Cortisol and ghrelin concentrations following a cold pressor stress test in overweight individuals with and without night eating.

OBJECTIVE: To explore appetite-related hormones following stress in overweight individuals, and their relationship with night eating (NE) status. METHOD: We measured plasma cortisol and ghrelin concentrations, and recorded ratings of stress and hunger in response to a physiological laboratory stressor (cold pressor test, CPT), in overweight women with (n=11; NE) and without (n=17; non-NE) NE. RESULTS: Following the CPT, cortisol (P<0.001) and ghrelin (P<0.05) levels increased, as did stress and hunger ratings (all P<0.001), across all subjects (NE and non-NE). NE exhibited higher baseline cortisol (P<0.05) levels than non-NE. NE also had greater cortisol area under the curve (AUC) than non-NE (P=0.019), but not when controlling for baseline cortisol levels. Ghrelin baseline and AUC did not differ between groups. NE showed higher AUC stress (P<0.05), even when controlling for baseline stress. DISCUSSION: Overweight individuals showed increased cortisol, ghrelin, stress and hunger following a laboratory stressor, and there was some evidence for greater increases in cortisol and subjective stress among NE. The greater AUC cortisol level in NE was due to higher baseline levels, but the group difference in stress was in direct response to the stressor. Our results support a role for cortisol and stress in NE.

Comparison of eating disorders and body image disturbances between Eastern and Western countries.

Factors associated with the development of eating disorders in countries with non-Western cultures have not been adequately investigated in relation to Westernized countries. We therefore studied 243 girls [age =16.5+/-1.2 (SD)], recruited from schools in India, Tibet, the US and France. They completed the Figure Rating Scale (FRS), the Eating Attitudes Test (EAT), and the Beck Depression Inventory (BDI). The Tibetan group had a lower body mass index (BMI) than the other groups (p<0.0001), which did not differ from each other. All groups differed significantly on socio-economic status (SES), with those living in India having the highest (p<0.0001). Prior to controlling for age, SES, and BMI, there were no significant differences on any psychological measure between the individual countries, or when collapsed by East vs. West. However, after controlling for the same covariates, the Tibetan group selected a significantly larger current (p<0.0001) and ideal body size (p=0.03), compared to all the other countries, and had more body image discrepancy than the American group (p=0.04). After controlling only for BMI, the girls from the East had a larger current and ideal, but no difference on body image discrepancy. Body image discrepancy scores were best predicted by EAT scores and BMI, accounting for 35% of the variance (p<0.0001). EAT scores themselves were best predicted by mother's education, BDI, body image discrepancy, and drug and tobacco use, accounting for 33% of the variance (p<0.0001). Unlike some other studies, we did not observe greater body image discrepancy and eating pathology in Western cultures, whether or not controlling for age, SES, and BMI. There were no differences in eating and depression pathology between those in the US, France, or India. Indeed, the Tibetans, after controlling for their low BMI and SES, had the greatest body image discrepancy.

Night eating syndrome is associated with depression, low self-esteem, reduced daytime hunger, and less weight loss in obese outpatients.

OBJECTIVE: The objective of this study was to assess the relationship between the night eating syndrome (NES), measures of depression and self-esteem, test meal intake, and weight loss in obese participants. RESEARCH METHODS AND PROCEDURES: The study included 76 overweight (body mass index = 36.7 +/- 6.5 SD) outpatients (53 women and 23 men; aged 43.5 +/- 9.5 years) entering a weight loss program. They completed a Night Eating Questionnaire, the Zung Depression Inventory, and the Rosenberg Self-Esteem SCALE: Based on criteria by Stunkard et al. (Stunkard A, Berkowitz R, Wadden T, Tanrikut C, Reiss E, Young L. Binge eating disorder and the night eating syndrome. Int J Obes Relat Metab DISORD: 1996;20:1-6), participants had NES if they reported: (1) skipping breakfast > or =4 d/wk, interpreted as morning anorexia; (2) consuming more than 50% of total daily calories after 7 PM; and (3) difficulty falling asleep or staying asleep > or =4 d/wk. Eleven (14%) participants met the criteria for NES. After an 8-hour fast, all participants ingested a nutritionally complete liquid meal through a straw from a large opaque cooler until extremely full. They also completed ratings of hunger and fullness before and after this meal. RESULTS: Night eaters had higher depression (p = 0.04), lower self-esteem (p = 0.003), and less hunger (p = 0.005), and a trend for more fullness (p = 0.06) before the daytime test meal than the others. However, there were no significant differences in test-meal intake between groups. Nevertheless, test-meal intake was greater later in the day only for the night eaters (p = 0.01). Over a 1-month period, the night eaters lost less weight (4.4 +/- 3.2 kg) than the others (7.3 +/- 3.2 kg; p = 0.04), after controlling for body mass index. DISCUSSION: NES is a syndrome with distinct psychopathology and increased food intake later in the day, both of which may contribute to poorer weight loss outcome. NES criteria need to be better quantified and NES deserves consideration as a diagnostic eating disorder.

Work-shift period and weight change.

The present study was done to determine whether weight gain was more prevalent in workers on late shifts than in those on day shifts. A questionnaire about changes in weight, food intake, exercise, and sleep since starting the job on the current shift was given to day-shift and late-shift (evening and night) hospital workers. Data were analyzed for 85 subjects, 36 of whom worked during the day shift and 49 the late shift. The late-shift group reported a mean weight gain of 4.3 kg, which was greater than the mean weight gain of 0.9 kg for the day-shift group (P = 0.02). There were, however, no significant differences in current body mass index (26.7 +/- 5.4 SD) between groups. There was a trend for late-shift workers to report eating more since beginning the later shift (P = 0.06). When combined with those reporting exercising less (P = NS), this trend became significant (P = 0.04). Late-shift workers reported eating fewer meals (1.9 +/- 0.9 SD) than the day-shift workers (2.5 +/- 0.9; P = 0.002). In addition, late-shift workers reported eating the last daily meal later (mean = 22:27, or 10:27 PM) than day-shift workers (17:52 or 5:52 PM; P < 0.00005). Late-shift workers also reported more naps (P = 0.01) and longer naps (P = 0.05) during the work week than did day-shift workers. The reported changes in eating, exercise, and sleep may contribute to the increased weight gain of late-shift workers.

A Medicare prescription drug benefit.

Even though almost two-thirds of Medicare beneficiaries have some coverage for outpatient prescription drugs, pharmaceuticals are a major part of their out-of-pocket expenses and threaten the financial security of growing numbers of beneficiaries. Because pharmaceuticals are an integral part of modern health care, some have proposed adding a drug benefit to Medicare. Such proposals pose difficult questions of design, cost, and administration. A drug benefit could add between 7 and 13 percent per year to Medicare costs over the next decade. If such a benefit were added to Medicare, policymakers would have to decide who should bear these costs and whether subsidies should be provided to help lower income beneficiaries pay the portion of the costs borne by participants.