Data analysis shows increased risk of eating disorders in women with PCOS

Women with the common reproductive and metabolic condition polycystic ovary syndrome (PCOS) are at greater risk of developing bulimia, binge eating disorder and eating disorders, according to new research published in The Journal of Clinical Endocrinology and Metabolism.

The title of the article is: “Increased prevalence of binge eating disorder and bulimia nervosa in women with polycystic ovary syndrome: a systematic review and meta-analysis.”

PCOS affects about one in eight women. Women with the condition are at increased risk of developing metabolic problems such as diabetes, reproductive problems such as infertility, and psychological problems such as anxiety and depression.

Women are diagnosed with PCOS if they exhibit at least two of the three main features of PCOS:

• An increased number of ovarian follicles containing immature eggs (called polycystic ovaries) is visible on ultrasound;
• Slightly elevated testosterone levels or clinical symptoms of elevated testosterone levels, such as excess body hair; and
• Irregular or no menstrual cycle.

The systematic review and meta-analysis examined results from 20 cross-sectional studies in nine countries. The studies included data from 28,922 women with PCOS and 258,619 women who did not have the condition.

“With this analysis, we have been able to confirm for the first time that there is an increased risk for specific eating disorders, including bulimia nervosa, better known as bulimia, and binge eating disorder,” said the study’s lead author, Laura Cooney, MD, MSCE, an associate professor at the University of Wisconsin in Madison, Wisconsin.

“Many women with PCOS experience stigma around their weight, which can be detrimental to their mental health and contribute to disordered eating patterns.”

When the researchers analyzed the women for body mass index (BMI), both those with normal weight and those with higher weight had higher eating disorder scores compared with women without PCOS, suggesting the association is not dependent on BMI, Cooney said.

“Our findings highlight the importance of screening women with PCOS for eating disorders before physicians provide lifestyle advice,” Cooney said.

“The lifestyle changes we often recommend for women with PCOS, including physical activity, a healthy diet, and behavioral changes, can hinder the recovery process from eating disorders. Healthcare providers should be vigilant about screening for eating disorders in this population.”

The meta-analysis found no association between PCOS and the eating disorder anorexia. However, the authors caution that studies of anorexia and PCOS are more limited and that there should always be a high suspicion of eating disorder pathology in someone being evaluated for PCOS.

Researchers conducted the study to International Evidence-Based Guideline for PCOS 2023.