Binge Eating and PCOS
The most common endocrine condition in women is Polycystic Ovary Syndrome (PCOS), affecting 1 out of 10 women in the UK. Women with PCOS have more issues related to blood sugar levels and risk for type 2 diabetes; they're also at increased odds than healthy controls when it comes to gaining weight and having a high BMI.
PCOS and binge eating are both complex disorders that can have a profound impact on an individual's physical and mental health. Management of PCOS often requires a multi-disciplinary approach, as it can be associated with a range of metabolic and hormonal abnormalities. Similarly, treatment of binge eating disorder often requires a comprehensive approach that addresses the underlying psychological drivers of the disorder. In both cases, it is essential that the individual is at the centre of the treatment plan, as each person's experience of these disorders is unique.
Women with PCOS are more likely to have disordered eating
Excess adipose tissue (fat) significantly worsens PCOS symptoms and also fertility-related factors, so physicians are advised to tell women with PCOS that they should lose weight, but this can be extremely problematic for those who binge eat. Women with PCOS are almost four times more likely to meet criteria for an eating disorder, compared to women without PCOS (Lee et al, 2018). In particular, close to 40% of women with PCOS experience clinically significant binge eating (Jeanes et al, 2017). Although binge eating can be a feature of several eating disorders, including bulimia nervosa, anorexia nervosa and Binge Eating Disorder, the latter is the most common (Bernadett et al, 2016).
When there is both: disordered eating and PCOS
PCOS and binge eating together present a unique problem. The best practice guidelines for managing Binge Eating Disorder advise to delay any attempts to lose weight until the treatment for Binge Eating Disorder has been completed. This is because traditional diets such as restriction of calorie or carbohydrate intake can make binge eating worse, further exacerbating the hormone imbalance and the symptoms of PCOS.
Binge eating or overeating?
Many people use the term ‘binge’ to describe the occasions where they overeaten. But what does a binge episode really look like? The Binge Eating Disorder is defined by regularly eating far more food than most adults would in a similar time period and in similar circumstances and feeling that their eating is out of control during a binge. For a typical Binge Eating Disorder, binge eating would occur at least twice a week for three months.
People with Binge Eating Disorder often feel shame, guilt, disgust and embarrassment about their binge eating episodes and will try to eat in secret or hide their overeating from others. When it comes to overeating, most of us have probably been there at one point or another. An example of overeating would be getting up to get seconds during a festive meal. An example of binge eating would be eating a large amount of food in a short amount of time and feeling as if you were out of control.
Three reasons why binge eating is more common in PCOS
1 Insulin resistance
Most attempts to explain the relationship between PCOS and binge eating have rested on the role of insulin. Insulin allows the cells in the body to use glucose as a fuel. Approximately 70% of women with PCOS will have insulin resistance, meaning that that insulin is not as effecting in doing its job, therefore more and more of it gets produced. High levels of insulin have been shown to cause low blood sugar, which at times can lead to an appetite stimulant and strong cravings for carbohydrates. This is how an overwhelming desire for carbohydrates can explain a binge.
Insulin resistance is a major factor in weight gain, which can lead to emotional distress regarding one's own body image. This can start a cycle of ‘yo-yo dieting’: starting a diet, staying on it for a while with some weight loss, however dietary restraint promotes disinhibition and binge eating, and weight re-gain.
2 Too much of male hormones
Male hormones (androgens) are present in both sexes, however, the levels are generally lower in females than males. A prominent feature of PCOS is elevated concentrations of testosterone (one of the many androgens), which account for numerous of the PCOS related symptoms, including hirsutism, acne, male pattern hair loss, diminished fertility and irregular periods. The latter have been linked with increased hunger and psychological distress, potentially resulting in an increase in binge eating frequency (Krug et al. 2019).
High levels of male hormones in women have been found to stimulate appetite and increase anxious, depressed moods. This is a perfect recipe for binge eating as binge sessions often occur when someone tries alleviate negative affective states such as anxiety or depression with food (Krug et al. 2019).
3 PCOS can be an emotional rollercoaster
Women with PCOS suffer from body dissatisfaction, especially in the presence of symptoms, such as acne, hair loss, excessive hair growth and weight gain. Research has shown that high levels of body dissatisfaction confer risk for engaging in disordered eating.
Moreover, the hormonal imbalances in PCOS make women more prone to mood disturbances. Women with PCOS are more likely to live with depression and anxiety. Experiencing negative emotions may predispose individuals to engage in disordered eating behaviours to regulate emotions.
Three things to consider if you think you suffer with binge eating
1 Speak about it with your healthcare provider- they will be able to assess this and discuss the support available. Your health is not just physical health- look after your mental health and consider talking therapies if you suffer with anxiety and/ or depression. If you have disordered eating, weight loss should not be your imminent goal- there are many dietary and lifestyle changes that have been shown to improve PCOS.
2 The successful management and treatment of PCOS and binge eating behaviours rely on both conditions being addressed in a holistic manner, taking great care of all aspects of health and with the individual at the centre of the treatment plan.
3 For many women, managing both Binge Eating Disorder and PCOS can be a challenge. However, it is important to remember that both conditions can be successfully treated with a holistic approach that takes into account all aspects of health. The most important thing is to work with a healthcare professional who understands your unique situation and can create a treatment plan that is tailored to your individual needs.
References:
- Lee, Iris et al. “Increased Odds Of Disordered Eating In Polycystic Ovary Syndrome: A Systematic Review And Meta-Analysis”. Eating And Weight Disorders – Studies On Anorexia, Bulimia And Obesity, vol 24, no. 5, 2018, pp. 787-797. Springer Science And Business Media LLC, doi:10.1007/s40519-018-0533-y
- Jeanes, Y. M., et al. “Binge Eating Behaviours and Food Cravings in Women with Polycystic Ovary Syndrome.” Appetite, vol. 109, 2017, pp. 24–32. Crossref, doi:10.1016/j.appet.2016.11.010.
- Bernadett M, Szemán-N A. [Prevalence of eating disorders among women with polycystic ovary syndrome]. Psychiatr Hung. 2016;31(2):136-45.
Krug et al. 2019 Neuropsychiatric Disease and Treatment 2019:15 1273–1285
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