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TOPLINE: Women with polycystic ovary syndrome (PCOS) face a significantly higher risk of developing various eating disorders, including bulimia nervosa, binge eating disorder, and disordered eating. This increased risk persists regardless of body weight.
METHODOLOGY: A recent systematic review and meta-analysis, as part of the 2023 update to the International Evidence-based Guideline for PCOS management, has shed light on the heightened risk of eating disorders among women with PCOS. This comprehensive analysis expanded upon previous research by including adolescents and examining the impact of body mass index (BMI) on these risks.
The review encompassed 20 cross-sectional studies, involving a total of 28,922 women with PCOS and 258,619 women without the condition. PCOS diagnoses were based on criteria from the National Institutes of Health, Rotterdam, patient self-reports, or hospital records. Eating disorders were assessed using validated screening tools and diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
TAKEAWAY: Women with PCOS were found to have a 53% increased likelihood of any eating disorder compared to those without PCOS (odds ratio [OR], 1.53; 95% CI, 1.29-1.82). Specifically, the risk of bulimia nervosa was 34% higher (OR, 1.34; 95% CI, 1.17-1.54), while the risk of binge eating disorder was more than double (OR, 2.09; 95% CI, 1.18-3.72). No significant association was observed for anorexia nervosa.
The study also revealed that women with PCOS had higher mean disordered eating scores (standardized mean difference [SMD], 0.52; 95% CI, 0.28-0.77) and a higher likelihood of disordered eating (OR, 2.84; 95% CI, 1.0-8.04). These elevated scores were present in both normal weight (BMI < 25; SMD, 0.36; 95% CI, 0.15-0.58) and higher weight categories (BMI ≥ 25; SMD, 0.68; 95% CI, 0.22-1.13).
IN PRACTICE: The study underscores the necessity for clinicians to screen women with PCOS for eating disorders before recommending lifestyle changes. “Our findings highlight the importance of thorough screening for eating disorders in women with PCOS, especially before suggesting lifestyle modifications like increased physical activity or dietary changes, which might exacerbate disordered eating symptoms,” said lead author Laura G. Cooney, MD, MSCE, from the University of Wisconsin, Madison.
SOURCE: This study, led by Dr. Laura G. Cooney and published online on August 8, 2024, in The Journal of Clinical Endocrinology & Metabolism, aims to refine recommendations within the 2023 International Evidence-based Guideline for PCOS.
LIMITATIONS: The research is constrained by its observational nature and cross-sectional design, which limits the ability to determine causality or adjust for potential confounders. Additionally, while the study incorporated data from ten countries, there is limited representation from developing and Asian countries, potentially affecting the generalizability of the findings.
DISCLOSURES: The study was funded by the Australian National Health and Medical Research Council, the Centre for Research Excellence in Polycystic Ovary Syndrome, and other contributors. The authors have declared no conflicts of interest.
