Insomnia versus daytime sleepiness: distinct behavioural phenotypes of mood and binge eating in adults with clinical obesity
Authors' conclusion
Insomnia and daytime sleepiness identify distinct behavioural phenotypes in clinical obesity, independently of BMI. Joint screening at intake may help personalise behavioural obesity management.
Study context
- Population
- Adults seeking specialist obesity care (76% women; mean BMI 37.1 kg/m²)adults seeking specialist obesity care
- Participants
- 2,016 adults
- Exposure
- Sleep phenotypes defined by insomnia and daytime sleepiness
- Outcome
- Phenotype distribution
Methodological detailsfour phenotypes defined a priori using Insomnia Severity Index (ISI) ≥ 15 and Epworth Sleepiness Scale (ESS) ≥ 11, multivariable regressions adjusted for age, sex and BMI
- Four phenotypes defined a priori using ISI ≥ 15 and ESS ≥ 11
- Multivariable regressions adjusted for age, sex and BMI
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
Correlation of ISI and ESS
- ISI and ESS only moderately correlated (ρ)
- 0.30
Anxiety (HAD-A ≥ 11)
- Isolated insomnia, adjusted OR (aOR), 95% CI 3.41-5.89, p < 0.001
- 4.48
- Comparator group of the aOR not stated; isolated insomnia most strongly associated
Depression
- Isolated insomnia, aOR (2.20-4.33), p < 0.001
- 3.09
- Comparator group of the aOR not stated
Severe binge eating (Binge Eating Scale (BES) ≥ 27)
- Isolated sleepiness, aOR (1.69-3.83), p < 0.001
- 2.55
- Comparator group of the aOR not stated
Intuitive eating (IES-2)
- Isolated sleepiness, β (−0.33 to −0.15), p < 0.001; lower intuitive eating
- −0.24
- Comparator group not stated
Overall risk
- The combined phenotype carried the highest risk overall
BMI
- BMI did not differ across phenotypes
Sensitivity analyses
- Findings were robust to OSA exclusion and to alternative insomnia thresholds
Original publication
Insomnia versus daytime sleepiness: distinct behavioural phenotypes of mood and binge eating in adults with clinical obesity. Int J Obes (Lond). Published 12 November 2026. doi:10.
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