Are my ovaries making me eat?

pcos

Binge eating disorder (BED) is the most common eating disorder you have never heard of. Studies estimate that 2-3.5% of the population suffer from this disorder, compared to ~1% for anorexia nervosa and bulimia nervosa. BED is characterised by an excessive intake of food, without regular purging or other compensatory behaviours (like vomiting, laxative use, or excessive exercise).

Food cravings and binge-eating behaviours are often described by women suffering from polycystic ovary syndrome (PCOS), and evidence is growing that there is, indeed, some association between PCOS and BED (1, 2).

So what is PCOS?

Polycystic ovary syndrome (PCOS) is a condition that affects up to 15% of reproductive age people with ovaries (3). The syndrome involves having high levels of male sex hormones (such as testosterone) circulating in the body, which can lead to undesired features such as acne and excessive body hair. Additionally, as the name would suggest, characteristic cysts may be observed on the ovaries. People with PCOS are at increased risk for reproductive problems and infertility, as well as metabolic features such as obesity, insulin resistance, type 2 diabetes, high blood pressure, and heart disease. To add to that burden, those with PCOS are at greater risk of depression and anxiety (4).

Binge eating can be associated with several contributing factors, including anxiety, depression, and poor body image, all of which are implicated in PCOS. In a large study of PCOS sufferers, more than a third of healthy weight or overweight participants, and the majority of participants with obesity report binge eating behaviours (2). Given that people with PCOS are seemingly primed to suffer from anxiety or depression, binge-eating behaviours, and metabolic factors that can lead to weight gain, it is cruelly ironic that the frontline treatment for PCOS is weight management. Unsurprisingly, many people with PCOS find this difficult to achieve, reasons including tiredness, embarrassment about appearance, and feeling that their efforts are fruitless (2).

Controlling weight in PCOS may be medically indicated to reduce longer-term health concerns like diabetes and heart disease and to address fertility problems, but too often healthcare professionals prescribe weight loss without screening for the presence of binge eating. Any intervention that addresses medically necessary weight management needs to screen for the presence of binge eating and ensure that whatever is prescribed does not further perpetuate or even exacerbate binge eating. Fortunately, a simple screener does exist (the BEDS-7) that consists of 7 quick questions (5). A balance may need to be struck between achieving a healthy stable weight, and the mental health and quality of life of people with PCOS and BED.

If you have ever experienced regular binge-eating episodes, we encourage you to visit edgi.nz to learn more about our genetic study of eating disorders. Eating disorders don’t discriminate and can strike individuals from all racial and ethnic backgrounds. We hope to enrol participants from all backgrounds so that we can fully understand both genetic and environmental factors that influence eating disorders.

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