacy. Interestingly, Thayer (2003) also notes that the low-energy levels experienced by these individual night leads to a form of disinhibition; which refers to the fact that "The usual levels of inhibition against overeating probably are dependent on energy, so in low-energy periods we are vulnerable to the temptations of food "(Thayer, 2003).

While there is a plethora of data and material on the theoretical aspect of this disorder, there is a relative paucity of material on the actual life experiences of this condition and how it impacts the lives of those who suffer from it. This factor serves to stress one of the main intentions of this proposal, which is to explore the life condition and the impact of night eating disorder on the individual. There are however a number of studies that provide insight into this central aspect.

Many of the above studies in their analysis of night eating syndrome suggest by implication that the individual who suffers from the condition will be stressed and anxious. This in turn posits the view that there will be elements and aspects in their life and immediate environment that gives rise to this sense of anxiety. One of the purposes of the questions that have been constructed fro this study will be to explore this aspect in detail.

The effects of this syndrome on the life of the individual is described in an article entitled MIDNIGHT MUNCHIES; Can a Drug Put an End to Those Good Health by Dobson ( 2004). This article provides some acute insights into the daily lives of these individuals; for example, the fact that the disorder tends to emerge after a critical or stressful life experience. As one person states in an interview

The condition became more noticeable when I was divorcing my husband and fighting a custody battle to keep the children. I used to wake up and find that the fridge had an almost empty plate where a large chocolate cake had been. (Dobson, 2004).

This article also makes the important point that, "Continual lack of sleep, obesity and anxiety take their toll. but, ironically, this anxiety often fuels the condition further as they unconsciously appear to seek out foods which will boost a naturally occurring 'feel-good' chemical in the brain" (Dobson, 2004).

Another article that provides insight into life experience is the loneliness of the nighttime snacker from USA Today ( 2004). This article also refers to the circularity of this syndrome and to the way that stress leads to further eating, which in turn leads to obesity with all the associated problems of this condition. "The emotional and physical impact is circular. The eating helps soothe people and make them feel better for a short time, but it also increases their weight, which makes them feel worse…" (the loneliness of the nighttime snacker, 2004). Another very useful work that provides insight into life experience was Nighttime Eating: A Descriptive Study ( 2006). The broader and more holistic effects of this syndrome are explored in Aggregation in the Night Eating Syndrome ( 2006) by Lundgren et al. This study found that "… NES was more likely to aggregate among family members of night eaters than of controls, suggesting that NES is familial" (Lundgren et al. 2006, p.518). Another useful study in this regard is Perceived Stress, Coping and Night- Eating College Students ( 2009). The study sheds light on the main theme of this proposal as it explores the way that individuals who have this disorder experience their own situation. The study found that, "… there was indeed a positive relationship between stress levels and night-eating in college students. Further analyses revealed that adaptive and maladaptive coping styles also had a differential effect on this relationship" (Wichianson et al. 2009, p.238).

Methodology

The subject matter and the theme of this proposed study is to investigate the life experience and assess the important effects that this condition has on the individual who suffers from night easting syndrome. This type of research is therefore not amenable to a quantitative or an overly structured form of methodology. The objective of the study is to inquire into and investigate lived experiences, therefore, a more interpretive and open-ended methodology is best suited to a subject of this nature.

The central methodology that is proposed for this study will therefore be a semi-structured qualitative approach to the understanding of the life experiences and the effects of this syndrome. It is envisaged that two interrelated methods will be useful in achieving these ends. The first includes a short questionnaire that will be designed to elicit information and responses that can be expanded on in further interviews. The questionnaire will therefore be designed to access information on certain key issues and concepts that have been referred to in the literature. The proposed questionnaire, which is included the appendix to this proposal, will include questions that will probe various aspect of the real life situation of the individual in terms of night eating syndrome.

The second phase of the methodology in this investigation will be based on the answers in the initial questionnaire. This will be intended to explore certain cardinal issues and areas of concern through extended and in-depth interviews with the respondents based on the questionnaire. The proposed sample base will therefore be relatively small in order to facilitate the most in-depth response. It is suggested that not more than twenty respondents who suffer from night easting syndrome should be involved in this project.

Furthermore, the approach in this methodology will be essentially integrative and holistic. This refers to the view that night eating syndrome is intimately linked to other extraneous and comorbid factors; and that the impact that this condition will have on the individual will therefore be dependent on social, psychological and other aspects that affect and possibly exacerbate the life situation of the individual. This also refers to a number of possible hypotheses that have been suggested by the literature. These can be summarized as follows:

1) Night eating syndrome is as condition that is affected and possibly instigated by stress and anxiety, which can manifest as abnormal psychological states such as depression.

2) the personal and life situation of the individual therefore plays a large part in this condition.

3) Night eating syndrome is linked to other eating disorders.

4) the fact that this disorder is linked to obesity further complicates the life situation of the individual and results in a cycle of guilt and anxiety, night-eating and further obesity.

While many quantifiable methodologies were considered for this proposal, such as the Self Rating Anxiety Scale (SAS) and the Binge Eating Scale, it was felt that this would be counterproductive and would limit the project to a great extent. The central aim of this study is to ascertain as clearly as possible the underlying life constitution and experience of the individual who suffers from this condition. To this end, a more open-ended interview methodology was therefore felt to be the method that would allow for the most insightful and in-depth results.

The results of the interviews will however be dealt with in a more structured manner. While a recording and transcript of the interviews will be appended to the final study, the results will also be broken down in terms of a few central categories and criteria. At this stage the exact nature of these criteria cannot be known as they will emerge from an in-depth analysis of the interviews. However, the following is a rough estimate of some the categories that may emerge from the interviews fro consideration.