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Albert J Stunkard

Publications and source records attributed to Albert J Stunkard.

At least 19 recordsLinked to original sources
PubMed2006

Familial aggregation in the night eating syndrome.

OBJECTIVE: This study examined the extent to which the night eating syndrome (NES) affects first-degree relatives of NES and control probands. METHOD: NES participants and controls were assessed with the Night Eating Questionnaire (NEQ), the Night Eating Syndrome History and Inventory (NESHI), 10 day sleep and food records, the Eating Disorder Examination (EDE), the Structured Clinical Interview for DSM IV Axis I Disorders (SCID I), and a Family History Questionnaire (FHQ) to assess the presence of NES among first-degree relatives. A proband predictive model, using logistic regression analyses and the generalized estimating equation to control for correlation among observations within families was used to assess familial aggregation. RESULTS: The odds of an NES proband having an affected first-degree relative were significantly greater than that of a control proband (odds ratio=4.9, p<.001). A number of covariates were included in the model: proband body mass index (BMI) (kg/m2), proband gender, proband age, proband ethnicity, first-degree relative gender, relationship to proband (i.e., mother, father, or sibling), and the interaction between relationship to proband and proband status (night eater or control); none was statistically significant (p>.05). CONCLUSION: The study showed a strong aggregation of NES in families.

Adult↗
PubMed2006

Eating in the absence of hunger: a genetic marker for childhood obesity in prepubertal boys?

OBJECTIVE: Eating in the absence of hunger (EAH) may be a behavioral trait through which obesity-promoting genes promote positive energy balance. The primary aim of this study was to compare children born at high vs. low risk for obesity with respect to EAH at 5 years of age. RESEARCH METHODS AND PROCEDURES: This was an observational investigation of families enrolled in the University of Pennsylvania and The Children's Hospital of Philadelphia's Infant Growth Study. Five-year-old children born at high (N = 28) or low (N = 25) risk for obesity on the basis of maternal prepregnancy body weight were evaluated at a hospital-based laboratory. Children consumed 11 snack foods ad libitum after consuming an ad libitum dinner and reporting fullness. Parents reported on snack foods at home and their own eating styles. Nutritive sucking at 3 months of age was evaluated by computerized apparatus. RESULTS: EAH in high-risk boys (mean +/- standard error = 326 +/- 66 kJ] was more than twice that of low-risk boys (mean +/- standard error = 151 +/- 39 kJ), p = 0.03. Among girls, there was a trend for EAH to be associated with increased parental limitations on daughter snack food consumption at home (p = 0.06). EAH was unrelated to 3-month sucking behavior. DISCUSSION: Genes that promote childhood obesity may partially exert their influence through EAH, an effect that was limited to boys born at risk for obesity. The unique influences of genes and home environment on this trait should be disaggregated in subsequent studies.

Birth Weight↗
PubMed2006

Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features.

OBJECTIVE: To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery. RESEARCH METHODS AND PROCEDURES: A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria. RESULTS: Percentages of participants who met diagnostic criteria for NES by interview were 1.9% for the strictest definition and 8.9% across all definitions of NES. After interview, full DSM-TR criteria for BED were met by 4.2%; an additional 1.4% reported binge eating at least once per week. Self-reported prevalence of NES and BED were higher. Those with NES or BED had significantly more symptoms of depression and a greater history of psychological complications than the remaining sample. DISCUSSION: The prevalence rates of NES and BED among this population of bariatric surgery candidates were lower than expected based on previous reports. Findings and hypotheses regarding lowered prevalence rates are discussed.

Adult↗
PubMed2006

The perceived effectiveness of continuing care and group support in the long-term self-help treatment of obesity.

OBJECTIVE: Obesity is increasingly considered a chronic disease requiring continuing care, but professional long-term treatment for most patients is not available. This study examined treatment recipients' perception of the effectiveness of different components of a group self-help, continuing-care treatment program for obesity. RESEARCH METHODS AND PROCEDURES: Members (n = 120) and volunteer leaders (n = 66) of a self-help, continuing-care treatment program of previously demonstrated effectiveness (mean treatment duration, 40.6 months; mean weight lost, 14.1 kg) rated how helpful and effective they found the various therapeutic strategies used by this program. The strategies examined were continuing care, group support, behavior therapy, motivational enhancement strategies involving positive reinforcement, and motivational enhancement strategies involving punishment. RESULTS: The single most highly valued aspect of treatment was the provision of continuing care, followed by group support. Greater success at achieving one's goal weight was associated with perceptions of greater effectiveness of the program's strategies overall (r = 0.219, p < 0.005), of continuing care (r = 0.225, p < 0.005), and of positive reinforcement strategies (r = 0.223, p < 0.01). Participants who had successfully attained their goal weight perceived behavior therapy strategies as more effective than did participants who had not reached their goal weight [t(170) = 2.93, p < 0.005]. DISCUSSION: The high ratings given to continuing care and group support strategies indicate the acceptability of supportive self-help treatment for obesity administered over the long term. The findings suggest that continuing care and group support should be made available to participants in the self-help treatment of obesity.

Behavior Therapy↗
PubMed2006

Assessment of sleep in women with night eating syndrome.

STUDY OBJECTIVES: Evaluation of sleep in subjects with night eating syndrome (NES). DESIGN: Polysomnographic and questionnaire comparisons between subjects with NES and controls. SETTING AND PARTICIPANTS: Fifteen women with NES (mean +/- SD = 41 +/- 8 years) and 14 women (comparable age and weight) without NES (39 +/- 10 years) were studied in the laboratory for 3 days. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Subjects with NES did not differ from controls in timing of sleep onset or offset. They had less stage 2 sleep than controls (minutes, p = .012; percentage, p = .016) and less stage 3 sleep (p = .023), which contributed to their having a lower total sleep time (p = .05) and reduced sleep efficiency (p = .03). Subjects with NES did not have more awakenings than controls, but 93.3% of them ate on awakening during all 3 nights, while 92.9% of controls did not eat on any night. Logistic discriminant analyses identified a multiple sleep parameter model associated with increased likelihood of NES that had sensitivity of 84.6% and specificity of 76.9%. Patients with NES were more depressed than controls (p < .001) and reported greater sleep disturbance that included lower sleep quality (p < or = .001), reduced sleep duration (p < or = .001), and increased number of awakenings (p < or = .001). CONCLUSIONS: Patients with NES appear to have sleep maintenance insomnia rather than sleep-related eating disorder or a parasomnia. The maintenance of normal timing for sleep-wake behavior in the presence of a phase delay in the timing of caloric intake suggests this disorder reflects a state of internal circadian desynchrony associated with significant sleep complaints. It remains unknown whether the sleep disturbance precedes the abnormally timed eating.

Adult↗
PubMed2006

A randomized, placebo-controlled trial of sertraline in the treatment of night eating syndrome.

OBJECTIVE: The authors assessed the efficacy of sertraline in the treatment of night eating syndrome. METHOD: Thirty-four outpatients diagnosed with night eating syndrome were randomly assigned to receive either sertraline (N=17) or placebo (N=17) in an 8-week, double-blind, flexible-dose (50-200 mg/day) study. A mixed effects linear regression model was used to analyze change in the primary outcome measure, Clinical Global Impression (CGI) improvement rating. Secondary outcomes included changes in night eating symptoms, the number of nocturnal awakenings and ingestions, total daily caloric intake after the evening meal, CGI severity ratings, quality of life ratings, and weight. RESULTS: Sertraline was associated with significantly greater improvement than placebo. Twelve subjects in the sertraline group (71%) were classified as having responded (CGI improvement rating < or = 2, indicating much or very much improved) versus only three (18%) in the placebo group. There were also significant improvements in night eating symptoms, CGI severity ratings, quality of life ratings, frequency of nocturnal ingestions and awakenings, and caloric intake after the evening meal. Overweight and obese subjects in the sertraline group (N=14) lost a significant amount of weight by week 8 (mean=-2.9 kg, SD=3.8) compared with overweight and obese subjects receiving placebo (N=14) (mean=-0.3 kg, SD=2.7). CONCLUSIONS: In this 8-week trial, sertraline was effective in the treatment of night eating syndrome and was well tolerated.

Adult↗
PubMed2006

Prevalence of the night eating syndrome in a psychiatric population.

OBJECTIVE: This study assessed the prevalence of night eating syndrome and its comorbid psychopathology in a psychiatric population. METHOD: The Night Eating Questionnaire was administered to 399 patients in two psychiatric outpatient clinics. Those scoring above 20 on the questionnaire (N=205) were assessed for night eating syndrome with a semistructured telephone interview. Chart reviews of all participants were performed to determine their psychiatric diagnoses and medications. RESULTS: Forty-nine participants (12.3%) met criteria for night eating syndrome. Greater rates of substance use disorders were found among patients diagnosed with night eating syndrome than among those without the syndrome. Obese patients were more likely than nonobese patients to manifest night eating syndrome. CONCLUSIONS: Night eating syndrome is prevalent among psychiatric clinic outpatients and is likely to co-occur with substance use disorders and obesity.

Adult↗
PubMed2006

A paradigm for facilitating pharmacotherapy at a distance: sertraline treatment of the night eating syndrome.

OBJECTIVE: To test a novel method of facilitating pharmacotherapy at a distance and assess the effectiveness of sertraline for the treatment of night eating syndrome (NES). METHOD: The effectiveness of the selective serotonin reuptake inhibitor sertraline in the treatment of NES was assessed at a distance. NES is characterized by a delay in the circadian rhythm of food intake, with evening hyperphagia and/or nighttime awakenings and ingestions. Persons who contacted us through our Web site, e-mail, or telephone for help with their NES completed a Night Eating Questionnaire and received a semistructured interview (Night Eating Syndrome History and Inventory) to determine the presence of NES. Fifty such persons received treatment with sertraline from their own physicians, to whom we offered consultation. Participants completed questionnaires every 2 weeks for 8 weeks and received a final telephone interview to assess their progress. Outcomes were compared with those from an earlier face-to-face open-label trial of sertraline. The study was conducted from September 2003 to May 2005. RESULTS: Both the questionnaires and interviews showed improvements in 5 key aspects of NES: the general Night Eating Symptom Scale, evening hyperphagia, nighttime awakenings, nocturnal ingestions, and the Beck Depression Inventory (all p < .001), and the mean body weight of the 41 overweight and obese subjects, reported by survey, fell 3.0 kg (p = .01). These results are similar to those obtained in an earlier face-to-face trial of sertraline with NES. CONCLUSION: The study confirmed the effectiveness of sertraline in the treatment of NES and introduced a paradigm for facilitating pharmaco-therapy at a distance.

Body Weight↗
PubMed2005

Randomized trial of lifestyle modification and pharmacotherapy for obesity.

BACKGROUND: Weight-loss medications are recommended as an adjunct to a comprehensive program of diet, exercise, and behavior therapy but are typically prescribed with minimal or no lifestyle modification. This practice is likely to limit therapeutic benefits. METHODS: In this one-year trial, we randomly assigned 224 obese adults to receive 15 mg of sibutramine per day alone, delivered by a primary care provider in eight visits of 10 to 15 minutes each; lifestyle-modification counseling alone, delivered in 30 group sessions; sibutramine plus 30 group sessions of lifestyle-modification counseling (i.e., combined therapy); or sibutramine plus brief lifestyle-modification counseling delivered by a primary care provider in eight visits of 10 to 15 minutes each. All subjects were prescribed a diet of 1200 to 1500 kcal per day and the same exercise regimen. RESULTS: At one year, subjects who received combined therapy lost a mean (+/-SD) of 12.1+/-9.8 kg, whereas those receiving sibutramine alone lost 5.0+/-7.4 kg, those treated by lifestyle modification alone lost 6.7+/-7.9 kg, and those receiving sibutramine plus brief therapy lost 7.5+/-8.0 kg (P<0.001). Those in the combined-therapy group who frequently recorded their food intake lost more weight than those who did so infrequently (18.1+/-9.8 kg vs. 7.7+/-7.5 kg, P=0.04). CONCLUSIONS: The combination of medication and group lifestyle modification resulted in more weight loss than either medication or lifestyle modification alone. The results underscore the importance of prescribing weight-loss medications in combination with, rather than in lieu of, lifestyle modification.

Adult↗
PubMed2005

Neuroendocrine profiles associated with energy intake, sleep, and stress in the night eating syndrome.

CONTEXT: Night eating syndrome (NES) is characterized by evening hyperphagia and frequent awakenings with ingestion of food. It is associated with obesity and depressed mood. Greater understanding of hormonal influences on NES is desirable. OBJECTIVE: Our objective was to evaluate 25-h profiles of hormones involved in energy balance, sleep, and stress in NES. DESIGN: Blood assays for glucose, insulin, ghrelin, leptin, melatonin, cortisol, TSH, and prolactin were sampled repeatedly among NES and control subjects. Food intake and depressive symptoms were assessed. SETTING AND PARTICIPANTS: Fifteen NES and 14 matched control participants stayed three nights in a General Clinical Research Center. MAIN OUTCOME MEASURES: We assessed differences between NES and control participants in the 25-h profiles of eight hormones. RESULTS: Nocturnal food intake was higher among NES participants, although their daily calorie intake was similar to that of controls. Reflecting their increased nocturnal intake, insulin (P < 0.001) and glucose levels (P = 0.07) among NES participants were higher than those of controls. Ghrelin levels were significantly lower in NES participants than in controls from 0100-0900 h (P = 0.003). Levels of plasma cortisol, melatonin, leptin, and prolactin did not differ between groups, but there was a trend for TSH levels (P = 0.07) to be higher during the 25 h in NES. NES participants had greater depressive symptoms than controls (P < 0.001). The differences in the levels of glucose, insulin, and ghrelin between NES and controls are closely associated with nocturnal food intake.

Adult↗
PubMed2005

The night eating syndrome: a progress report.

The night eating syndrome (NES) is an eating disorder marked by a delay in the circadian pattern of eating that disrupts sleep. Studies have shown that those with NES eat a significant proportion of their calories after their evening meal and wake up during the night to eat. However, the timing of the sleep cycles are phase appropriate, with similar bedtimes and morning wake up times as control subjects, suggesting that the delayed eating rhythm may secondarily disrupt sleep. A case study and an open-label trial with SSRIs suggest that they may treat NES effectively. Randomized controlled trials are needed.

Adult↗
PubMed2005

Appetite: measurement and manipulation misgivings.

Humans appear to have a genotype that permits, or even encourages, an energy intake that is greater than energy expenditure when food is available. This was functional throughout most of human evolution but is less so in the current environment of inexpensive, palatable, and readily available foods. To achieve dietary goals of weight loss or maintenance, attempts have been made to influence appetitive sensations through the manipulation of the physical properties of foods, their composition, or their pattern of consumption. This has led to limited success, in part, because measurement of appetitive sensations is difficult but, more fundamentally, because the association between appetite and food choice or intake is not robust. This article critically reviews the most common methods for assessment of appetite and the effects of selected food constituents on appetitive sensations. Translation of current knowledge to dietetic practice must be made cautiously.

Appetite Regulation↗
PubMed2005

Binge eating disorder and night eating syndrome: a comparative study of disordered eating.

The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance.

Adult↗
PubMed2005

Stigmatized students: age, sex, and ethnicity effects in the stigmatization of obesity.

OBJECTIVE: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. RESEARCH METHODS AND PROCEDURES: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m2; range, 14.4 to 45.0 kg/m2) who ranked six drawings of same-sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth- and sixth-grade children. RESULTS: Obesity was highly stigmatized relative to physical disabilities. African-American women liked obese peers more than did African-American men, white men, or white women [F(1,216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t(761) = 9.16, p < 0.001]. DISCUSSION: Although the stigmatization of obesity was high among participants overall, African-American women seemed to have more positive attitudes toward obesity than did white women, white men, or African-American men. Participants' weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non-overweight adults. Such internalized stigmatization could help to explain the low self-esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African-American women could help efforts to reduce stigma.

Adult↗
PubMed2005

Growth of children at high risk of obesity during the first 6 y of life: implications for prevention.

BACKGROUND: The contribution of familial factors to adiposity in children is poorly understood. OBJECTIVE: The objective was to assess differences in growth in the first 6 y of life in children born to either overweight or lean mothers. DESIGN: The body size and composition of 33 children at high risk and 37 children at low risk of obesity on the basis of the mother's overweight [body mass index (BMI; in kg/m(2)) of 30.2 +/- 4.2 and 19.5 +/- 1.1, respectively] were measured repeatedly from 3 mo to 6 y of age at the Children's Hospital of Philadelphia. RESULTS: At year 2, no significant differences in any measure were observed between the high- and low-risk groups. By year 4, weight, BMI, and lean body mass were greater in the high-risk than in the low-risk children. By year 6, weight was even greater in the high-risk than in the low-risk children (23.4 +/- 6.4 compared with 20.4 +/- 2.1 kg; P < 0.02), and, for the first time, fat mass was greater in the high-risk than in the low-risk children (6.7 +/- 5.7 compared with 3.8 +/- 1.2 kg; P < 0.02). Ten of 33 high-risk children exceeded the 85th percentile of BMI at year 6 compared with 1 of 37 low-risk children (odds ratio = 15.7). Accelerated weight gain was predicted by high-risk group status, greater weight at year 2, and lower family income. CONCLUSION: Anthropometric measures were not significantly different between groups at year 2; weight and lean body mass were greater at years 4 and 6, and fat mass was greater at year 6 in high-risk children.

Body Mass Index↗
PubMed2004

Clinical trial of sertraline in the treatment of night eating syndrome.

OBJECTIVE: To test the efficacy of sertraline in the treatment of night eating syndrome. METHODS: Seventeen patients meeting criteria for night eating syndrome received sertraline in a 12-week open-label, nonblind trial. Outcome was assessed by four primary measures, namely, the number of nocturnal awakenings, the number of ingestions, total daily caloric intake after the evening meal, and an overall rating of change from the Clinical Global Impression of Improvement scale (CGI-I). RESULTS AND DISCUSSION: An intent-to-treat analysis revealed highly significant improvements across all four primary outcome measures for all 17 subjects. Five subjects achieved full remission of symptoms (CGI-I score of 1 = very much improved) and lost a significant amount of weight over the course of the study (-4.8 +/- 2.6 kg, p < .05). Sertraline, a selective serotonin reuptake inhibitor, may be beneficial in the treatment of night eating syndrome.

Adolescent↗
PubMed2004

Night eating syndrome among nonobese persons.

OBJECTIVE: To compare the characteristics of obese persons with the night eating syndrome (NES) with those of nonobese persons with the NES. METHODS: Eighty subjects (40 with a body mass index [BMI] greater than 30 and 40 with a BMI less than 25) identified themselves on a website for the Night Eating Questionnaire (NEQ) as suffering from the NES. The responses of the 40 obese website subjects were compared with 21 obese persons with the NES who had undergone face-to-face interviews. The responses on the NEQ of the 40 obese and the 40 non-obese website subjects were then compared. RESULTS: There was no difference in the NEQ results of the 40 website obese subjects and 21 obese night eaters who had undergone face-to-face interviews. The responses of these same 40 obese subjects showed very little difference compared with those of the 40 nonobese subjects. The major difference between the two groups was the considerable younger age of the normal-weight NES subjects. DISCUSSION: The striking similarity in the characteristics between obese and nonobese subjects with the NES indicates that this disorder, considered until now to occur primarily among obese persons, also occurs among nonobese persons. The younger age of the nonobese subjects suggests that the NES may contribute to the development of obesity.

Adult↗