For Tessa, weight has always been a painful struggle, from the shame she felt as a child to the dread of dinner dates with past boyfriends. By the time she was 40, she was suffering from osteoarthritis of the knee. And now, the 54-year-old Manhattan consultant is dealing with another ailment so many of us are familiar with: sleeplessness.
Could the two be connected?
It’s no secret that sleep and weight are related, but science is finding some special connections between the nightmare of no sleep and obesity, perhaps the No. 1 epidemic in the U.S. Indeed, you might call the new cure “sleeping off the fat.” In growing numbers, scientists are unearthing evidence that weight-loss programs that target sleep can help, and some believe they could soon become part of the primary care setting. Clinical trials for sleep education programs and behavioral therapy for patients struggling with obesity have been promising so far. And once research untangles the molecular pathways involved in regulating sleep and appetite, doctors could one day prescribe pills that act on them.
Certainly, the research is promising. In 2012, researchers at Laval University in Quebec City found they could predict how much fat a group of overweight or obese adults lost based on the quality and amount of sleep they got, while a National Institutes of Health–led trial discovered that people who underwent behavioral therapy to promote sleep were more willing to work out and had fewer nighttime munchies. The Chinese University of Hong Kong is starting a trial investigating whether a yearlong sleep education program for people with type 2 diabetes (which obese people are likelier to develop) will improve their blood sugar control and lower their heart disease, stroke and diabetes risk.
Others have also linked a lack of sleep to heightened activity in brain regions involved in appetite and higher levels of stress and appetite-boosting hormones in the blood.
Increasingly, the world has begun to recognize that sleeplessness is at the root of a range of issues across the globe, from worker productivity to car accidents. To some degree, weight management specialists consider it for obesity and already ask patients about their sleep. But most primary care doctors don’t have the time for such conversations, experts say. Holly Lofton, director of the Medical Weight Management Program at NYU Langone Medical Center, who helps Tessa manage her obesity, thinks that could change as obesity rates rise, and more professional societies publish weight management protocols that incorporate sleep disorder treatment, as well as more referrals to sleep specialists. To start out, primary care doctors will probably educate patients about sleep “hygiene” — habits like swearing off your cellphone an hour before bedtime.
According to the Centers for Disease Control and Prevention, more than 1 in 3 American adults is obese, which puts them at risk for a slew of ailments, from heart disease to certain types of cancer. Although the weight-loss mantra of “eat less, move more” has proved mostly effective, results can still vary. About a decade ago, researchers started to wonder whether improving sleep might tip the scales, with analyses of large-scale studies correlating poor sleep with obesity. Others have also linked a lack of sleep to heightened activity in brain regions involved in appetite and higher levels of stress and appetite-boosting hormones in the blood. Jennifer Teske, an assistant professor of nutritional sciences at the University of Arizona, describes the research area as “rapidly expanding” as Americans grow bigger and sleepier; a 2013 Gallup poll found that 40 percent of Americans clock in less than the recommended minimum of seven hours of sleep each night.
As with any chronic disease intervention, scientists need to conduct long-term trials. “Obesity doesn’t happen overnight,” says Bernd Schultes, an endocrinologist at the eSwiss Medical and Surgical Center in Switzerland. But the interventions tested so far don’t last nearly as long as obesity takes to develop — usually over the course of a few years — and it’s not clear how long their effects last. Evaluating efficacy is also tricky, since it’s hard to measure sleep accurately in your own home.
Teske’s research drills down to the biochemical level, focusing on a neurotransmitter that spurs weight loss by increasing physical activity. Her studies could lead to a pill that stimulates this pathway, but might not roll out for several more years. In the meantime, Teske is testing how existing sleep aids affect weight gain, food intake and energy expenditure. So far, they do seem to disrupt the balance. “We don’t want to improve one problem and make something else worse,” she says. As for Tessa? While not thrilled about taking medication, she says that “anything that helps is good.” Even if that means sleeping on it.