Sleep-Eating and the Dynamics of Morbid Obesity, Weight Loss, and Regain of Weight in Five Patients

The Permanente Journal/ Spring 2001/ Volume 5 No. 2 Case 1 A 25-year-old nurse ’s aide weighed 410 lb (184.5 kg) when she applied to our Very Low Calorie Diet (VLCD) Program for assistance with losing weight. Fiftyone weeks later, she weighed 132 lb, having lost 278 lb without incident. She then started incrementally adding food to her diet and within a few weeks was eating normally. After a month of this normal diet, she was briefly hospitalized twice because of weakness, dizziness, and hypotension. Coincidentally, she had a flareup of psoriasis after several years of methotrexate therapy, which had stabilized the psoriasis. Sudden appearance of dental caries on the anteromedial surface of the patient’s incisors led to the discovery that she had been inducing herself to vomit so that she could maintain her weight loss. Her clinical symptoms thus appeared to be caused by hypovolemia and electrolyte disturbance. Treatment with amitriptyline ended the self-induced vomiting within ten days. Her weight remained stable for several weeks, after which she suddenly gained a documented 38 lb (17.1 kg) in two weeks, ultimately returning to a Sleep-Eating and the Dynamics of Morbid Obesity, Weight Loss, and Regain of Weight in Five Patients By Vincent J Felitti, MD