55 light therapy80,81 and topiramate82 as possible treatments for NES. Unfortunately small participant numbers in these studies make interpretation of results difficult. Interpreting the effect of restrictive weight loss surgical procedures on NES is problematic as the identification and management of ED presurgery varies widely.83 Busetto et al.84 found no difference in the per cent excess weight loss ( EWL) in the first 5 years after laparoscopic gastric banding by patients with and without disordered eating. Similar results were seen after gastric bypass, although greater weight loss was related to a reduction in NE episodes.85 Others report individuals with NES to have less success postoperatively than those with BED.15 APPLICABILITY OF NES CRITERIA TO SEVERE OBESITY Obesity and perceived loss of control Evening hyperphagia is common in severe obesity, NES and BED. An assessment of the energy content of food eaten is required to determine both evening hyperphagia and BED, and may be very high in those with severe obesity. In clinical practice, individuals with severe obesity frequently underreport energy intake, especially if they are also depressed, confounding interpretation further.86 Hence, it may be necessary to place more emphasis on determining other behaviours and cognitions such as the timing of eating (EH) or presence of perceived loss of control (BED), to distinguish AZD0156 supplier between these conditions. `Presence of a belief that one must eat to initiate or return to sleep’ is often described as a feature of NES. Yet physical impairment due to obesity and obesity-related comorbidity results in disturbed sleep in many severely obese individuals, only some will get up to eat once awake and others will return to sleep. A greater understanding of the cognitions influencing the urge to eat in some individuals and not others may help to answer why NES individuals find restraint at these high-risk times particularly difficult. Obesity and distress Although NES is characterised by significant distress, interpreting this BX795 dose relationship in the context of severe obesity is problematic. Published evidence of the links between trauma and the onset of obesity is limited. Distress related to NE has been described as `distress about weight gain, shame of eating and inability to stay within a prescribed calorie deficit’.4 However, these are all common features of severe obesity. Future studies examining the origin and nature of distress in obese NES populations may help to clarify this relationship.2012 Macmillan Publishers LimitedNight eating syndrome J Cleator et al7 Obesity and morning anorexia Striegel-Moore’s34 typology study noted a strong relationship between NE and morning anorexia and the presence of morning anorexia has been a consistent feature of all versions of NES criteria despite difficulties in defining `morning anorexia’ objectively. As a similar relationship also exists between morning anorexia and chronic obesity, its relevance as a distinguishing feature of NES in a severely obese population remains unclear.87 The obesity, sleep and depression axis The complex interplay between obesity, depression and impaired sleep makes understanding NES behaviour in this context even more difficult. The deleterious effects on health of impaired sleep have been well documented in recent years with long (X9 h) and short sleep (p6 h) duration both linked to increased mortality.88,89 A link between sleep duration and obesity has been demonstrated w.55 light therapy80,81 and topiramate82 as possible treatments for NES. Unfortunately small participant numbers in these studies make interpretation of results difficult. Interpreting the effect of restrictive weight loss surgical procedures on NES is problematic as the identification and management of ED presurgery varies widely.83 Busetto et al.84 found no difference in the per cent excess weight loss ( EWL) in the first 5 years after laparoscopic gastric banding by patients with and without disordered eating. Similar results were seen after gastric bypass, although greater weight loss was related to a reduction in NE episodes.85 Others report individuals with NES to have less success postoperatively than those with BED.15 APPLICABILITY OF NES CRITERIA TO SEVERE OBESITY Obesity and perceived loss of control Evening hyperphagia is common in severe obesity, NES and BED. An assessment of the energy content of food eaten is required to determine both evening hyperphagia and BED, and may be very high in those with severe obesity. In clinical practice, individuals with severe obesity frequently underreport energy intake, especially if they are also depressed, confounding interpretation further.86 Hence, it may be necessary to place more emphasis on determining other behaviours and cognitions such as the timing of eating (EH) or presence of perceived loss of control (BED), to distinguish between these conditions. `Presence of a belief that one must eat to initiate or return to sleep’ is often described as a feature of NES. Yet physical impairment due to obesity and obesity-related comorbidity results in disturbed sleep in many severely obese individuals, only some will get up to eat once awake and others will return to sleep. A greater understanding of the cognitions influencing the urge to eat in some individuals and not others may help to answer why NES individuals find restraint at these high-risk times particularly difficult. Obesity and distress Although NES is characterised by significant distress, interpreting this relationship in the context of severe obesity is problematic. Published evidence of the links between trauma and the onset of obesity is limited. Distress related to NE has been described as `distress about weight gain, shame of eating and inability to stay within a prescribed calorie deficit’.4 However, these are all common features of severe obesity. Future studies examining the origin and nature of distress in obese NES populations may help to clarify this relationship.2012 Macmillan Publishers LimitedNight eating syndrome J Cleator et al7 Obesity and morning anorexia Striegel-Moore’s34 typology study noted a strong relationship between NE and morning anorexia and the presence of morning anorexia has been a consistent feature of all versions of NES criteria despite difficulties in defining `morning anorexia’ objectively. As a similar relationship also exists between morning anorexia and chronic obesity, its relevance as a distinguishing feature of NES in a severely obese population remains unclear.87 The obesity, sleep and depression axis The complex interplay between obesity, depression and impaired sleep makes understanding NES behaviour in this context even more difficult. The deleterious effects on health of impaired sleep have been well documented in recent years with long (X9 h) and short sleep (p6 h) duration both linked to increased mortality.88,89 A link between sleep duration and obesity has been demonstrated w.
