番茄社区

Clinicians should monitor for eating disorders among women with polycystic ovary syndrome (PCOS), regardless of weight, according to a systematic review and meta-analysis used to inform PCOS guidelines.

In the analysis of 20 cross-sectional studies, women with PCOS had higher odds of any eating disorder compared with controls (OR 1.53, 95% CI 1.29-1.82), reported Laura Cooney, MD, of the University of Wisconsin in Madison, and co-authors in the .

Specifically, women with PCOS had increased odds of bulimia nervosa (OR 1.34, 95% CI 1.17-1.54) and binge eating disorder (OR 2.09, 95% CI 1.18-3.72), but not anorexia nervosa (OR 0.94, 95% CI 0.69-1.28).

"Women with PCOS have increased risk of a lot of different metabolic conditions -- obesity, diabetes, high blood pressure -- but there's really emerging evidence that there is also an increased risk of mental health disorders," Cooney told 番茄社区. "We've known about depression and anxiety for a long time, but these data looking at eating disorders are newer."

Notably, five studies showed that mean disordered eating scores stratified by body mass index (BMI) were higher for women with PCOS, regardless of BMI:

• BMI <25: standardized mean difference 0.36 (95% CI 0.15-0.58)
• BMI ≥25: standardized mean difference 0.68 (95% CI 0.22-1.13)

Cooney pointed out that since BMI did not affect the association, lifestyle modifications would likely be ineffective.

"When we think about treatment of PCOS in general, the focus has been on lifestyle -- nutrition, physical activity, [and] dietary changes," she said. "It's important to know, because of the increased risk of the eating disorders, some of those traditional recommendations for lifestyle management might really be counterproductive in women with PCOS who have an eating disorder."

Lucy Hutner, MD, co-founder and chief medical advisor for , a digital platform focused on pregnancy and the postpartum period, told 番茄社区 that this study should bring attention to an important challenge facing women with PCOS, particularly when it comes to weight loss-based treatment approaches.

"The traditional advice can actually significantly backfire, and not only can it backfire in terms of not being a successful strategy, it can backfire in terms of promoting ineffective, frustrating dietary behaviors that can then be linked to disordered eating," said Hutner, who was not involved in the study.

This study shows that weight, body image, and eating issues need to be considered when healthcare professionals are treating women with PCOS, she added. "PCOS is a complex metabolic condition that is intricately related to mental health, and this study shows that eating disorders are a part of that."

Cooney noted that this study was conducted to help inform recommendations for the update of the .

"It's important for clinicians to be aware of how to screen for eating disorders," she said. "If someone is high risk, it's really important that they also refer the patient to someone who specializes in eating disorders and potentially can help them manage safe weight loss or safe lifestyle interventions."

For this systematic review and meta-analysis, Cooney and colleagues conducted a literature search for studies in Ovid Medline, Embase, PsycInfo, and All EMB that looked at eating disorders in adolescent or adult women from inception through February 1, 2024. They included 20 studies involving 28,922 women with PCOS and 258,619 women without PCOS from 10 countries, including the U.S.

Of these studies, 13 defined PCOS diagnoses using the Rotterdam criteria. In the other studies, PCOS was identified through self-reporting, insurance claims data, or ICD codes.

In a sensitivity analysis of four studies that used only the Rotterdam criteria, women with PCOS had higher odds of having any eating disorder (OR 2.88, 95% CI 1.55-5.34).

Limitations included not being able to account for potential confounding variables outside of BMI because most of the studies were observational in nature. Authors were also not able to determine whether the PCOS diagnosis preceded any disordered eating symptoms.

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