Sleep, mood and eating pattern

Why the sleep section has no score

The two questionnaires normally used for this, STOP-BANG and the Epworth Sleepiness Scale, are copyrighted instruments. Both require a licence before anyone may publish them, and the Epworth requires one whether or not a fee is payable. Rather than reproduce them without permission, or rename them and pretend, this page lists the same clinical features with no score and no threshold.

You lose a number. You lose very little else, because the number was only ever a way of deciding whether to ask for a sleep study, and a list of features you can hand to a doctor does that job.

Why sleep apnoea matters so much here

• It is very common in people with obesity, and in India it is very commonly undiagnosed.
• It makes weight loss harder, through disrupted appetite hormones and daytime exhaustion.
• It drives blood pressure independently of weight.
• Weight loss treats it. Each 10 per cent of body weight lost was associated with roughly a 26 per cent fall in the number of breathing interruptions per hour, and in a randomised lifestyle trial in people with type 2 diabetes, weight loss reduced it by about 10 events an hour against the control group and halved the proportion with severe disease.
• The relationship is not symmetrical, which is worth knowing: gaining 10 per cent raised it by about 32 per cent, more than losing 10 per cent took off.
• Driving while chronically sleepy is dangerous, and this is the part of the conversation that most often changes behaviour.

On the mood questions

These two are the PHQ-2, which is free to use and was validated across 6,000 people. It is a screen, not a diagnosis: it correctly identifies about 83 out of 100 people with major depression, and it also flags plenty of people who do not have it.

The reason it is on an obesity page is practical. Low mood is common alongside obesity in both directions, it makes every part of a treatment plan harder to sustain, and it is one of the commonest unstated reasons people stop. It is also treatable, and treating it often makes the weight work possible rather than the other way round.

On the eating questions

Binge eating disorder is more common in people seeking weight treatment than in the general population, and it is systematically under-asked. It matters for three reasons. It changes which treatment is appropriate. Some approaches to weight loss make it worse rather than better. And daily weighing, which this section otherwise recommends, is not advisable for someone with a disordered eating pattern.

The formal questionnaires for this are also licensed instruments, so what is above is a plain checklist drawn from the recognised features rather than a scored screen. If any of it rang true, the useful thing is to say so out loud to a doctor. It is a common conversation and it is not a shameful one.

PHQ-2: Kroenke K, Spitzer RL, Williams JBW, Medical Care 2003;41:1284-1292. Free to reproduce; Pfizer released all copyright in 2010. Sleep apnoea and weight: Peppard PE and colleagues, JAMA 2000;284:3015-3021, and the Sleep AHEAD trial, Archives of Internal Medicine 2009;169:1619-1626. The sleep and eating sections are unscored feature checklists, not validated instruments, for the licensing reasons set out above.