Fitness Disorder Nighttime Overeating - Treatment and how to remedy

Nighttime Overeating

By Michael Craig Miller, M.D., Harvard Health Publications

As the day winds down in my house, the TV is tuned to late news, a review of the day's sports action or a talk show. This is when I often find a late-night snack irresistible. It's never clear to me where the impulse comes from. Maybe it starts with a bit of hunger, but I'm just as likely to make my way to the kitchen without thinking. And the temptation to eat is great enough that I have to be more mindful of the habit. I know that I'm not alone.

The occasional late-night snack is nothing to worry about. But nightly bingeing merits a closer look. Experts may debate whether nocturnal overeating needs its own diagnostic category, but they don't debate the significance of the problem.

Two Types of Nighttime Eating Disorders

Sleep-related eating syndrome is a highly-publicized malady, though it's not clear how common it is. People with this problem eat while sleepwalking, or while in a twilight state between sleep and wakefulness. They generally aren't conscious of what they're doing, so they may wake up to find the bed littered with candy wrappers — with no memory of consuming the candy.

A better-documented problem is night eating syndrome, in which people do the majority of their eating late at night. A 1999 study in the Journal of the American Medical Association found that by 6 p.m., people with night eating syndrome consumed a little more than a third of their daily calories, while a control group had consumed almost three-quarters. Between 8 p.m. and 6 a.m., however, the night eaters consumed 56% of daily calories, while controls consumed only 15%.

Night eating syndrome may affect 1 or 2 out of 100 people in the general population. Dr. Albert J. Stunkard, a psychiatrist at the University of Pennsylvania, first described the disorder in the 1950s. Researchers have recently explored its link to weight gain. The problem affects anywhere from 9% to 14% of people seeking treatment at obesity clinics, and as many as 27% of severely obese people.

Night eating syndrome also occurs in people who are treated in mental health clinics. In one study of psychiatric outpatients in Pennsylvania and Minnesota, 12% had night eating syndrome. Night eaters in this study were also much more likely than other individuals to have an addiction problem. Other research indicates that people with night eating syndrome tend to suffer from a distinct form of depression. In contrast to the usual pattern where depression is more pronounced in the early part of the day, night eaters tend to become more depressed during the evening.

It's not clear what causes night eating syndrome and why it is associated with depression or addiction. One theory is that night eating syndrome involves a disruption in the hormones that regulate sleep, appetite or mood. Because late-night snacking usually involves carbohydrate-rich "comfort" foods, this theory holds that night eating syndrome is a form of self-medication.

Treatment

Scientists note that sleeping and eating are probably connected, given the discovery of a link between lack of sleep and weight gain. Getting plenty of sleep may be a helpful substitute for nighttime trips to the refrigerator. Until more is known about night eating syndrome, it's probably best to take a broad approach to treatment.

• See your doctor for a complete physical evaluation of the problem.
• An evaluation by a mental health professional is a good idea to determine whether or not there is another mental disorder at the root of the eating problem.
• Get treated for any underlying mental health problems, such as depression or anxiety. Treatment can help improve eating patterns and the chances of getting to sleep earlier.
• Preliminary studies indicate that the anticonvulsant topiramate (Topamax) or an SSRI antidepressant, such as sertraline (Zoloft), may help.
• See a dietitian about how to better pace meals throughout the day, which might help break the cycle of late-night eating.
• Case reports indicate that some people can improve their eating patterns by being mindful of the problem and by trying to identify its triggers.
• Stress-reduction techniques may help avert trips to the refrigerator.

I am Addicted to Exercise

The Never-Ending Workout
Always at the gym and no time for life

By Nando Pelusi for MSN Health & Fitness

Q: I'm addicted to exercise. While I mostly enjoy it, I'm emotionally unable to skip a day. I work out seven days a week for at least 2.5 hours a day—usually 60 minutes of cardio machines, 30 minutes of weight training, then 60 minutes of kickboxing or other cardio workout. If I'm not at the gym every day, I have trouble sleeping that night, worrying about how much weight I might have gained by not exercising that day. The rest of my family is obese, and I'm determined not to look like them. It seems like I have no life outside of work and the gym.

A: Exercise has many health benefits, but like anything, you could be doing a good thing for the wrong reasons, and therefore overdo it. Even professional athletes allow an essential period of recuperation and rest that helps them stay fit. You seem to be aware that you’re doing a good thing to a potentially harmful degree, since you call it an addiction.

You might be falling into several errors in thinking, making you more driven than you have to be to stay healthy. Are you telling yourself that if you slow down, you’ll start an inevitable slide into obesity? That type of all-or-nothing thinking drives you to exhaustion, and then may tempt you to call it quits altogether, making it hard to stay fit with a healthy regimen.

It’s possible that you have some genetic predisposition to obesity, and your rigor is good, but your absolutism could create physical strain or other problems. Then, if you’re sidelined, you might succumb to depression. Perhaps the absolutism about your fitness regimen is telling you: “I can and must attain perfection.” That also drives you to an extreme, and scares you into driving yourself to exhaustion.

The vicious spiral: You have less and less of a life outside of exercise, so you exercise more, then have less of a life, and so on. This is a recipe for depression. Better to schedule some healthy fun and social activity, get yourself out and interact with people.

Perhaps your endorphin levels are helping you to feel better temporarily (after an exhausting workout), only to fall back down, making the contrast seem depressive. This may warrant a question: Are you depressed? Are you masking feelings of depression with busywork that keeps moving hard and fast, never allowing yourself time to reflect in the least (lest you feel down)?

Your desire to fight your familial tendency toward obesity is to be commended. We want to encourage your dedication to health—but you need to focus on the long haul, rather than running yourself ragged, emotionally and physically.

Fight this absolutist thinking by asking yourself: Why must it be all or nothing? Ask yourself why you can’t keep to a rigorous—but not rigid—regimen.

Exercise is great, but if you do it for the wrong reasons you may do it too much. That could create problems and might mask underlying issues like depression. Tap into your talent for discipline and desire to stay fit and to schedule a daily regimen, but refuse to give in to self-talk: “You’ll go totally downhill unless you make exercise the sole focus of your life.”

Nando Pelusi is a licensed clinical psychologist. He has a doctorate from Hofstra University and is a certified supervisor in Rational Emotive Behavior Therapy. He maintains a private practice in New York City and serves on the board of advisers of the National Association of Cognitive Behavioral Therapists. He regularly leads workshops on cognitive behavioral therapy for both the public and professionals. He also serves as a contributing editor to Psychology Today. (read his full bio.)