Night eating syndrome

PERSONAL HEALTH; Peril of the Night, When Calories Come Calling

By JANE E. BRODY (NYT)

In 1963, master's degree in hand, I found myself in a new job 1,200 miles from my family home and old friends, 2,000 miles from my boyfriend and working under editors who seemed to enjoy making me miserable. I soon found myself sinking into a disturbed eating pattern that I was unable to break. Unaware of hunger, I ate little or nothing all day, then ate steadily all evening, often into the early morning, sometimes falling asleep with food in my mouth. As you might guess, despite regular exercise, I gained weight, until nearly 40 extra pounds padded my small frame. The weight gain made me increasingly anxious and angry with myself, making it harder to control the problem. On one bad night of nonstop nibbling, I felt so desperate I even considered suicide. After a few sessions with a psychologist who seemed particularly tuned in to the trauma of eating disorders, and a move back to my hometown to a new job at The New York Times, I made a decision: if I was going to be fat, at least let me be healthy. Hungry or not, I made myself eat three wholesome meals a day, with prearranged snacks if needed and one small ''no-no'' to keep me from feeling deprived. Miracle of miracles, I lost 10 pounds in a month and, by continuing with this ''normal'' eating pattern, another 25 over the next 23 months. Now comes a book, ''Overcoming Night Eating Syndrome,'' that describes in detail the various versions of the disorder that besieged me 40 years ago and that provides step-by-step guidelines to help people break this vicious cycle of disordered eating, self-disgust and depression. It is written by Dr. Kelly C. Allison, and Dr. Albert J. Stunkard, with Sara L. Thier (New Harbinger Publications, $14.95). Dr. Allison, an instructor at the University of Pennsylvania School of Medicine, does research on the physiological and psychological characteristics of this eating disorder. Dr. Stunkard, a professor of psychiatry and an expert on the causes of obesity, founded the university's Weight and Eating Disorders Program. Dr. Stunkard is also the lead author of a paper, ''The Night Eating Syndrome,'' published in The American Journal of Medicine in 1955, describing this strange ''pattern of food intake among certain obese patients.'' But while this not-exactly-rare problem was noted in the medical literature nearly half a century ago, it has been all but ignored by both eating-disorder specialists and weight control programs. Like the eating pattern itself, the problem seems to have hidden under the cloak of darkness. Yet the factors that precipitate and perpetuate it may be a major reason for the failure of so many obese patients to lose weight and keep it off.

The Syndrome
As outlined in the new book, five symptoms characterize night eating syndrome: not feeling hungry in the morning; overeating in the evening; difficulty falling asleep; waking at night and eating; and feeling depressed. The syndrome tends to run in families, suggesting that genetic as well as physiological and psychological factors are involved. A 29-year-old woman described in the 1955 paper typifies the problem. One of 10 children, she married at 18 to escape a home life of hardship and deprivation. Her new husband, however, was an alcoholic, and over the next eight years, in the throes of emotional turmoil, she gained 100 pounds. Her eating pattern was typical of night eating syndrome. She awoke each morning with no appetite and ate no breakfast and little lunch. Early in the evening, she ate a large supper and, plagued with anxiety both when alone and after quarreling with her husband, she continued nibbling at mostly sweet foods, often until early morning. She experienced temporary relief while hospitalized with a medical problem; she enjoyed talking to her roommate, stuck easily to an 800-calorie diet of breakfast, lunch and supper, and lost 28 pounds in a month. But as soon as she returned home, the disordered eating and insomnia recurred, along with a weight gain of two pounds a week. As Dr. Allison and Dr. Stunkard describe it, night eating syndrome is neither binge eating nor an outgrowth of anorexia nervosa or stringent dieting efforts. Nor is it a bad habit or a result of poor self-control. It is a disorder of eating, sleep and mood that seems most often to be precipitated by a stressful event or situation, like divorce, the death of a loved one or the loss of a job. ''Life stress is associated with the onset of night eating in 75 percent of sufferers, and it plays a role in the continuation'' of the syndrome, the authors write. The syndrome afflicts 9 to 15 percent of people seeking treatment in obesity clinics, and about half of those patients were of normal weight before they started night eating. In fact, some of those with the syndrome remain at healthy weights by exercising a lot and restricting their daytime eating, although their diets may suffer from serious nutrient imbalances. Typical night eaters consume a third or more of their daily calories after dinner, compared with the 10 percent consumed by normal eaters. A common though not invariable characteristic of night eating syndrome is repeated awakenings during the night, with the patient almost compulsively consuming food or drink each time in order to fall back to sleep. As one patient told her therapist, ''When I wake up at night, I feel a compulsive urge to eat and I feel I won't be able to fall back asleep if I don't eat.'' Another reported: ''The pattern is always the same. I get up about an hour to an hour and a half after falling asleep, and then I eat. The only way I can control it is to have my husband literally lock me in the bedroom at night and hide the key.'' Many sufferers are plagued by anxious or disturbing thoughts each time they wake up during the night. They eat to calm themselves so they can fall back to sleep. Eating becomes a conditioned response to waking, working better than any sleeping pill, the Pennsylvania specialists explained.

Gaining Control
The authors suggest that gaining control of this disordered eating pattern should start with keeping a diary and recording everything you eat, including amounts and calories; how hungry you were at the time; and the thoughts and feelings you experienced before and after eating. They also suggest not trying to diet while trying to get night eating under control. The next step involves creating a more normal meal plan of breakfast, lunch and supper and, hungry or not, sticking to it. Eat more calories early in the day and try to eat fewer at night. Plan snacks and perhaps measure them ahead of time, chewing each bite and paying attention to the taste as you eat. If you still feel hungry, wait at least 10 minutes before eating more to give your body time to register fullness. To help with disrupted sleep, go to bed at the same time each night, and if you wake up one or more times during the night, try to eat or drink as little as possible to help you fall back to sleep. Depression is common among night eaters, and the Pennsylvania researchers have found that many are helped by one of the new serotonin-enhancing antidepressants. Relaxation exercises also help, the researchers report, as do practicing imagery and making behavioral changes, like finding interesting things to do in the evening and allowing yourself a small amount of ''forbidden'' foods.

CAPTIONS: Drawing (Drawing by Sara Schwartz)