Stunkard Weighs In on 50 Years Of Eating Disorders Research

A 16-year-old woman, more than 100 pounds overweight, told the physician treating her for depression that she had no appetite in the morning. She ate voraciously in the evening, however, and even rose from sleep to snack.

This unusual pattern of food consumption intrigued her therapist, Albert Stunkard, M.D., then a resident in psychiatry at the Johns Hopkins Hospital. Although the woman dropped out of treatment, Stunkard never forgot her.

After completing his residency in 1953, Stunkard started a fellowship in psychosomatic medicine at the New York Hospital-Cornell Medical Center. Assigned to the obesity clinic, he asked patients both what and when they ate.

Stunkard and his mentor at Cornell, neurologist Harold Wolff, M.D., published the first report on what they called the night eating syndrome (NES) in the July 1955 American Journal of Medicine. They described 20 obese patients with morning anorexia who commonly consumed at least a quarter of their total daily calories after their evening meal. None of their 38 healthy non-obese control subjects displayed this pattern.

Fifty-two years and 447 papers later, Stunkard, at age 85, continues to investigate NES and other eating disorders. In 2006 alone, he and colleagues published nine papers on NES and other eating disorders. He also has co-authored a book for patients and their families, published in 2004, Overcoming Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle (New Harbinger Publications).

“At meetings, he's usually in the front row listening attentively or presenting his latest research findings,” said James Mitchell, M.D., professor and chair of clinical neuroscience at the University of North Dakota School of Medicine and a specialist in eating disorders.

Stunkard, a professor of psychiatry at the University of Pennsylvania, chaired its Department of Psychiatry from 1962 to 1973 and later founded its Center for Weight and Eating Disorders. The National Institute of Mental Health has supported his research for more than four decades.

Stunkard's many honors include APA's Award for Research in both 1960 and 1980 and Distinguished Service Award in 1994. He received the Rhoda G. and Bernard G. Sarnat International Prize in Mental Health from the Institute of Medicine in 2004.

And no, Stunkard has never had a weight problem himself, nor have any of his close relatives, he reports. Once 6 feet tall, now slightly stooped, Stunkard weighs 163 pounds.

World War II Memoir Coming

Stunkard's career path, like that of many of his contemporaries, included time in the military. After graduating from the Columbia University College of Physicians and Surgeons in 1945, he completed a one-year internship in medicine at Massachusetts General Hospital. He then spent two years in the Army taking care of Japanese prisoners charged with war crimes at Sugamo Prison in Tokyo. His recently completed memoir of his experiences in Japan, After the War: Remembrances of an American in Japan, will be published this spring by EastBridge Books.

Stunkard started his psychiatric residency at Hopkins in 1948, planning to become a psychoanalyst. Psychosomatic medicine, however, proved more appealing. While still a resident, Stunkard conducted a placebo-controlled trial of a psychotropic agent. The American Journal of Psychiatry published his report on this study, his first paper, in December 1950.

He arrived at Cornell with no thought of exploring obesity, he told Psychiatric News. “But the glamorous diseases—migraine, ulcers, and hypertension—already had been claimed by other research fellows,” he recalls. Wolff, a pioneer investigator in psychosomatic medicine, proposed that Stunkard study Buerger's disease. The young psychiatrist could not muster zeal for that disorder.

Then Stunkard's friend and former classmate at Columbia, Theodore VanItallie, M.D., piqued his interest with details of his own fledgling research on brain centers controlling hunger and satiety in rats. With Wolff's encouragement, Stunkard began to explore these issues in humans. He and VanItallie, a professor emeritus of medicine at Columbia, collaborated on studies of gastric hunger contractions, coming to view not only hunger but also satiety as an active process.

Twin Studies Influential

“Stunkard had the imagination to see that adoption studies and twin studies could clarify the role of genetics in the development of obesity,” VanItallie asserts.

Using data from the Danish Adoption Registry, Stunkard and colleagues found that adopted children developed a body mass index (BMI) similar to that of their biological parents. “Genetic influences have an important role in determining human fatness in adults, whereas the family environment alone has no apparent effect,” his group wrote in the January 23, 1986, New England Journal of Medicine.

Data from the large Swedish twin registry affirmed and extended the importance of genetics by showing that identical twins reared apart have a BMI as adults that is the same as that of twins raised together. Stunkard and colleagues reported these findings in the May 24, 1990, New England Journal of Medicine. In a study now in progress, his group is using the Swedish twin registry to explore genetic influences on NES.

He and colleagues also are conducting genetic studies of obesity among the Old Order Amish. Using linkage and association studies, they have identified a region on chromosome 7 that may be responsible, at least in part, for BMI and other obesity-related traits.

For an ongoing study at Penn that started in 1993, Stunkard's group recruited 40 obese pregnant women and 40 non-obese pregnant women and have followed their children from birth. By age 9, half of the children of obese mothers had become obese. “My guess is that most of the other half will become obese, too,” Stunkard says. “No children of lean mothers have become obese.”

Over the years, Stunkard has shown that the environment can lead to obesity in genetically vulnerable people. He was the first to show the now widely recognized inverse relationship between social class and obesity. He also designed a widely used eating assessment inventory and has documented the efficacy of psychological and pharmacological therapies, weight-loss regimens, and bariatric surgery on obesity.

He often returns to NES. Stunkard's group has reported that both normal-weight and obese individuals develop this disorder, and suggested NES may serve as a path to obesity.

“There's hardly an aspect of obesity that Stunkard hasn't investigated—from etiology, to treatment, to prevention of this disorder,” said Thomas Wadden, Ph.D., director of Penn's Center for Weight and Eating Disorders.

“He has inspired many young investigators to pursue research in these areas,” Wadden added. “He's the dean of our field.”▪