Journal of College Student Psychotherapy, 24:3948, 2010

Copyright Taylor & Francis Group, LLC

ISSN: 8756-8225 print/1540-4730 online
DOI: 10.1080/87568220903400161

An Exploratory Study of the Relationship

Between Night Eating Syndrome and
Depression Among College Students

1540-4730
8756-8225
WCSP
Journal
of College Student Psychotherapy,
Psychotherapy Vol. 24, No. 1, Nov 2009: pp. 00

Night
S.
H. Thompson
Eating Syndrome
and R. and
D. DeBate
Depression

SHARON H. THOMPSON

Department of Health, Kinesiology, and Sport Science, College of Natural and Applied
Sciences, Coastal Carolina University, Conway, South Carolina, USA

RITA DIGIOACCHINO DEBATE

Department of Community and Family Health, College of Public Health,
University of South Florida, Tampa, Florida, USA
Night eating syndrome criteria include skipping breakfast, night
eating, and sleep difficulties. It is associated with mood disturbances,
particularly depression, and may contribute to later obesity development. Most research on night eating syndrome has focused on
obese persons seeking weight loss treatment, and little is known
about night eating syndrome in other populations; therefore, the
purpose of this exploratory study was to examine night eating and
depression among college-age students. A paper-pencil survey was
completed by 270 students at a southeastern university that
included demographic information, self-reported heights and
weights, Night Eating Questionnaire (NEQ), and Beck Depression
Inventory (mean age = 21.05, 64.1% female, 78.5% White). A
significant correlation was found between total scores for the Beck
Depression Inventory and NEQ (r = .35, p < .0001). Health professionals should be aware of characteristics of the syndrome to better
diagnose and treat those students who exhibit traits of both depression
and night eating syndrome.
KEYWORDS college students, depression, eating problems

Special thanks are due to Allanah Dobson and Kelly Stroud for their assistance in
administering the surveys.
Address correspondence to Sharon H. Thompson, Department of Health, Kinesiology,
and Sport Science, College of Natural and Applied Sciences, Coastal Carolina University, PO
Box 261954, Conway, SC 25928, USA. E-mail: thompson@coastal.edu.
39

40

S. H. Thompson and R. D. DeBate

INTRODUCTION
Say good night to night eating is the slogan for a new dietary supplement
that purports to curb night eating and control body weight. As obesity rates
have increased in our country, so has interest in products such as these that
are targeted toward weight loss. Although night eating syndrome (NES) was
first described over five decades ago by Albert Stunkard (Stunkard, Grace, &
Wolff, 1955), only recently has interest emerged due to the increases in obesity.
A 1.5% prevalence of NES has been reported among the general population
(Rand, Macgregor, & Stunkard, 1997), and the syndrome is believed to be
more common among the obese. Persons with NES are believed to share
common characteristics, such as difficulty sleeping, skipping breakfast,
consuming most calories in the evening, and a negative mood that worsens
in the evening (Vander Wal, Waller, Klurfeld, McBurney, & Dhurandhar,
2005; Walsh & Satir, 2005). As such, it has been described as a combination
of three disorders: eating, sleep, and mood (Stunkard, 2002).
There is a lack of research on NES among the college population and
how this might contribute to mental health, the development of obesity, and
sleep problems. It is well known that sleep disturbances (Dusselier, Dunn,
Wang, Shelley, & Whalen, 2005), stress (Towbes & Cohen, 1996), and
disordered eating (In Recent Poll, 2006) are common among the college-age
population. Mental health problems among college students appear to also be
increasing on college campuses, and sleep disorders will likely escalate as
well (Jensen, 2003). Furthermore, researchers who examined NES among
young adults recently reported those exhibiting traits of the syndrome were
more likely to use marijuana and cocaine (Striegel-Moore et al., 2008).
Due to the triad of disorders, the classification of NES is still open, and
researchers have noted many questions and variations in devising the
proposed criteria for the syndrome (Striegel-Moore et al., 2006). Researchers
are currently examining support for inclusion of NES into the Diagnostic
and Statistical Manual of Mental Disorders (DSM) as a potential candidate
for a new diagnostic eating disorder (Striegel-Moore et al., 2006). The triad
of disorders will be briefly outlined in the next few paragraphs.

Eating
Night eaters have been found to consume a significant number of their daily
calories after their last evening meal, often during nocturnal awakenings.
Other characteristics include little or no hunger in the morning, thus skipping
breakfast and lunch (de Zwaan, Roerig, Crosby, Karaz, & Mitchell, 2006).
Because those persons who exhibit characteristics of night eating often report
a lack of control over evening eating and nocturnal eating episodes, researchers
have sought to determine if NES contributes to obesity (Lundgren et al., 2006)
and if so, to the severity of obesity (Gluck, Geliebter, & Satov, 2001).

Night Eating Syndrome and Depression

41

In Lundgren and colleagues (2006) study of psychiatric outpatient clients,

obese persons (BMI >30 kg/m2) were 5.2 times more likely to meet NES criteria
than normal weight participants. In another study of obese and nonobese
persons with NES, the only difference found between the groups was a
younger age of nonobese night eaters; furthermore, 52% of those obese
persons with NES reported that night eating preceded obesity. This finding
led the researchers to hypothesize that NES may lead to the later development of obesity (Marshall, Allison, OReardon, Birketvedt, & Stunkard, 2004).

Mood
Geliebter (2002) has noted that NES is more than overeating in the evening
and also consists of abnormal psychological states and hormonal problems.
The combination of these patterns may reduce the efficacy of weight reduction
(Geliebter, 2001). Depression is the most common mood disturbance found
among those with NES as researchers have found that night eaters have
higher depression scores and report lower self-esteem than nonnight eaters
(Gluck et al., 2001). Substance abuse may also be associated with NES.
Young adults exhibiting traits of NES were found to be more likely to use
marijuana and cocaine than those who did not report night eating (StriegelMoore et al., 2008). Lifetime substance abuse has also been found to be
more likely among those with NES as compared to those without the syndrome
(Lundgren et al., 2006). Other mood disorders reported by those with NES
include anxiety disorders and eating disorders (de Zwaan et al., 2006). It
has recently been reported that treating low serotonin levels may alleviate
the symptoms of NES (Stunkard, Allison, & Lundgren, 2008).

Sleep
NES is also marked by sleep problems due to multiple awakenings to eat
each night. Persons with NES have more sleep awakenings than controls
(3.6 versus 0.3 per night) and among the night eaters, 52% of the awakenings
were found to be associated with food intake as compared to 0% of the
controls (Birketvedt et al., 1999). Researchers have noted that night eating is
not equivalent to nighttime snacking and that sleep disturbances are a
defining component of NES (Vander Wall et al., 2005). Other sleep problems
noted by those with NES include initial insomnia, sleepwalking, and confusional arousal (de Zwaan et al., 2006).
Researchers have called for collaboration between sleep and eating
research to better understand the evolving NES (de Zwaan et al., 2006) and
for additional studies to assess nighttime eating in community as well as
population samples. In order to determine characteristics of NES among a
college population, the purpose of this study was to examine night eating
among this group. In particular, two distinct areas were examined: (a) the

42

S. H. Thompson and R. D. DeBate

percentage of college students exhibiting traits of NES and (b) if significant

correlations exist between depression and NES among a college population.

METHOD
The sample for this study consisted of college students at a southeastern
coastal university. Data were collected through the completion of a paper
and pencil survey of 300 students (n = 300) from a convenience sample of
various college classes. The survey was anonymous and approved by the
universitys institutional review board prior to dissemination.

Measures
DEMOGRAPHIC

INFORMATION

Demographic information obtained from the students included age, height,

weight, gender, and race.
BODY

MASS INDEX

Body mass index (BMI) was calculated from self-reported heights and
weights (BMI = kg/m2). BMI is a very commonly used method of weight standardization (United States Department of Health and Human Services, 1988).
After each participants BMI value was calculated, they were then placed into
BMI categories of underweight, average weight, overweight, and obese.
NIGHT

EATING QUESTIONNAIRE

Thirteen items on the survey consisted of the Night Eating Questionnaire

(NEQ), which was scored in the manner noted by Marshall and colleagues
(2004). These items were answered with Likert scales ranging from 04. The
questionnaire has previously been used to determine morning appetite, sleep
disturbances, prevalence of nocturnal eating, and control over evening calories
consumed. Although the NEQ consists of 14 items, only 13 items were used in
this study. The 14th item was designed for those persons who show characteristics of night eating syndrome (How long have your current difficulties with
night eating been going on?); therefore, this item was excluded in this research
since the study population had not been previously diagnosed with NES.
BECK

DEPRESSION INVENTORY

In order to determine if the participants suffered from depression, the Beck

Depression Inventory was used (Resource Centers for Minority Aging

Night Eating Syndrome and Depression

43

Research, 2005). The Beck Depression Inventory is a 21 item self-administrated

questionnaire in multiple choice form measuring supposed manifestations
and characteristics of depression. Each of the 21 items on the survey has four
statements to choose from relating to how the participant has been feeling in
the past few days. The level of depression is determined by categorizing the
total score into six categories: normal, mild, borderline, moderate, severe,
and extreme depression. The purpose of the Beck Depression Inventory is to
assess depressive symptoms and differentiate between depressed and nondepressed patients. According to the RCMAR, the Beck Depression Inventory
has been used for 35 years and has proved to be reliable among all population sizes (Resource Centers for Minority Aging Research, 2005).
DATA

ANALYSIS

Surveys were scanned and data were exported to the Statistical Analysis System
(SAS). Statistical tests were performed to examine means and frequencies for
various survey items. Univariate statistics were used as a summary measure to
describe the sample. The chi-square test of independence was used to assess
between differences by gender for BMI categories. T-tests were used to determine mean differences by gender for age, BMI values, and overall NEQ scores.
Bivariate relationships between overall Beck Depression Inventory
scores and the 13 individual NEQ items as well as total NEQ scores were
determined by Pearson correlation coefficients. A p value of < .05 was used
to determine statistical significance for all data analyses performed.

RESULTS
Participants
Three-hundred students completed the survey. Results from 30 surveys were
not able to be used due to the absence of gender, height, or weight information. After excluding these surveys, the final sample size was 270 (n = 270).
By gender, the sample was comprised of 173 women (64.1% female) and
97 men (35.9%). Most students reported their race as White (n = 212, 78.5%),
followed by African American (n = 37, 13.7%), Hispanic (n = 11, 4.1%), and
other race category (n = 10, 3.7%). Mean age of participants was 21.05
(SD = 3.87). A t-test revealed no significant differences by gender for the age
of students (females: M = 21.23, SD = 4.09; males: M = 20.74, SD = 2.65).

Body Mass Index Classifications

Mean BMI for all collegiate students was in the average weight category at
23.89 (SD = 4.5). T-tests revealed significantly higher means for BMI by gender,

44

S. H. Thompson and R. D. DeBate

TABLE 1 Body Mass Index Categories for All Students and by Gender (n = 270)
BMI categories
Underweight
(BMI 18.5)
Average Weight
(BMI = 18.524.9)
Overweight
(BMI = 2529.9)
Obese
(BMI 30)

All

Male

Female

5.6%
(n = 15)
62.6%
(n = 169)
22.2%
(n = 60)
9.6%
(n = 26)

1.0%
(n = 1)
47.4%
(n = 46)
34.0%
(n = 33)
17.5%
(n = 17)

8.1%
(n = 14)
71.1%
(n = 123)
15.6%
(n = 27)
5.2%
(n = 9)

Note: [c2 (3, n = 270) = 30.43, p < .0001].

t (268) = 5.8, p < .0001. Males had higher BMI values (M = 25.91, SD = 4.53)
than females (M = 22.75, SD = 4.14). A chi square test of BMI categories also
revealed significant differences by gender [c2 (3, n = 270) = 30.43, p < .0001]
(see Table 1).

Night Eating Questionnaire Items

A t-test was used to determine significant differences by gender for the total
NEQ scores and no significant differences were found. The percentage of
participants who responded at higher levels of NES tendencies was next
examined for each of the 13 NEQ items. For example, for the NEQ item
How would you rate your level of hunger in the morning? the percentage
of those who noted none or very low was determined. Percentages and
specific responses for the NEQ 13 items and NEQ total score can be found
in Table 2.

TABLE 2 Percentage of Participants Responding as Noted to Night Eating Questionnaire

Items (n = 270)
NEQ item
Level of morning hunger
First meal of day
Percentage of daily food intake after supper
Trouble sleeping at night
Times waking up other than bathroom use
When waking at night, number of times eating a snack
If you eat at night when you wake up, awareness
of what you are doing
Current level of feeling blue
When feeling blue, when mood is lowest
Cravings or urges to eat snacks after supper
Cravings to eat when wake up at night
When wake up at night, need to eat to fall back asleep
Control over night eating

Response
None or very low
After 1:30 p.m.
51% and higher
Usually or always
Once a night or more
Usually or always
Unaware or mostly
unaware
Very much or extremely
Early or late morning
Very much or extremely
Very much or extremely
Very much or extremely
None or a little

%
22.6%
11.2%
5.0%
17.1%
32.6%
3%
19.7%
so

9.3%
24.8%
so 27.1%
so 2.3%
so 4.1%
8.6%

45

Night Eating Syndrome and Depression

TABLE 3 Pearson Correlations Coefficients for Beck Depression Inventory Scores as
Compared to Individual Night Eating Syndrome Items and Total Night Eating
Syndrome Scores (n = 270)

Night eating syndrome items

1. Morning appetite
2. First meal of day
3. Percentage of calories consumed after supper
4. Trouble sleeping
5. Number of times per night awake
6. Number of times per night snacking
7. Level of awareness
8. Level of feeling blue
9. Time of day when mood is lowest
10. Cravings or urges to eat after supper
11. Cravings to eat when wake up at night
12. Need to eat to fall back asleep
13. Control over night eating
Night Eating Syndrome Total Score

SD

1.67
1.65
1.19
1.33
1.79
.28
2.96
1.15
1.5
1.8
.48
.28
.70

1.07
.78
.67
1.07
1.32
.72
1.43
.96
1.46
1.04
.79
.77
1.09

Correlations with beck

depression inventory
total scores
.01
.09
.02
.26*
.20**
.15**
.09
.58*
.11
.11
.25**
.23**
.12
.35**

*p < .0001; **p < .05.

Beck Depression Inventory

Using Pearson correlation coefficients, the collegiate students responses to
the individual 13 NEQ items and total NEQ scores were compared to their
total Beck Depression Inventory scores. Significant correlations between the
total Beck Depression Inventory scores and 5 NEQ items were found, and
all were in the same direction (as depression scores increased, so did
increases in NES behavior). The five significant NEQ items included: How
often do you have trouble sleeping at night? (r = .26, p < .0001), Other
than to use the bathroom, how many times do you wake up in the middle
of the night? (r = .20, p = .0011), When you wake up during the night,
how many times do you go eat a snack? (r = .15, p = .0124), What is your
current level of feeling blue or down in the dumps? (r = .58, p < .0001),
What are your cravings to eat when you wake up at night? (r =. 25,
p <.0001), and When you wake up at night, do you feel the need to eat
before you can fall back to sleep? (r = .23, p = < .0001). A significant correlation was also found between Beck Depression Inventory scores and NEQ
scores (r = .35, p < .0001). See Table 3 for these complete results.

DISCUSSION
To our knowledge, this is the first study of NES among a college population;
therefore, the results of this study should be considered preliminary and

46

S. H. Thompson and R. D. DeBate

exploratory in nature. College students are often stereotyped as keeping late

hours, consuming a high number of calories in the evening, and skipping
breakfastall characteristics of NES. Because of these lifestyle patterns, it
was speculated that the college population may be more likely to demonstrate
NES traits than the population in general.
Criteria for night eating syndrome are not specifically defined (Rand
et al., 1997), and validated assessment instruments are not available to
assess night eating (de Zwaan et al., 2006); therefore, we were hesitant to
use a hypothesized set of NES criteria to provide the prevalence of night
eating syndrome among our college population. We did, however, examine
responses for each of the NEQ individual 13 items and some interesting
findings were revealed. For example, 17% said they usually or always have
trouble sleeping, more than 10% of students reported their first meal of the
day to be after 1:30 p.m., 27% said they usually or always had cravings to
eat snacks after supper, and almost 9% said they have little or no control
over their night eating, The NES item that elicited the highest affirmative
response was times waking up per night other than bathroom use, with
32.6% noting once a night or more. Previously researchers have reported
that the shared collegiate living environment contributes to sleep disturbances and stress among this population (Dusselier et al., 2005). This could
be a possible reason for the elevated response for this NES item.
According to Lundgren (2006), night eating is often secretive, and
counselors may not learn patients have characteristics of the syndrome
unless they assess for it. Our study found several items on the NES to be
significantly correlated with Beck Depression Inventory total scores as well
as a significant correlation for total NES and Beck scores. College counselors
might note that depression and night eating may go hand in hand; however,
an actual clinical diagnosis of NES is impossible. Currently, there are too
few published articles on NES for the syndrome to be considered as a distinct
category in the DSM and a uniform definition is also needed (Striegel-Moore
et al., 2006). There are, however, a few strategies a counselor may employ
to determine if a student has characteristics of NES. First, students might be
asked to complete a 24-hour food record, which includes specific foods
consumed by time of day, to identify possible morning anorexia and
evening eating. Second, the Night Eating Syndrome Questionnaire (Marshall
et al., 2004) might be used as an assessment tool. Finally, counselors should
also be aware that substance abuse, particularly marijuana and cocaine use,
might also be a marker for NES (Striegel-Moore et al., 2008). Further
research is needed here.
Treatment may include pharmaceutical approaches and cognitivebehavioral treatment (Lundgren, 2006). The recent editorial by Stunkard and
colleagues (2008) that outlined the use of selective serotonin reuptake
inhibitors to improve serotonin function and alleviate night eating syndrome
brings hope for treatment of NES.

Night Eating Syndrome and Depression

47

Several limitations of this study must be noted. First, survey information

was based on self-reports, which generates reliability and validity questions.
Some participants may have been unwilling to reveal personal information on
the paper-and-pencil survey. Second, the study was conducted at a single
college in the southeastern region of the United States. As a consequence, our
results may not translate to other institutions of higher education with different
ethnic diversity. Third, because there are no available validated instruments to
assess night eating, the syndrome is often defined in multiple ways.
In conclusion, our exploratory study confirms earlier research findings
on NES. Our results indicated that persons who scored higher for depression
problems may also exhibit characteristics of night eating, a finding that was
previously noted by Gluck and colleagues (2001). Mental health professionals,
health educators, medical personnel, and dieticians should be aware of
characteristics of the syndrome to better diagnose and treat those persons
who exhibit traits of both depression and NES. Finally, researchers should
examine characteristics of NES in varied community settings. Although some
students exhibited behaviors consistent with NES, without a clear definition
of nighttime eating, it is difficult to assess the problem of night eating.
Researchers have clearly stated a need for continued research on NES so
that it will spur full recognition in future editions of the DSM and the development of needed treatments. Further delineation of NES traits is needed so
that a better understanding of how depression, sleeping, and eating may be
interlinked.

REFERENCES
Birtketvedt, G. S., Florholmen, J., Sundsfjord, J., Osterud, B., Dinges, D., Bilker, W., &
Stunkard, A. (1999). Behavioral and neuroendocrine characteristics of the nighteating syndrome. Journal of the American Medical Association, 282, 657663.
De Zwaan, M., Roerig, D. B., Crosby, R. D., Karaz, S., & Mitchel J. E. (2006).
Nighttime eating: A descriptive study. International Journal of Eating Disorders,
39(3), 224232.
Dusselier, L, Dunn, B., Wang, Y., Shelley, M. C., & Whalen, D. F. (2005). Personal,
health, academic and environmental predictors of stress for residence hall
students. Journal of American College Health, 54(1), 1524.
Geliebter, A. (2001). Night-eating syndrome in obesity. Nutrition, 17(6), 483484.
Geliebter, A. (2002). New developments in binge eating disorder and the night eating
syndrome. Appetite, 39, 175177.
Gluck, M. E., Geliebter, A., & Satov, T. (2001). Night eating syndrome is associated
with depression, low self-esteem, reduced daytime hunger, and less weight
loss in obese outpatients. Obesity Research, 9, 264267.
In recent poll, nearly 20% of students admit to disordered eating. (2006, November/
December). Eating Disorders Review, 8. Retrieved July 17, 2006, from Academic
Premier database.

48

S. H. Thompson and R. D. DeBate

Jensen D. R. (2003). Understanding sleep disorders in a college student population.

Journal of College Counseling, 6, 2534.
Lundgren, J. D. (2006, October). Awake, hungry, and stressed. Behavioral
Healthcare, 301.
Lundgren, J. D., Allison, K. C., Crow, S., OReardon, J. P, Berg, K. C., Galbraith, J.,
Martino, N. S., & Stunkard, A. J. (2006). Prevalence of night eating syndrome in
a psychiatric population. American Journal of Psychiatry, 163, 156158.
Marshall, H. M., Allison, K. C., OReardon, J. P., Birketvedt, G., & Stunkard, A. J.
(2004). Night eating syndrome among nonobese persons. International Journal
of Eating Disorders, 35, 217222.
Rand, C. W., Macgregor, A. M., & Stunkard, A. J. (1997). The night eating syndrome
in the general population and among postoperative obesity surgery patients.
International Journal of Eating Disorders, 22, 6569.
Resource Centers for Minority Aging Research. (2005). RCMAR measurement tools:
Beck Depression Inventory (2nd ed.). Retrieved May 10, 2005, from http://
www.musc.edu/dfm/RCMAR/Beck.html.
Striegel-Moore, R. H., Franko, D. L., May, A., Ach, E., Thompson, D., & Hook, J. M.
(2006). Should night eating syndrome be included in the DSM? International
Journal of Eating Disorders, 39(7), 544549.
Striegel-Moore, R. H., Franko, D. L., Thompson, D., Affenito, S., May, A., &
Kraemer, H. C. (2008). Exploring the typology of night eating syndrome. International Journal of Eating Disorders, 41(5), 411418.
Stunkard, A. J. (2002). Night eating syndrome. In C. G. Fairburn & K. D. Brownell
(Eds.), Eating disorders and obesity: A comprehensive handbook (2nd ed.,
pp. 183187). New York: The Guilford Press.
Stunkard, A. J., Allison, K., & Lundgren, J. (2008). Issues for DSM-V: Night eating
syndrome. The American Journal of Psychiatry, 165, 424.
Stunkard, A. J., Grace, W. J., & Wolff, H. G. (1955). The night-eating syndrome: A
pattern of food intake among certain obese patients. American Journal of
Medicine, 19, 7886.
Towbes, L. C, & Cohen, L. H. (1996). Chronic stress in the lives of college students:
Scale development and prospective prediction of distress. Journal of Youth
and Adolescence, 25, 199217.
United States Department of Health and Human Services. (1988). The surgeon generals report on nutrition and health. (DHHS [PHS] Publication No. 88-50210).
Washington, DC: U.S. Government Printing Office.
Vander Wal, J. S., Waller, S. M., Klurfeld, D. M., McBurney, M. I., & Dhurandhar,
N. V. (2005). Night eating syndrome: Evaluation of two screening instruments.
Eating Behaviors, 6, 6373.
Walsh, T. B., & Satir, D. A. (2005). Classification of eating disorders 20022003. In S.
Wonderlich, J. Mitchell, M. de Zwaan, & H. Steiger (Eds.), Eating disorders
review: Part 1. (pp. 155164). Seattle: Radcliffe Publishing.

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