PCOS and eating disorders… any association at all?
Please note this is part 2 of the PCOS at a glance series. Before you jump into this topic, if you haven’t read part 1 yet, you can click here to access it and get an overview of the polycystic ovary syndrome, including its main features, diagnosis criteria, and learn how its resulting metabolic and hormonal changes can impact eating habits.
So, let’s dive in! As explained in part 1, current treatment approaches to manage PCOS symptoms usually involve dietary and lifestyle changes, encouraging weight loss, restrictive diets, and exercise [1]. The symptoms can directly affect body image and self-esteem [2], so, if you are assuming that they may lead to the development of disordered eating or eating disorders... well, you are right.
Women with PCOS are more likely to experience disordered eating or even eating disorder behaviors, with binge eating episodes appearing to be the most prevalent [3]. With weight loss and diets being frequently recommended, women with this hormonal disorder may feel the only way to improve their symptoms and conceive a child is by dieting. Many have a history of yo-yo dieting (a.k.a. weight cycling) even before their diagnosis. They may have struggled with weight gain (a common PCOS symptom), which can often fuel restrictive eating patterns.
The diet cycle is deceiving and punitive, and dieting is a risk factor for eating disorders [4]. A person starts dieting under a false promise that it will be a quick fix, so they restrict food - either by cutting out specific foods/food groups or limiting the amount eaten. Over time, deprivation and boredom set in with limited options. They start craving those foods that are “off-limits”, although they will make an effort to keep eating what they are “allowed” to. Inevitably, those cravings intensify… and, eventually, they break the diet. Overeating and/or feeling out of control around food usually happen at this point (and it’s biologically expected; after all, the person is hungry!). Guilt and shame quickly creep in and they tend to come up with more restrictive rules next… and another cycle starts again. Sounds familiar?
Dieting has an extensive list of cons, but two things stand out as a result:
- It teaches you to see foods as “good” or “bad” (if you eat some food considered “bad”, you will likely experience guilt and, consequently, feel bad about yourself); and,
- It disconnects you from your body (you will no longer trust your body cues to decide if you need to eat as well as when and how much to eat).
Working towards relying on your body’s wisdom is key, especially in the context of PCOS. The goal is to approach food from a place of neutrality and be attuned to what your body is communicating to you. You can start off by practicing mindful eating and identifying hunger and fullness signals to help reconnect to internal cues and normalize eating patterns. By doing so, it will be easier to make changes in your eating habits that will help with the PCOS symptoms.
Nutrition therapy can help you heal your relationship with food, and it will provide you with the tools and knowledge you need to clear up any negative and false beliefs about food. A weight-inclusive approach to treat women with PCOS is optimal since it prevents accomplishing changes in weight at the cost of their psychological well-being [5]. Thus, whenever possible, a collaborative effort involving weight-inclusive registered dietitians, mental health professionals, endocrinologists, gynecologists, and/or primary care physicians is the best way to manage the PCOS symptoms.
References:
1. Phelan N, O’Connor A, Tun TK, et al. Hormonal and metabolic effects of polyunsaturated fatty acids in young women with polycystic ovary syndrome: results from a cross-sectional analysis and a randomized, placebo-controlled, crossover trial. The American Journal of
Clinical Nutrition. 2011;93(3).
2. McClusky S, Evans C, Lacey JH, Pearce JM, Jacobs H. Polycystic ovary syndrome and bulimia. Fertility and Sterility. 1991;55(2):287-291.
3. Krug I, Giles S, Paganini C. Binge eating in patients with polycystic ovary syndrome: prevalence, causes, and management strategies. Neuropsychiatric Disease and Treatment. 2019;15:1273-1285.
4. Hilbert A, Pike K, Goldschmidt A, et al. Risk factors across the eating disorders. Psychiatry Research. 2014;220(1-2):500-506.
5. Grassi A. PCOS and eating disorders. In PCOS: the Dietitian’s Guide. Haverford, PA: Luca Publishing; 2013.