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OBJECTIVE: Sleep disturbance is common among individuals with eating disorders (EDs), with approximately 50% of patients with EDs reporting sleep disturbance. Sleep problems may promote, exacerbate, or maintain ED symptoms through a variety of hypothesized mechanisms, such as impaired executive function, increased negative affect, and disruptions to appetitive rhythms. Although research investigating the role of sleep in EDs is growing, the current literature suffers from methodological limitations and inconsistencies, which reduce our ability to translate findings to improve clinical practice. The purpose of this forum is to propose a coordinated approach to more seamlessly integrate sleep research into ED research with particular emphasis on best practices in the definition and assessment of sleep characteristics. METHODS: In this article, we will describe the current status of sleep-related research and relevant gaps within ED research practices, define key sleep characteristics, and review common assessment strategies for these sleep characteristics. Throughout the forum, we also discuss study design considerations and recommendations for future research aiming to integrate sleep research into ED research. RESULTS/DISCUSSION: Given the potential role of sleep in ED maintenance and treatment, it is important to build upon preliminary findings using a rigorous and systematic approach. Moving forward as a field necessitates a common lens through which future research on sleep and EDs may be conducted, communicated, and evaluated.
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PURPOSE: Researchers have theorized that interactions between appetitive and circadian disruptions result in increased eating disorder (ED) symptoms and insomnia. However, it is unclear how specific insomnia symptoms present among people with EDs and if the latent structure of insomnia in this population is similar to that of people with insomnia disorder. METHODS: We conducted a secondary analysis of data collected on ED and insomnia symptoms using a subset of students (N = 547; 79.52% female) with probable EDs at a large Midwestern American university. Item response theory (IRT) for polytomous items was performed to identify item difficulty, discrimination, and information parameters for the Insomnia Severity Index (ISI). IRT parameters were compared to those established in a 2011 study of people diagnosed with insomnia disorder by Morin and colleagues. RESULTS: Clinically significant insomnia symptoms were common among students with ED pathology and symptom endorsement for each ISI item ranged from 40.77 to 86.65%. ISI items assessing insomnia-related impairment and distress showed better discriminative capacities and had higher item information than items assessing sleep behavior alterations (i.e., difficulties falling asleep, difficulties maintaining sleep, waking too early). Item discrimination was largely similar among the ED sample compared to previous IRT analyses in an insomnia disorder sample. CONCLUSION: Insomnia symptoms are common among university students with probable EDs and similar to those reported by people with insomnia disorder. When considering insomnia assessment, items assessing sleep behaviors alone are likely inadequate to provide information about insomnia severity among people with EDs. LEVEL V: Evidence obtained from a cross-sectional descriptive study.
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Transtornos da Alimentação e da Ingestão de Alimentos , Distúrbios do Início e da Manutenção do Sono , Estudantes , Humanos , Distúrbios do Início e da Manutenção do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Feminino , Estudantes/psicologia , Universidades , Masculino , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Adulto Jovem , Adulto , Adolescente , Índice de Gravidade de DoençaRESUMO
Many American adolescents and adults report that they are not meeting sleep duration recommendations. Although insufficient sleep duration can occur due to factors outside an individual's direct control, many individuals choose to restrict their own sleep. The theory of planned behaviour (TPB) offers a framework to study this phenomenon. Recent research efforts have used the TPB to study sleep and have demonstrated success predicting sleep-related intentions and behaviour but have failed to consider volitional sleep behaviour or consider between- and within-person differences. The present study used an intensive longitudinal design to test how constructs of the TPB relate to nightly sleep opportunity. Healthy college students (N = 79) participated in a weeklong study in which they completed four ecological momentary assessment signals per day that measured their attitudes, subjective norms, perceived behavioural control, and intentions relating to their nocturnal sleep opportunity. Participants wore an actiwatch each night of the study to measure their sleep opportunity. Mixed linear models found that both intentions and perceived behavioural control were significant predictors of subsequent sleep opportunity, and that perceived behaviour control was the strongest within-day predictor of intentions. Results demonstrate that within-person changes in perceived behavioural control and intentions predict subsequent sleep opportunity and provide insight into the potential refinement of sleep promotion efforts.
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Avaliação Momentânea Ecológica , Teoria Psicológica , Adolescente , Adulto , Atitude , Humanos , Intenção , Sono , Estudantes , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Restricting daytime naps is a common sleep hygiene recommendation to improve nocturnal sleep, but research on whether napping is related to sleep is mixed. The current literature is limited in that day level, bidirectional associations have not been tested in college students, and existing studies have not sufficiently examined the role of individual differences in these daily associations. PURPOSE: The current study addressed these limitations by assessing the temporal associations between self-reported daytime nap duration and objectively assessed nocturnal sleep, and whether these associations were moderated by chronotype or nap frequency, in college students. METHODS: Participants (N = 384) self-reported nap duration and wore an actiwatch to measure nocturnal sleep for 14 consecutive days and nights. Mixed linear models were used to test the daily associations between daytime nap duration and total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). In addition, random slope modeling was used to test whether these associations significantly varied between participants. RESULTS: Longer nap duration was significantly associated with greater WASO, lower SE, and longer SOL. Shorter TST, shorter WASO, and greater SE were related to longer next-day nap duration. CONCLUSIONS: There were several significant associations between daytime napping and nocturnal sleep, and nap frequency significantly moderated the association between TST and next-day nap duration. Future research should test daily and contextual moderators of daytime napping and nocturnal sleep, which could refine sleep hygiene efforts by identifying individuals for whom recommendations would be most helpful.
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Higiene do Sono , Sono , Humanos , Polissonografia , Fatores de Tempo , AutorrelatoRESUMO
Caffeine is the most widely used psychoactive substance in the world and is known to disrupt healthy sleep. However, very few studies have directly tested the effect of caffeine abstinence on sleep, and these have yielded inconsistent findings. The purpose of the present study was to examine changes in sleep following caffeine abstinence and examine the extent to which characteristics of habitual caffeine use moderated this change. Participants included 66 healthy, young adults with habitual caffeine use and poor sleep. During the 2-week baseline, sleep was assessed using wrist actigraphy and daily caffeine use was assessed with bedtime diaries. Eligible participants then completed 1 week of caffeine abstinence, during which sleep was measured with wrist actigraphy. Multilevel models found no significant differences between either mean levels or growth trajectories of total sleep time or sleep efficiency between baseline and caffeine abstinence. Mean levels of sleep onset latency also did not differ between baseline and caffeine abstinence. A small but significant quadratic effect was observed, such that sleep onset latency decreased during the first few days of caffeine abstinence, then increased to levels above baseline. Characteristics of caffeine use did not moderate changes in sleep between baseline and caffeine abstinence. These data suggest that abstaining from caffeine may not result in long-term sleep improvement for habitual caffeine users, which contradicts the common sleep health recommendation. The present findings encourage more rigorous investigation of the effectiveness of caffeine restriction on sleep.
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Cafeína/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Sono/efeitos dos fármacos , Adolescente , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Recent research has used the theory of planned behavior (TPB) to predict sleep. However, this research has focused on between-person effects and has failed to capture the intraindividual variability of sleep-related attitudes, subjective norms, perceived behavioral control, and intentions. PURPOSE: The current study sought to characterize the between- and within-day patterns of these constructs. METHODS: Participants (N = 79) completed a 1 week ecological momentary assessment protocol in which they reported their attitudes, subjective norms, perceived behavioral control, and intentions toward nightly sleep opportunity four times per day. RESULTS: Analyses revealed both between- and within-day variability of these constructs, with perceived behavioral control and intentions demonstrating greater variability than attitudes and subjective norms. Mixed linear models revealed that attitudes and subjective norms significantly increased throughout the week, while perceived behavioral control and intentions significantly decreased throughout the day. CONCLUSIONS: The between- and within-day patterns of the TPB constructs highlight important methodological considerations and provide insight into the potential refinement of sleep promotion efforts.
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Atitude , Controle Comportamental/psicologia , Intenção , Teoria Psicológica , Sono , Variação Biológica Individual , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND: Although self-help strategies to improve sleep are widely accessible, little is known about the ways in which individuals interact with these resources and the extent to which people are successful at improving their own sleep based on sleep health recommendations. The present study developed a lab-based model of self-help behavior by observing the development of sleep health improvement plans (SHIPs) and examining factors that may influence SHIP development. METHOD: Sixty healthy, young adults were identified as poor sleepers during one week of actigraphy baseline and recruited to develop and implement a SHIP. Participants viewed a list of sleep health recommendations through an eye tracker and provided information on their current sleep health habits. Each participant implemented their SHIP for 1 week during which sleep was assessed with actigraphy. RESULTS: Current sleep health habits, but not patterns of visual attention, predicted SHIP goal selection. Sleep duration increased significantly during the week of SHIP implementation. CONCLUSIONS: Findings indicate that the SHIP protocol is an effective strategy for observing self-help behavior and examining factors that influence goal selection. The increase in sleep duration suggests that individuals may be successful at extending their own sleep, though causal mechanisms have not yet been established. This study presents a lab-based protocol for studying self-help sleep improvement behavior and takes an initial step toward gaining knowledge required to improve sleep health recommendations.
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Actigrafia , Sono , Comportamentos Relacionados com a Saúde , Humanos , Adulto JovemRESUMO
Although sleep hygiene is often used for broad sleep health promotion efforts, sleep hygiene education programmes are largely ineffective. These programmes are limited by their lack of a theoretical foundation. Health behaviour theory (HBT) has been used for decades to successfully predict and modify many health behaviours, but its use in the study of sleep health is rare. The purpose of this review is threefold. First, four dominant HBTs will be introduced. Second, the brief literature on HBT and sleep health will be reviewed. Lastly, a translational research agenda will be proposed. The present review concludes that HBT shows potential in both the prediction and modification of sleep health, and that there are several short- and long- term research goals to advance these efforts.
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Comportamentos Relacionados com a Saúde/fisiologia , Promoção da Saúde/métodos , Higiene do Sono/fisiologia , Sono/fisiologia , HumanosRESUMO
In this study, we aimed to examine the relationship between active smoking and environmental tobacco smoke exposure on sleep-quality complaints. In total, 1023 young adult participants completed online surveys. Based on these surveys, participants were classified into three groups according to their level of smoke exposure (low, moderate, high). An analysis of covariance revealed that, after controlling for sex, participants with high and moderate smoke exposure reported more sleep complaints than those with low exposure. Among non-smokers, hierarchical linear regression indicated that environmental tobacco smoke exposure was positively associated with sleep complaints. Improved understanding of modifiable risk factors for young adults' poor sleep quality, such as smoke exposure, could enable lifestyle changes that might lay the foundation for improved health at later life stages.
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Exposição Ambiental/efeitos adversos , Sono/fisiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Análise de Variância , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Research has demonstrated a correlational relationship between sleep and physical activity, though this work has been largely cross sectional and fails to demonstrate temporal relationships. The purpose of this study was to test the daily, bidirectional relationships between sleep and physical activity, and whether this varied between weekdays and weekend days. METHOD: Fifty-four healthy, young adults wore a Fitbit Flex to measure sleep and physical activity during a 6-day study period. RESULTS: Mixed linear models revealed that physical activity did not predict subsequent night's sleep. However, on nights when participants had longer than their own average total sleep time, and greater than their own average wake after sleep onset, this predicted less physical activity the following day. CONCLUSION: Results suggest that, in healthy young adults, physical activity may not promote healthier subsequent sleep, but sleep duration and continuity influence physical activity in their own way. Young adults may respond differently to health promotion efforts, and a greater understanding of these temporal associations can enhance the efficacy of these efforts.
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Exercício Físico/fisiologia , Monitores de Aptidão Física , Sono/fisiologia , Adolescente , Feminino , Humanos , Masculino , Adulto JovemRESUMO
PURPOSE: Some research suggests that eating disorders are related to poor sleep health. To increase knowledge on the relation between sleep and eating disorders, we used a multi-method approach to examine associations between sleep, chronotype, and eating disorder psychopathology. METHODS: We investigated associations between ED psychopathology, both diagnostic categories (ascertained through self-report data) and dimensional measures, and self-report and ambulatory measures of sleep. Adults currently enrolled in a commercial weight loss program completed self-report measures as well as 1 week of ambulatory sleep monitoring and sleep diaries. RESULTS: Participants with full- or sub-threshold bulimia nervosa and binge eating disorder reported significantly lower subjective sleep health and greater eveningness. Additionally, greater severity of eating disorder psychopathology was associated with lower subjective sleep health and greater eveningness. Eating disorder psychopathology was generally not related to objective sleep measures. Regarding diary measures, global eating disorder psychopathology was negatively correlated with subjective reports of feeling rested. CONCLUSION: Eating disorder psychopathology is associated with participants' subjective sense of sleep quality, but appears to have little relation to objective sleep characteristics. Level of evidence Level V, descriptive study.
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Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Sobrepeso/terapia , Transtornos do Sono-Vigília/complicações , Sono/fisiologia , Adolescente , Adulto , Idoso , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Autorrelato , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/diagnóstico , Programas de Redução de Peso , Adulto JovemRESUMO
OBJECTIVES: Caring for a spouse with dementia is a source of chronic stress and is associated with a heightened prevalence of self-reported sleep problems. Styles and strategies for coping with stress have been associated with objective measures of sleep in non-caregiver populations. The current study evaluated relationships between caregiver coping style and sleep disturbance using in-home polysomnography. METHODS: Sixty spousal caregivers (mean [standard deviation] age = 73.31 [7.05] years; 81.7% female) completed the Brief Cope, the Hamilton Rating Scale for Depression, and three nights of in-home polysomnography. Participants were categorized into two groups based on the presence or absence of clinically significant low sleep efficiency (<80%). A factor analysis of the Brief Cope yielded higher-order factors that included approach coping and avoidant coping (explained variance, 27.2% and 16.9%, respectively). Coping factors were entered into a binary logistic regression predicting sleep efficiency group while controlling for sleep apnea, medication use, and depression, as measured by the Hamilton Rating Scale for Depression. RESULTS: In fully adjusted models, for each unit increase on the avoidant coping factor, participants were 3.4 times more likely to be classified in the low sleep efficiency group (B = 1.224, χ2(1) = 4.967, p = .026, exp(B) = 3.401, 95% confidence interval = 1.159-9.981). Approach coping was unrelated to sleep efficiency in both adjusted and unadjusted models. CONCLUSIONS: These findings highlight the importance of coping among caregivers and indicate that avoidant coping may be a modifiable predictor of sleep disturbance in conditions of chronic stress.
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Adaptação Psicológica , Aprendizagem da Esquiva , Cuidadores/psicologia , Demência , Privação do Sono/epidemiologia , Cônjuges/psicologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Masculino , Polissonografia/métodos , Autorrelato , Privação do Sono/etiologia , Privação do Sono/psicologia , Estresse Fisiológico , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Although sleep is often associated with waking health behaviors (WHB) such as alcohol consumption, caffeine use, smoking, and exercise, the causal direction of these relationships is unclear. PURPOSE: The present study used time series data to examine the temporal dynamics of WHB and sleep characteristics in participants of the Study of Women's Health Across the Nation Sleep Study. METHODS: Three hundred three women completed daily assessments of WHB and wore wrist actigraphs to measure sleep characteristics for the duration of the study (mean = 29.42 days, SD = 6.71). RESULTS: Vector autoregressive modeling revealed that weekly patterns of sleep and WHB best predicted subsequent sleep and WHB suggesting that the associations between WHB and sleep persist beyond their immediate influence. Some WHB predicted some subsequent sleep characteristics, but sleep did not predict subsequent WHB. CONCLUSIONS: These novel findings provide insight into the temporal dynamics of 24-h behaviors and encourage consideration of both sleep and WHB in health promotion and behavior change efforts.
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Consumo de Bebidas Alcoólicas , Comportamentos Relacionados com a Saúde , Sono/fisiologia , Fumar , Saúde da Mulher , Actigrafia , Feminino , Promoção da Saúde , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: Both disordered eating and disturbed sleep represent significant threats to mental health. Accumulating evidence suggests that disordered eating behaviors and sleep problems co-occur. A majority of current research, however, has focused on these behaviors as components of eating disorder diagnoses, rather than investigating the independent associations of transdiagnostic disordered eating behaviors and sleep. The present study sought to examine fasting, binge eating, self-induced vomiting, laxative or diuretic misuse, and driven exercise as predictors of sleep quality complaints. METHOD: An online sample of 648 U.S. adults completed the Eating Disorder Examination - Questionnaire, the Pittsburgh Sleep Quality Index, and the Patient Health Care Questionnaire-2 as part of a larger parent study. RESULTS: Results of a hierarchical linear regression revealed that, collectively, disordered eating behaviors predicted worse sleep quality [R2 = 0.30, F(7, 640) = 31.21, p < .001], and that both binge eating and fasting, but not other compensatory behaviors, accounted for unique variance in sleep quality after controlling for BMI and depression. CONCLUSIONS: Overall, findings suggest that transdiagnostic disordered eating behaviors are associated with sleep quality complaints. Improved understanding of the specific relationships between individual eating behaviors and sleep characteristics can help refine the identification of individuals at high risk for sleep disturbance and address the potential reciprocal influence of sleep quality on disordered eating behaviors.
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OBJECTIVE: The present study evaluated the extent to which sleep assessed soon after a trauma predicted subsequent physical health and immune functioning in rescue workers. METHODS: Participants included 159 men and women who performed rescue and clean-up operations at the site of a major airplane crash. One hundred twenty-eight participants were retained for a 1-year follow-up. Self-report measures of sleep quality and psychological distress were obtained within 2 months of the crash, and a physical health questionnaire was completed at 1-year follow-up. Natural killer cell number and cytotoxicity were assessed using blood samples collected from a subset of participants (n=51) at 1-year follow-up. RESULTS: After adjustment for sex, age, body mass index, and initial distress, initial sleep quality complaints were associated with more physical symptoms (ß=.32; p<.001), poorer perceived health (ß=-.27; p=.009), and increased healthcare utilization (ß=.31; p=.003) on follow-up. In contrast, initial sleep quality was not associated with natural killer cell number (r=0.10; p=.55) or activity (r=0.02; p=.90). Change in sleep quality during the year after the crash was not a significant predictor of health or immune outcomes. CONCLUSIONS: These data suggest that poor sleep quality in the aftermath of trauma signals an increased risk for future adverse physical health outcomes and underscore the importance of addressing sleep complaints soon after trauma to mitigate negative impact on physical health.
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Acidentes Aeronáuticos , Nível de Saúde , Células Matadoras Naturais/fisiologia , Trabalho de Resgate/estatística & dados numéricos , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Índice de Massa Corporal , Citotoxicidade Imunológica , Feminino , Humanos , Células Matadoras Naturais/imunologia , Modelos Lineares , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Autorrelato , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/imunologia , Estresse Psicológico/imunologia , Adulto JovemRESUMO
BACKGROUND: It has been suggested that a history of trauma exposure is associated with increased vulnerability to the physical health consequences of subsequent trauma exposure, and that posttraumatic stress symptoms (PTSS) may serve as a key pathway in this vulnerability. However, few studies have modeled these relationships using mediation, and most have failed to consider whether specific characteristics of the prior trauma exposure have a differential impact on physical and mental health outcomes. METHODS: The present study examined 180 victims of a serious motor vehicle accident (MVA) who reported prior exposure to traumatic events. PTSS were assessed by clinical interview 6 weeks post-MVA, and physical health was assessed 6 months post-MVA. Using structural equation modeling, the present study examined the extent to which event (age at first trauma, number, and types of trauma) and response (perceptions of life threat, physical injury, and distress) characteristics of prior trauma were related to physical health outcomes following a serious MVA, and whether these relationships were mediated by PTSS. RESULTS: Results revealed that both event and response characteristics of prior trauma history were associated with poorer physical health, and that PTSS served as a mechanism through which response characteristics, but not event characteristics, led to poorer physical health. CONCLUSIONS: These results highlight the enduring impact of trauma exposure on physical health outcomes, and underscore the importance of considering multiple mechanisms through which different aspects of prior trauma exposure may impact physical health.
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Acidentes de Trânsito/psicologia , Nível de Saúde , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Modificador do Efeito Epidemiológico , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto JovemRESUMO
The present study examined how different types of social support differentially moderated the relationship between trauma history characteristics and the development of posttraumatic stress disorder symptoms (PTSS) following a motor vehicle accident (MVA). Two hundred thirty-five MVA victims self-reported levels of social support and trauma history, and were evaluated for PTSS 6- and 12-months post-MVA. Results indicated that after controlling for gender, injury severity and income, number of prior trauma types and subjective responses to prior traumatization predicted subsequent PTSS (ps < .05). Appraisal social support was a significant moderator of the total number of types of trauma (appraisal: 6-months ß = -.16, p < .05; 12-months ß = -.17, p < .05) and subjective physical injury during the prior trauma (appraisal: 6-months ß = -.14, p < .05; 12-months ß = -.19, p < .05) in predicting PTSS. Results underscore the importance of examining both trauma history and social support as multi-dimensional constructs and suggest merit to addressing social support in trauma victims with a prior trauma history.
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Chrononutrition (i.e., circadian timing of food intake) has been linked to indicators of health status such as body weight and insulin resistance. A measure of general chrononutrition patterns, the Chrononutrition Profile - Questionnaire, has been developed and preliminary evidence of validity and reliability of the measure has been documented in a homogenous group of undergraduates. However, this measure has not yet been validated in an online, community-based sample. The present study therefore aimed to evaluate the validity of the Chrononutrition Profile - Questionnaire in a web-based community sample. Analyses suggested that the Chrononutrition Profile - Questionnaire displays acceptable validity for use in diverse community samples of adults, with moderate to strong correlations (r = 0.39-0.91) between the Chrononutrition Profile - Questionnaire and measures of dietary intake and sleep. This measure is suitable for use in a variety of settings, by stakeholders and scientists, and may contribute to future development of health behavior interventions and research programs centered around chrononutrition.
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Ingestão de Alimentos , Comportamento Alimentar , Adulto , Humanos , Reprodutibilidade dos Testes , Sono , Inquéritos e QuestionáriosRESUMO
A significant proportion of the population is classified as having overweight or obesity. One framework which has attempted to explain biobehavioral mechanisms influencing the development of overweight and obesity is the energy balance model. According to this model, the body continually attempts to balance energy intake with energy expenditure. When energy intake and energy expenditure become imbalanced, there is an increase in homeostatic and allostatic pressure, generally to either increase energy intake or decrease energy expenditure, so as to restore energy homeostasis.Recent research has indicated that circadian aspects of energy intake and energy expenditure may influence energy balance. This paper provides a narrative review of existing evidence of the role of circadian timing on components of energy balance. Research on the timing of food intake, physical activity, and sleep indicates that unhealthy timing is likely to increase risk of weight gain. Public health guidelines focus on how much individuals eat and sleep, what foods are consumed, and the type and frequency of exercise, but the field of circadian science has begun to demonstrate that when these behaviors occur may also influence overweight and obesity prevention and treatment efforts.