This thesis has been prepared in a paper based format and comprises of three stand-alone papers. Paper 1, a systematic review; Paper 2, an empirical study; and Paper 3, a critical appraisal and reflection of the work. Paper 1 has been prepared for submission to Appetite. The paper presents a systematic literature review of studies measuring or reporting potential psychological mechanisms within Night Eating Syndrome (NES). Databases were systematically searched and 20 studies were included in the review. The quality of evidence was mixed and NES was identified and diagnosed in a variety of ways. Studies utilised a variety of different instruments to identify thirteen psychological mechanisms. Syntheses of the studies suggest that there are distinct overlapping features within these mechanisms and five overarching themes were identified to accommodate these overlapping features. Suggestions are made relating to the potential function of the identified psychological mechanisms within NES.Paper 2 has been prepared for submission to Appetite. The paper is a qualitative study exploring the relationship between NES and the experience of emotion specifically from the perspective of patients identified as obese. Ten participants were interviewed and a constructivist grounded theory approach was used to analyse transcripts. A key category to emerge from the analysis was termed 'Emotional Hunger'; reflecting an urge or need to satiate a set of underlying unmet emotional needs. 'Emotional hunger' was underpinned by the following six interrelated themes: (1) The development of a relationship with food; (2) Loss; (3) The significance of night time; (4) A separation of the body and mind; (5) Why I eat, not what I eat; and (6) Consequences of night eating. The clinical implications of the findings are discussed with reference to existing literature. Paper 3 is not intended for publication. The paper provides a critical review of the research process, in which the strengths and weaknesses of the systematic review and empirical study are discussed. Personal and professional reflections on the experience of conducting a systematic review and an empirical study are explored. The clinical implications of the research are also discussed.

Night eating syndrome (NES) is characterized by excessive evening and/or nocturnal eating episodes. Studies indicate an attentional bias towards food in other eating disorders. For NES, however, evidence of attentional food processing is lacking. Attention towards food and non-food stimuli was compared using eye-tracking in 19 participants with NES and 19 matched controls without eating disorders during a free exploration paradigm and a visual search task. In the free exploration paradigm, groups did not differ in initial fixation position or gaze duration. However, a significant orienting bias to food compared to non-food was found within the NES group, but not in controls. A significant attentional maintenance bias to non-food compared to food was found in both groups. Detection times did not differ between groups in the search task. Only in NES, attention to and faster detection of non-food stimuli were related to higher BMI and more evening eating episodes. The results might indicate an attentional approach-avoidance pattern towards food in NES. However, further studies should clarify the implications of attentional mechanisms for the etiology and maintenance of NES.

Introdução: Os seres vivos sincronizam suas atividades com os ciclos ambientais influenciados por fatores externos como as condições de luz, horários de alimentação, interações sociais e por fatores endógenos como os genéticos, níveis hormonais e apetite, entre outros. Sensores percebem a variação temporal informando o estado de iluminação ambiental através da rede neural ou sistema endócrino mediado pelos relógios circadianos. Os genes do relógio pertencem a quatro famílias: CLOCK, BMAL1, Cryptochromes e Period onde a formação, expressão e supressão da transcrição destes e de seus heterodímeros resultam na ritmicidade de 24h. O relógio circadiano modula o metabolismo de energia através do controle da atividade de diversas enzimas, dos sistemas de transporte e de receptores nucleares envolvidos no metabolismo dos nutrientes. Alterações nos horários de alimentação podem modificar a relação entre o relógio central e or relógios periféricos podendo causar mudanças no metabolismo e afetar o sistema circadiano. Em algumas desordens alimentares como a Síndrome do Comer Noturno (SCN), reconhecida como um atraso de fase da alimentação, o ritmo de alimentação está alterado. Assim sendo, a SCN pode ser um fator que influencia na obesidade, modificando padrões do sono, padrão alimentar, apetite e regulação neuroendócrina. Objetivos: Estudar os aspectos cronobiológicos na SCN. Métodos: Características, como aspectos emocionais, cronotipo e qualidade do sono foram avaliadas por meio de questionários. Variáveis de ritmicidade da atividade e exposição à luz foram avaliadas por actigrafia e a expressão dos genes do relógio CLOCK, BMAL1, Cry 1 e Per 2 foi medida em leucócitos. Resultados: 28 pacientes (14 com SCN - 10 mulheres e 14 controles - 9 mulheres) participaram deste estudo. A média de idade foi de 40,71 ± 12,37 anos e IMC foi de 26,8 ± 5,7kg/m². Não foi encontrada nenhuma evidência cronobiológica nas análises realizadas relacionada à SCN. Conclusão: Nossos resultados não corroboram a hipótese de que o the time system pode ser ligado à fisiopatologia da SCN, pois a associação de sintomas que definem a SCN como uma síndrome. Os tempos e a qualidade da alimentação devem ser mais profundamente estudados para esclarecer a relação entre a alimentação e o fato de que se os seres humanos alocam a sua principal alimentação no turno da noite pode trazer consequências ao metabolismo e refletir mudanças no comportamento e contribuir no controle da obesidade. Este é o primeiro estudo em humanos para relacionar os genes do relógio e a SCN. / Introduction: Living beings synchronize their activities with environmental cycles influenced by external factors such as light conditions, feeding schedules, social interactions and endogenous factors such as genetics, hormone levels and appetite, among others. Sensors perceive the temporal variation informing the state of ambient lighting through the neural network or endocrine mediated by circadian clocks. The clock genes belong to four families: CLOCK, BMAL1, Cryptochromes and Period where the formation, expression and suppression of these transcriptions and their heterodimers result in 24h rhythmicity. The circadian clock modulates energy metabolism by controlling the activity of several enzymes, transport systems and nuclear receptors involved in the metabolism of nutrients. Changes in feeding schedules may modify the relationship between the central clock and peripheral clocks and cause changes in metabolism and affect the circadian system. Some eating disorders, such as Night Eating Syndrome (NES) recognized as a phase delay in the feed, the feed rthythmicity coul be changed. Thus, NES may be a factor that influences in obesity, changing sleep and eating patterns, appetite and neuroendocrine regulation. Objectives: Cross-sectional study to examine the chronobiological aspects of NES. Methods: Features such as emotional aspects, chronotype and sleep quality were assessed by questionnaires. Variables rhythmicity of activity and light exposure were assessed by actigraphy and expression of clock genes CLOCK, BMAL1, Cry 1 and Per 2 was measured in leukocytes. Results: 28 patients (14 with SCN - 10 women and 14 controls - 9 women) participated in this study. The age average was 40.71 ± 12.37y and BMI was 26.8 ± 5.7kg/m². We found no evidence in chronobiological analyzes related to SCN. Conclusion: Our results do not support the hypothesis that the time system can be conected to the pathophysiology of NES, because the association of symptoms that define the NES as a syndrome mainly by the characteristic temporal power that is possibly involved with the time system. The timing and quality of food should be further studied to clarify the relationship between food and the fact that humans allocate their main food in the night shift may have consequences for metabolism and reflect changes in behavior and contribute to the control of obesity. This is the first study in humans to relate the clock genes and NES.

Introdução: Os seres vivos sincronizam suas atividades com os ciclos ambientais influenciados por fatores externos como as condições de luz, horários de alimentação, interações sociais e por fatores endógenos como os genéticos, níveis hormonais e apetite, entre outros. Sensores percebem a variação temporal informando o estado de iluminação ambiental através da rede neural ou sistema endócrino mediado pelos relógios circadianos. Os genes do relógio pertencem a quatro famílias: CLOCK, BMAL1, Cryptochromes e Period onde a formação, expressão e supressão da transcrição destes e de seus heterodímeros resultam na ritmicidade de 24h. O relógio circadiano modula o metabolismo de energia através do controle da atividade de diversas enzimas, dos sistemas de transporte e de receptores nucleares envolvidos no metabolismo dos nutrientes. Alterações nos horários de alimentação podem modificar a relação entre o relógio central e or relógios periféricos podendo causar mudanças no metabolismo e afetar o sistema circadiano. Em algumas desordens alimentares como a Síndrome do Comer Noturno (SCN), reconhecida como um atraso de fase da alimentação, o ritmo de alimentação está alterado. Assim sendo, a SCN pode ser um fator que influencia na obesidade, modificando padrões do sono, padrão alimentar, apetite e regulação neuroendócrina. Objetivos: Estudar os aspectos cronobiológicos na SCN. Métodos: Características, como aspectos emocionais, cronotipo e qualidade do sono foram avaliadas por meio de questionários. Variáveis de ritmicidade da atividade e exposição à luz foram avaliadas por actigrafia e a expressão dos genes do relógio CLOCK, BMAL1, Cry 1 e Per 2 foi medida em leucócitos. Resultados: 28 pacientes (14 com SCN - 10 mulheres e 14 controles - 9 mulheres) participaram deste estudo. A média de idade foi de 40,71 ± 12,37 anos e IMC foi de 26,8 ± 5,7kg/m². Não foi encontrada nenhuma evidência cronobiológica nas análises realizadas relacionada à SCN. Conclusão: Nossos resultados não corroboram a hipótese de que o the time system pode ser ligado à fisiopatologia da SCN, pois a associação de sintomas que definem a SCN como uma síndrome. Os tempos e a qualidade da alimentação devem ser mais profundamente estudados para esclarecer a relação entre a alimentação e o fato de que se os seres humanos alocam a sua principal alimentação no turno da noite pode trazer consequências ao metabolismo e refletir mudanças no comportamento e contribuir no controle da obesidade. Este é o primeiro estudo em humanos para relacionar os genes do relógio e a SCN. / Introduction: Living beings synchronize their activities with environmental cycles influenced by external factors such as light conditions, feeding schedules, social interactions and endogenous factors such as genetics, hormone levels and appetite, among others. Sensors perceive the temporal variation informing the state of ambient lighting through the neural network or endocrine mediated by circadian clocks. The clock genes belong to four families: CLOCK, BMAL1, Cryptochromes and Period where the formation, expression and suppression of these transcriptions and their heterodimers result in 24h rhythmicity. The circadian clock modulates energy metabolism by controlling the activity of several enzymes, transport systems and nuclear receptors involved in the metabolism of nutrients. Changes in feeding schedules may modify the relationship between the central clock and peripheral clocks and cause changes in metabolism and affect the circadian system. Some eating disorders, such as Night Eating Syndrome (NES) recognized as a phase delay in the feed, the feed rthythmicity coul be changed. Thus, NES may be a factor that influences in obesity, changing sleep and eating patterns, appetite and neuroendocrine regulation. Objectives: Cross-sectional study to examine the chronobiological aspects of NES. Methods: Features such as emotional aspects, chronotype and sleep quality were assessed by questionnaires. Variables rhythmicity of activity and light exposure were assessed by actigraphy and expression of clock genes CLOCK, BMAL1, Cry 1 and Per 2 was measured in leukocytes. Results: 28 patients (14 with SCN - 10 women and 14 controls - 9 women) participated in this study. The age average was 40.71 ± 12.37y and BMI was 26.8 ± 5.7kg/m². We found no evidence in chronobiological analyzes related to SCN. Conclusion: Our results do not support the hypothesis that the time system can be conected to the pathophysiology of NES, because the association of symptoms that define the NES as a syndrome mainly by the characteristic temporal power that is possibly involved with the time system. The timing and quality of food should be further studied to clarify the relationship between food and the fact that humans allocate their main food in the night shift may have consequences for metabolism and reflect changes in behavior and contribute to the control of obesity. This is the first study in humans to relate the clock genes and NES.

Introdução: Os seres vivos sincronizam suas atividades com os ciclos ambientais influenciados por fatores externos como as condições de luz, horários de alimentação, interações sociais e por fatores endógenos como os genéticos, níveis hormonais e apetite, entre outros. Sensores percebem a variação temporal informando o estado de iluminação ambiental através da rede neural ou sistema endócrino mediado pelos relógios circadianos. Os genes do relógio pertencem a quatro famílias: CLOCK, BMAL1, Cryptochromes e Period onde a formação, expressão e supressão da transcrição destes e de seus heterodímeros resultam na ritmicidade de 24h. O relógio circadiano modula o metabolismo de energia através do controle da atividade de diversas enzimas, dos sistemas de transporte e de receptores nucleares envolvidos no metabolismo dos nutrientes. Alterações nos horários de alimentação podem modificar a relação entre o relógio central e or relógios periféricos podendo causar mudanças no metabolismo e afetar o sistema circadiano. Em algumas desordens alimentares como a Síndrome do Comer Noturno (SCN), reconhecida como um atraso de fase da alimentação, o ritmo de alimentação está alterado. Assim sendo, a SCN pode ser um fator que influencia na obesidade, modificando padrões do sono, padrão alimentar, apetite e regulação neuroendócrina. Objetivos: Estudar os aspectos cronobiológicos na SCN. Métodos: Características, como aspectos emocionais, cronotipo e qualidade do sono foram avaliadas por meio de questionários. Variáveis de ritmicidade da atividade e exposição à luz foram avaliadas por actigrafia e a expressão dos genes do relógio CLOCK, BMAL1, Cry 1 e Per 2 foi medida em leucócitos. Resultados: 28 pacientes (14 com SCN - 10 mulheres e 14 controles - 9 mulheres) participaram deste estudo. A média de idade foi de 40,71 ± 12,37 anos e IMC foi de 26,8 ± 5,7kg/m². Não foi encontrada nenhuma evidência cronobiológica nas análises realizadas relacionada à SCN. Conclusão: Nossos resultados não corroboram a hipótese de que o the time system pode ser ligado à fisiopatologia da SCN, pois a associação de sintomas que definem a SCN como uma síndrome. Os tempos e a qualidade da alimentação devem ser mais profundamente estudados para esclarecer a relação entre a alimentação e o fato de que se os seres humanos alocam a sua principal alimentação no turno da noite pode trazer consequências ao metabolismo e refletir mudanças no comportamento e contribuir no controle da obesidade. Este é o primeiro estudo em humanos para relacionar os genes do relógio e a SCN. / Introduction: Living beings synchronize their activities with environmental cycles influenced by external factors such as light conditions, feeding schedules, social interactions and endogenous factors such as genetics, hormone levels and appetite, among others. Sensors perceive the temporal variation informing the state of ambient lighting through the neural network or endocrine mediated by circadian clocks. The clock genes belong to four families: CLOCK, BMAL1, Cryptochromes and Period where the formation, expression and suppression of these transcriptions and their heterodimers result in 24h rhythmicity. The circadian clock modulates energy metabolism by controlling the activity of several enzymes, transport systems and nuclear receptors involved in the metabolism of nutrients. Changes in feeding schedules may modify the relationship between the central clock and peripheral clocks and cause changes in metabolism and affect the circadian system. Some eating disorders, such as Night Eating Syndrome (NES) recognized as a phase delay in the feed, the feed rthythmicity coul be changed. Thus, NES may be a factor that influences in obesity, changing sleep and eating patterns, appetite and neuroendocrine regulation. Objectives: Cross-sectional study to examine the chronobiological aspects of NES. Methods: Features such as emotional aspects, chronotype and sleep quality were assessed by questionnaires. Variables rhythmicity of activity and light exposure were assessed by actigraphy and expression of clock genes CLOCK, BMAL1, Cry 1 and Per 2 was measured in leukocytes. Results: 28 patients (14 with SCN - 10 women and 14 controls - 9 women) participated in this study. The age average was 40.71 ± 12.37y and BMI was 26.8 ± 5.7kg/m². We found no evidence in chronobiological analyzes related to SCN. Conclusion: Our results do not support the hypothesis that the time system can be conected to the pathophysiology of NES, because the association of symptoms that define the NES as a syndrome mainly by the characteristic temporal power that is possibly involved with the time system. The timing and quality of food should be further studied to clarify the relationship between food and the fact that humans allocate their main food in the night shift may have consequences for metabolism and reflect changes in behavior and contribute to the control of obesity. This is the first study in humans to relate the clock genes and NES.

Background: Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Objectives: This study sought to investigate the prevalence of BED and NES and associations with various forms of non-normative eating behavior and psychopathology in prebariatric patients. Setting: Within a consecutive multicenter registry study, patients in six bariatric surgery centers in Germany were recruited. Methods: Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures. Results: Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Comorbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED. Conclusions: BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with non-normative eating behavior and psychopathology point to their clinical significance and discriminant validity.

The aim of this thesis is to summarize findings of causes and consequences of obesity, the most common health problem in the world. The theoretical part deals with many key issues of obesity, from definition through the epidemiology, etiology and obesity prevention and treatment. However the main topics of this thesis are the psychological characteristics that are associated with obesity. It includes personality factors of obese people, willpower and self-control and specific psychopathology. The research part of this thesis is mapping the occurrence of a specific psychopathological phenomena focusing on the emotional eating disorder, night eating syndrome and binge eating and symptoms of eating disorder. Applied methods were "Eating Behavior and Emotionality Questionnaire" (JICHEM), "The Eating Disorder Examination Questionnaire 6.0" (EDE - Q) and "The Night Eating Questionnaire" (NEQ). The data of quantitative research was evaluated by standard statistical methods. Keywords: Obesity Psychopathology Eating Disorder Night Eating Syndrome Emocional eating theory

Background: Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Objectives: This study sought to investigate the prevalence of BED and NES and associations with various forms of non-normative eating behavior and psychopathology in prebariatric patients. Setting: Within a consecutive multicenter registry study, patients in six bariatric surgery centers in Germany were recruited. Methods: Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures. Results: Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Comorbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED. Conclusions: BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with non-normative eating behavior and psychopathology point to their clinical significance and discriminant validity.