Identification of Night Eating Behaviour and Investigation into Its Characteristics in an Obese Population

Cleator, Jacqueline (2011) Identification of Night Eating Behaviour and Investigation into Its Characteristics in an Obese Population. Doctoral thesis, University of Central Lancashire.

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Night Eating Syndrome (NES) was characterised in 2003 as comprising; morning anorexia, evening hyperphagia, night-time awakenings, consumption of high calorie snacks during awakenings and an absence of other eating disorders (ED).
An identification study was conducted in a hospital–based UK obesity clinic with 81 individuals undertaking a diagnostic interview and completing a proposed screening tool. Full NES (n=7) and partial NES (n=24) individuals were combined into one Night Eating Behaviour (NEB) group (n=31) and compared to all other participants (n=50). NEB characteristics were identified through qualitative thematic analysis of interview data, based on techniques used by Grounded Theorists. NEB individuals (n=28) were compared with matched controls. In a separate prevalence study, night-eating, sleep quality and suspected Obstructive Sleep Apnoea (OSA) were estimated in 103 participants using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and a validated Night Eating Questionnaire. Correlational analysis was also performed.
In the identification study, full NES was rare (9%). Comparison of the NEB and non-NEB group showed significant differences in mood (p=0.001), work status (p= 0.03), perceived lack of control over eating (p= 0.03) and variability in sleep duration (p<0.01). The study tool successfully identified NEB, but not other ED. Interview analysis identified the compulsive nature of night-eating and chaotic eating patterns. A variety of physical factors affected night-time awakenings. The matched control comparison showed no difference in levels of significant life events, childhood-onset obesity and poor sleep quality. Prevalence study results showed; suspected NES 14.6% (n=15), based on a lower cut score of >25, 3.9% (n=4), based on a higher cut score of >30, poor sleep quality 74% (n= 76) and suspected OSA 32% (n= 33). A strong relationship (r = 0.55, p = < 0.001) between night-eating and poor sleep quality was found, with day-time sleepiness having no influence over this relationship.
Comparison of the study findings with new NES criteria (2010) shows poor differentiation between NES and morbid obesity. In obese populations, a shift of focus is proposed to an alternative ‘Impaired Sleep Syndrome’ of which night-eaters may be a sub-group, often with severe depression. Night-eaters also exhibit too many features of other ED for this relationship to be ignored.

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