New research has found that women living with PCOS may be more at risk of disordered eating. That might come as a surprise to some people, but anyone who’s gone through the rigmarole of seeking help for the condition will know only too well just how toxic a lot of the generic PCOS support can be. We’re told to lose weight, cut carbs and change how we work out – all in the name of insulin. Even clinical studies refer to the presence of PCOS without weight gain as “lean PCOS”. As such, experts have now identified a connection between the syndrome and poor body image.

We asked the experts to explain what’s really going on here. 

How common are eating disorders among women with PCOS?

Recent studies show that women with PCOS are over three times more likely to have an eating disorder than those without PCOS, and according to PCOS expert and functional nutritionist Clare Goodwin, the link is complex. 

“Researchers aren’t entirely sure what causes this high prevalence, but bulimia and binge eating disorder (BED) are the most commonly reported eating disorders in the PCOS community, with up to 58% of women and people with PCOS fitting the diagnostic criteria for BED.”

While more research is needed to understand the links, there are some common themes. 

Insulin resistance is largely to blame for PCOS symptoms

“85% of people with PCOS have a condition called insulin resistance,” explains Goodwin. “This means that when they eat food, their body produces much more of the hormone insulin than it should. Insulin is responsible for keeping our blood glucose levels steady, and producing too much of it causes our blood glucose levels to drop too low – known as reactive hypoglycemia.”

When our blood glucose levels are low – we’ll know about it. We can feel hangry, irritable and sometimes even faint. All these symptoms are designed to make us go and find food to increase our blood sugar. But if you’ve just eaten, this can throw your whole system out of whack.

“These feelings can lead you to overeat and binge,” acknowledges Goodwin. “Unfortunately, this just makes your blood glucose spike again, releasing more insulin and perpetuating the cycle. This is what we call a blood sugar rollercoaster and it’s common in people with binge eating disorder.”

85% of people with PCOS experience weight gain

An extremely common side effect of PCOS is weight gain. It’s estimated that over 85% of people with PCOS experience weight gain, caused by what Goodwin calls a “vicious hormonal cycle. Higher levels of the hormone insulin and testosterone both lead to weight gain, which leads to even higher insulin and higher testosterone and even more weight gain,” she says. “Unfortunately there is no negative feedback in this loop in the body, so it just keeps going and going and is incredibly hard to stop.”

Therefore, PCOS in itself can create disordered eating, as women seek to overcome the body and weight changes that come with the condition. Often compounding the issue is medical advice to lose weight.

“People with PCOS who have weight gain as a symptom are told to lose weight but are rarely given any advice of to how to do this safely and effectively,” warns Goodwin. “Weight loss is almost always recommended to people with PCOS, but very rarely are patients given details on how they can achieve this. 

“Most of the patients I see have been trying to lose weight for many years of their life, but the common advice to eat less and exercise more doesn’t actually fix the problem, due to insulin resistance and hormonal factors. So, when we don’t see much success, it’s all too easy to arrive at the most logical explanation: that we have to eat even less. This can lead to very restrictive eating, which is unachievable for most people for more than a few days or weeks at most.”

If you are concerned about either PCOS or eating disorder symptoms, always consult your GP.

Physical changes can lead to poorer mental health

It’s easy to see how a combination of physical changes and social stigma can lead to low self-esteem in the PCOS community.

“PCOS includes many symptoms that affect how women feel about their body,” explains Goodwin. “These symptoms include weight gain, acne, facial and body hair, hair loss and fertility challenges. These symptoms all contribute to higher levels of body dissatisfaction – and research shows that this is a risk factor for developing disordered eating.”

In addition, the seeming inability to lose weight despite restrictive eating patterns can lead to feelings of failure, which can make binge eating more likely.

“Binging leads to feelings of guilt and self-loathing, prompting further restriction and then further binging,” warns Goodwin. “But the reality is that it isn’t anyone’s fault – if you’re on a blood sugar rollercoaster, no amount of willpower can stop the blood sugar crash that leads to another binge.

When someone is already suffering from low self-esteem and body image (both of which are risk factors for developing eating disorders), these feelings just perpetuate the seemingly never-ending cycle of bingeing and restricting.

How to overcome poor body image with PCOS

All of this makes for pretty depressing reading, but there is some good news. Many of us can manage and even reduce our PCOS symptoms through a few simple lifestyle changes, and there can be light at the end of the tunnel.

Try to forget about weight

Firstly, Goodwin advises that we have to take the emphasis off weight (a good motto for life, regardless of PCOS).

“It’s important firstly to focus treatment on the underlying root cause of any eating problems for an individual,” she says. “And in order to do this, we have to remove the focus on weight loss, as a continual focus on this just perpetuates the bingeing and restricting cycle.

Eat enough food to avoid energy dips

“Instead it’s vital to focus on eating to avoid the blood sugar dips, as they are the most common bingeing trigger. This means eating enough to fuel our bodies and brains well (which means more food) and not skipping meals.”

Focus on lowering stress and improving sleep

We can’t change a PCOS diagnosis – it’s often down to genetics. We can, however, make small, incremental changes to factors such as food, sleep, exercise and stress levels – all of which impact PCOS and its associated symptoms. Addressing these can also help to improve mental help, reducing the risk of developing or worsening disordered eating patterns.

Get professional support

It’s important to remember that eating disorders are complex and multifactorial, and treating them effectively will most likely require a psychologist alongside a nutritionist – but you don’t have to suffer alone. If you’re struggling with disordered eating, a good place to start is by contacting Beat on one of their 365-day helplines. 

Images: Getty