Night eating syndrome: a psychiatric disease, a sleep disorder, a delayed circadian eating rhythm, and/or a metabolic condition?

ABSTRACT

Introduction: Night Eating Syndrome (NES) refers to an abnormal eating behavior which presents as evening hyperphagia consuming >25% calorie intake and/or nocturnal awaking with food ingestion which occurs ≥2 times per week. Although the syndrome has been described more than seven decades ago, the literature has been growing slowly on its etiology, diagnosis, and treatment.

Areas covered: The proposed treatment options for NES are all at a case-study level. Moreover, our understanding of its etiology, comorbidities, and diagnosis is still premature. We performed a literature review in Medline/PubMed to identify all the studies proposing a management plan for NES and summarized all the existing data on its diagnosis and treatment.

Expert opinion: To date, none of the proposed treatment options for NES have been promising and long-term data on its efficacy is lacking. The slow growth of evidence on this debilitating but underreported condition may be due to unawareness among clinicians, under-reporting by patients, and unrecognized diagnostic criteria. Objective screening of symptoms during office visits especially for patients at a high-risk for NES will identify more patients suffering from the syndrome.

KEYWORDS:

• Night eating syndrome
• NES
• sleep-related eating disorder
• diagnostic criteria
• treatment

Article highlights

• Night eating syndrome (NES) has been introduced to the literature more than seven decades ago. However, literature has been slowly progressing on its etiology, diagnosis, and treatment.

• Current diagnostic criteria for NES include 1) nighttime eating and/or evening hyperphagia, at least 2 times a week, (2) initial insomnia, and (3) nighttime arousal from sleep.

• NES has been recently included into the DSM-5, but under the unspecific category of ‘Other Specified Feeding or Eating Disorder’. Although an advancement, the clinical utility of its diagnostic criteria is still unknown and the entity is still underreported by the patients and neglected by the clinicians.

• Therapeutic modalities with some benefits in NES include cognitive behavioral therapy and progressive muscle relaxation, medications such as selective serotonin reuptake inhibitors and topiramate, and phototherapy. Also, some patients have reported attenuation of the symptoms after weight loss surgery.

• Despite initiation of extensive efforts in pursuit of an effective treatment for NES, no treatment option has been proven to be curative or lasting in the long term. Meanwhile, a multidisciplinary approach might show more promises than a single therapeutic approach.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.