Guidelines, Quibbles and Quirks — Part 3

Today, February 27, is the first day of National Eating Disorder Awareness Week, sponsored by the National Eating Disorders Association (NEDA). One of the problems with the new American Academy of Pediatrics guidelines for treating childhood obesity is a fear that making a big deal out of weight only leads to a rising incidence of eating disorders.

The Education and Awareness section of NEDA’s website includes articles on Anorexia, Bulimia, Binge Eating, Weight & Body Image, Body Dysmorphia, Orthorexia, Compulsive Eating, Addictions, Diabulimia, Night Eating Syndrome, Pregorexia, Atypical Anorexia, and more. Childhood Obesity News has already covered several of these, so let’s take a look at a few of the less frequently discussed conditions. Of these four, none holds the title of official mental health diagnosis as defined by the institutions in charge of definitions. Yet they have been observed, and present themselves distinctively enough to earn their own categories.


Whether it is regarded as a disease or a lifestyle, it affects a person by causing malnutrition, fatigue, emotional instability, social isolation, diminished quality of life, and stigmatization. In 2016, three defining characteristics of Orthorexia were named by Stevenn Bratman:

— An obsessive focus on “healthy” eating and avoidance of “unhealthy” foods,
— Mental preoccupation regarding dietary practices, and
— Very rigid dietary rules with violations causing exaggerated emotional distress (fear of disease, anxiety, shame, and negative physical sensations)

Night Eating Syndrome

In 2008, the First International Night Eating Symposium was held to figure out exactly what goes on with a phenomenon that, even though not officially named or claimed, was and is observed by many healthcare professionals. A person who takes in 25% or more of their daily calories after dinner or during the night may have Night Eating Syndrome. That is, if the disordered pattern “is not secondary to substance abuse or dependence, medical disorder, medication, or another psychiatric disorder” and has been going on for at least three months.

Other tentative diagnostic criteria are at least two episodes of nocturnal eating per week, along with awareness and recall of the event. Night Eating Syndrome is also considered to be present if three out of the following six items can be checked off:

— Lack of desire to eat in the morning and/or breakfast is omitted on four or more mornings per week.
— Presence of a strong urge to eat between dinner and sleep onset and/or during the night.
— Sleep onset and/or sleep maintenance insomnia is present four or more nights per week.
— Presence of a belief that one must eat in order to initiate or return to sleep.
— Mood is frequently depressed and/or mood worsens in the evening.
— The disorder is associated with significant distress or impairment in functioning.

(To be continued…)

Your responses and feedback are welcome!

Source: “NEDA National Eating Disorder Awareness Week 2023,”, undated
Image by Karen/CC BY 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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