Q & A: Treating the Night-Eating Syndrome

Q: One of my patients is a 45-year-old obese attorney who describes a 15-year pattern of eating voraciously at night, including awakening at night to eat. My assessment is that he meets criteria for the “night-eating syndrome.” He’s very skeptical about taking medication. Are there any evidence-based treatments I can offer him? (G. L., Chicago)

A: As of now, the evidence base for the treatment of night-eating syndrome is rather sparse. If your patient is concerned about “evidence-based treatment,” he should be informed about the results of a very recently published eight-week double-blind controlled study involving a group of 34 patients with night-eating syndrome. These patients were randomly assigned to receive 50 to 200 mg/day of sertraline, a well-known selective serotonin reuptake inhibitor (SSRI), or to placebo. Seventy-one percent of the patients receiving sertraline responded, with improvement of symptoms, whereas only 18% of those receiving placebo improved in this time period. Of note, among the 14 obese and overweight patients receiving sertraline, the average amount of weight lost was 2.9 kg, whereas among the 14 obese and overweight patients receiving placebo weight loss was only 0.3 kg. Of course, this was a very short-term study, and it’s not clear how lasting either the clinical improvement of night-eating syndrome symptoms or weight is likely to be in these patients (O’Reardon et al, Am J Psychiatry 163: 893, 2006). However, since night eating is likely to contribute to obesity and overweight, curtailing this eating pattern may reduce overall daily caloric intake and help in weight reduction.

— J.Y.