When we think about food-related behaviors in eating disorders, we often focus on the “what” and the “how.” What are they eating? Is it too much, too little, not enough variety? And how are they eating? Have they adopted rituals around food, do they eat in secret, do they lose control when they eat? But one important factor that tends to get ignored is the “when.” For those with eating disorders, disordered behaviors often involve the timing of meals and snacks—and for many, this means eating only (or mostly) at night.

When someone eats (or doesn’t eat) can be a sign of an eating disorder, and can perpetuate certain disordered patterns. This tends to show up as restricting food during the first part of the day, and eating all or the majority of one’s calories later in the day or at nighttime. Only eating at night can pose a variety of physical and psychological risks and challenges to recovery. Read on to learn more about why many people with eating disorders develop the pattern of eating only at night, what conditions the behavior is associated with, why it can be harmful, and how to stop.

What does night eating (or only eating at night) look like?

Only eating at night is exactly what it sounds like. The specifics will look different from person to person, but the general pattern remains the same: routinely skipping breakfast and eating nothing or very little throughout the rest of the day. Then, as evening approaches, a person who only eats at night allows themselves to have food. For some people, this might mean a binge; for others, it may mean eating a relatively small amount of food that still accounts for most of their daily intake.

What is night eating syndrome (NES)?

While people with several different eating disorder diagnoses may engage in night eating, it’s worth noting that there is a specific eating disorder characterized by this pattern, known as night eating syndrome (NES). NES is a type of other specified feeding or eating disorder (OSFED), and it’s defined by excessive food intake in the evening or nighttime. This means consuming at least 25% of a person’s daily calories after dinner, and waking up throughout the night to eat. About 1.5% of people in the United States have NES, but many people with other eating disorders tend to eat only or mostly later in the day without meeting the criteria for NES.

Those with NES typically wake up several times during the night to eat, and find it difficult to fall back asleep without feeling full. According to the DSM-5, NES involves recurrent episodes of night eating either after dinner or after waking up from sleep. NES is different from sleep-related eating disorder (SRED), which can cause individuals to eat uncontrollably while mostly or completely asleep and have little to no memory of the episodes the next morning. Those with NES are aware of their night eating and can recall it the next day, but the behavior can’t be explained by factors like sleep-wake cycle changes, social norms, substance or medication use, or other mental or physical disorders.

While the DSM doesn’t include criteria for how often night eating must occur or how long these behaviors should persist in order to receive an NES diagnosis, those with NES typically have at least two episodes per week. A diagnosis also includes meeting at least three of the following criteria:

1. A lack of desire to eat in the morning and/or skipping breakfast four or more times per week
2. The presence of a strong urge to eat between dinner and sleep onset and/or during the night
3. Trouble falling or staying asleep four or more times per week
4. Holding the belief that one must eat in order to initiate or return to sleep
5. Having a frequently depressed or worsened mood in the evening

Because a pattern of waking up to eat can significantly impair daytime functioning and negatively affect mental health, treatment for NES is essential and may include a variety of different therapies, including those used to treat general night eating.

What causes some people with EDs to only eat at night?

There are a number of different reasons why people with eating disorders develop this eating pattern. “Eating predominately at night is a common symptom in eating disorders because it can reflect a combination of physiological, psychological, and behavioral factors tied to the disorder’s underlying dynamics,” says Adriana Lindenfeld, LMHC, a therapist at Equip. “From a physiological standpoint, irregular eating patterns or prolonged restriction during the day can disrupt hunger and fullness cues, leading to increased cravings and overconsumption later in the day.” (This underscores the notion that most, if not all, eating disorders are rooted in restriction).

On a psychological level, people with restrictive eating disorders like anorexia might “save” calories for later in the day as a way to exert some control, both over their food intake and their emotional state. “Eating later in the day might reflect an attempt to delay or minimize caloric intake as long as possible, potentially as a way to ‘earn’ the right to eat,” says Lindenfeld. “This pattern might also reflect rigid, ritualized eating behaviors or avoidance of eating in social settings.” She points out that it can also be a way of managing anxiety, or avoiding feelings of guilt that they know they would feel after eating earlier in the day.

Night eating can also be a response to distressing emotions, like stress, anxiety, and loneliness, Lindenfeld explains. “The evening hours—often quieter and less structured—can create a vulnerable window for compulsive eating, especially if restriction or emotional suppression occurred earlier in the day,” she says. This nighttime eating, in turn, reinforces feelings of shame and keeps the cycle of disordered eating going.

From a physiological perspective, hormonal imbalances that throw off a person’s hunger and fullness cues can also play a role in some cases.

Which eating disorders involve only eating at night?

Lindenfeld says that eating only (or mostly) later in the day can be a symptom of a number of different eating disorders, including binge eating disorder (BED), anorexia, and bulimia.

“Although binge behaviors aren’t exclusive to nighttime, BED often involves episodes of consuming large quantities of food during the evening hours, especially if the person has restricted their intake earlier in the day,” she says. Research also demonstrates this pattern: in a study of people with BED, researchers found that breakfast was the least commonly consumed meal, with dinner being the most common meal and evening the most common time for snacking.

As mentioned above, people with anorexia might eat primarily at night to minimize overall caloric intake. Night eating can also be a symptom of bulimia: “While binge episodes in bulimia can occur at any time, they often happen at night due to emotional triggers, physical hunger following restriction, or feelings of isolation,” Lindenfeld says.

Could eating only at night be a sign of something besides an eating disorder?

Of course, people might eat only or mostly later in the day for reasons besides an eating disorder. For instance, Lindenfeld says, disrupted sleep patterns or emotional distress (which can trigger emotional eating) might play a role.

Diet culture can also be a factor. Unfortunately, it’s extremely common for people without eating disorders to adopt pretty disordered eating habits in an attempt to lose weight, look a certain way, or meet certain “healthy” standards around diet or fitness. One prime example is intermittent fasting, which might be appropriate for some people for a certain amount of time, but often does more harm than good (and may eventually lead to an eating disorder).

A lot of people who don’t intermittently fast formally do engage in calorie “banking,” or restricting food during the day to “save up” calories for later. This type of behavior is unfortunately common among dieters, and even those who aren’t on a diet might “bank” calories if they know they’re going to have a large meal or go out to eat later in the day.

What if I’m only hungry at night?

Some people struggle to feel hunger at any time of day other than night. For some, breakfast can be a challenge, and for others, a busy schedule might mask hunger cues throughout the day. While many of us have been told to “only eat when you’re hungry,” that rule isn’t helpful for people with suppressed or unreliable hunger cues, and it can perpetuate the cycle of disordered eating.

While different people have different cues for hunger and fullness (some may feel a stomach rumble when they are hungry and others may get a headache or feel weak, for example), eating disorders can make it difficult to feel those cues at all. Food restriction is at the core of most eating disorders—not just anorexia—so it’s important to understand that skipping meals and snacks throughout the day, even if you don’t feel hungry, can worsen eating disorder symptoms. Those with bulimia or binge eating disorder, for example, often binge after periods of restriction, and the biological hunger that results from that restriction is what triggers the binge and contributes to feeling out of control.

Getting adequate nutrition throughout each day is essential for overall health and for treating a variety of eating disorders. That’s why at Equip, patients and loved ones work closely with a registered dietitian to prioritize regularly timed meals and snacks, diversifying the types of food a patient eats, challenging and breaking established food rules, and more.

The risks of only eating at night

Eating only (or mostly) at nighttime can have negative effects on a person’s physical and mental health, as well as their relationships and quality of life, regardless of whether or not they have an eating disorder.

“Physically, nighttime eating disrupts the body’s natural circadian rhythm, which governs digestion and metabolism,” Lindenfeld explains. “Consuming large amounts of food late at night can lead to gastrointestinal issues, and increased risk of conditions like insulin resistance, type 2 diabetes, and cardiovascular disease.” She adds that it can affect sleep quality, because your body’s efforts to digest all that food can make it tough to fall or stay asleep.

Here’s a snapshot of the potential negative consequences of only eating at night:

• Increased risk of diabetes. Research has shown that regularly eating very large meals late in the day is linked to elevated levels of glucose and insulin, which decreases insulin sensitivity and increases the risk for type 2 diabetes.
• Cardiovascular risk. Habitual night eating has been associated with the progression of arterial stiffness, which is a significant predictor of heart disease.
• Acid reflux or gastroesophageal reflux disease (GERD). Eating within two to three hours of bedtime can trigger increased acid production in the stomach, and lying down soon after eating can encourage this acid to flow into the esophagus, causing acid reflux and heartburn.
• Hormonal imbalance and intense cravings: Restricting food during the day can disrupt the balance of hormones involved in the hunger-fullness cycle.

In terms of psychological impact, Lindenfeld notes that nighttime eating is often associated with feelings of shame, guilt, and loss of control, which can amplify anxiety, depression, and low self-esteem. Only eating later in the day can also impact social functioning, as people might avoid situations during the day that involve eating. This can contribute to social isolation and hurt relationships, which can worsen the other negative psychological effects of nighttime eating.

“Over time, these patterns can disrupt metabolism, perpetuate guilt and shame cycles, and exacerbate the psychological and physical toll of an eating disorder,” says Lindenfeld.

How night eating impacts sleep

One of the most significant ways that night eating negatively affects overall health is by disrupting sleep. Here are some of the ways that disordered eating patterns (including only eating at night) can negatively impact sleep:

• While a lack of nutrition can result in fatigue during the day, it can actually lead to insomnia at night, and hunger can also cause obsessive thoughts about food, making it more difficult to sleep.
• Because those with eating disorders may be undernourished or underweight, they may have trouble regulating their body temperature, which makes it difficult to feel physically comfortable and fall asleep.
• If a person binges (and/or purges) at night, physical side effects (like acid reflux, bloating, and digestive discomfort( and emotional effects (like shame and guilt) can make it hard for them to fall asleep.
• The possible malnutrition that may result from only eating at night can also cause daytime fatigue and sleep cycle disruptions, including reduced rapid eye movement (REM) sleep This can have a significant effect on mental health and cognitive function. Restricted or poor quality sleep can also cause a significant increase in ghrelin (the "hunger" hormone), which may perpetuate the cycle of disordered eating.

How is night eating addressed in eating disorder treatment?

According to Lindenfeld, addressing this pattern of eating involves a multidisciplinary approach that targets the behavioral, psychological, and physiological factors contributing to the behavior. “A key focus is restoring regular eating patterns throughout the day to regulate hunger and satiety cues,” she says. “This often involves structured meal planning with the guidance of a registered dietitian, and encouraging balanced meals and snacks spaced evenly to prevent daytime restriction, which can lead to nighttime eating.”

Treatment might also include cognitive behavioral therapy (CBT) to address distorted thoughts and feelings that tend to lead to nighttime eating, as well as helping people develop healthier coping strategies for dealing with triggers and distressing emotions.

What to do if you or a loved one are struggling with eating only at night

If you find that you’re eating all (or the majority of) your food in the evening and are restricting throughout the day, or have noticed someone in your life doing this, it could signal an eating disorder. And even if an eating disorder isn’t the underlying cause, eating only at night can be harmful to your mental and physical health, as well as your relationships and quality of life.

Either way, it’s important to reach out for support. Talk with your doctor or an eating disorder-informed dietitian about your concerns, and they can guide you toward resources and strategies to help shift this behavior. You can also schedule a consultation with the Equip team to talk through your concerns and what treatment options are available.