Women with PCOS at risk for emotional, uncontrolled eating in midlife
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Key takeaways:
- Women with vs. without PCOS had higher emotional and uncontrolled eating scores.
- Overweight perceptions predicted emotional eating and weight-loss attempt history predicted uncontrolled eating for PCOS.
Women with vs. without polycystic ovary syndrome have a higher risk for emotional and uncontrolled eating behaviors at midlife, with contrasts observed among different phenotypes, according to findings published in Fertility and Sterility.
In an analysis of more than 1,100 women with and without PCOS at midlife, researchers also found that a history of multiple weight-loss attempts and a perception of being overweight were independently associated with unfavorable eating behaviors among women with PCOS, suggesting more counseling is needed.
“Weight-sensitive talk and questions related to eating behavior should be systematic when seeing women with PCOS,” Terhi T. Piltonen, MD, PhD, professor and chief physician in the department of obstetrics and gynecology in the reproductive endocrinology and IVF unit at the Medical Research Centre at Oulu University Hospital in Finland, told Healio. “This may also affect treatment strategies.”
Piltonen and colleagues conducted a prospective cohort study using data from the general population-based Northern Finland Birth Cohort 1966. Researchers compared 251 women with PCOS at age 31 years with 935 women without PCOS. All women completed the revised Three-Factor Eating Questionnaire at age 46 years.
Researchers evaluated associations between PCOS, BMI, history of weight-loss attempts, perceptions of being overweight and psychological distress with eating behavior domains in the questionnaire.
Of women with PCOS, 60 had the hyperandrogenism and oligomenorrhea phenotype with or without elevated anti-Müllerian hormone, 84 had the hyperandrogenism and elevated anti-Müllerian hormone phenotype and 86 had the oligomenorrhea and elevated anti-Müllerian hormone phenotype.
Women with PCOS had higher emotional eating scores (39 vs. 33.1; P = .005) and uncontrolled eating (30.7 vs. 26.7; P = .003) scores compared with women without. However, researchers observed no difference in cognitive restraint at age 46 years between women with and without PCOS.
Women with the hyperandrogenism and oligomenorrhea phenotype with or without elevated anti-Müllerian hormone had higher emotional and uncontrolled eating scores compared with women without PCOS. Women with the hyperandrogenism and elevated anti-Müllerian hormone phenotype had higher uncontrolled eating scores compared with women without PCOS and women with the oligomenorrhea and elevated anti-Müllerian hormone phenotype.
For women with PCOS aged 46 years, perception of overweight status was an independent predictor for emotional eating (P = .008) and history of weight-loss attempts was a predictor of uncontrolled eating (P = .015).
Higher psychological distress at age 31 years was associated with emotional eating scores (adjusted OR = 2.85; 95% CI, 1.19-6.85) and uncontrolled eating scores (aOR = 4.37; 95% CI, 1.77-10.8) in the highest quartile at age 46 years for women with PCOS. In addition, women with PCOS and a BMI of 25 kg/m2 or more at age 31 and 46 years had significantly higher risk for emotional eating scores in the highest quartile at age 46 years vs. women with a BMI lower than 25 kg/m2 at age 31 and 46 years (aOR = 4.49; 95% CI, 1.36-14.9).
“Weight-sensitive talk and awareness of this long-term trait in PCOS should be acknowledged with the health professionals attending these women,” Piltonen told Healio.
For more information:
Terhi T. Piltonen, MD, PhD, can be reached at terhi.piltonen@oulu.fi.
Perspective
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Pamela J. Wright, PhD, MS, MEd, RN, CEN
The insightful findings from this cohort study indicated that midlife women with PCOS across most phenotypes exhibited a higher prevalence of emotional and uncontrolled eating behavior compared to age-matched controls without PCOS. BMI and psychological distress were significant mediators of disordered eating behavior, and a history of multiple weight loss attempts and a perception of being overweight were significant predictors. Consistent with general literature defining midlife as ages 40 to 65 years, the sample of midlife women in this study was aged 46 years. The authors noted that higher psychological stress at age 31 years predicted disordered eating at age 46 years. Unknown is the menopausal status of the women when evaluated at age 46 years. Research evidence indicates menopausal symptoms such as hot flashes and sleep disturbance negatively impact emotional well-being. Furthermore, women with PCOS reach menopause, on average, 2 to 4 years later than that of age-matched controls, indicating prolonged periods with menopausal symptoms and compounded psychological distress. Additionally, younger women with PCOS may have additional stressors compared with the general population of women, such as fertility struggles and miscarriages. These same women in midlife may be coping with a trauma-based response unsuccessful pregnancy attempts and miscarriages. Cross-sectional research has consistently indicated body dissatisfaction among women in general also does not diminish from young adulthood to late adulthood, with some evidence yielding higher levels of body dissatisfaction in midlife. Unfortunately, women with PCOS with a BMI greater than 24.9 kg/m2 report clinicians emphasize weight loss for PCOS symptom management. A more impactful health care approach may be the use of a weight-inclusive paradigm, such as body positivity and acceptance with emphasis on other factors such as endurance, strength and energy.
The authors’ recommendation that health care providers prioritize psychological factors when prescribing weight management is a strong conclusion. In fact, given the psychological morbidity associated with PCOS and women’s unique health care concerns with each life phase, psychological screenings should begin at diagnosis and continue into older adulthood, with treatment plans reflecting appropriate and individualized strategies at each stage. Follow-up with this cohort in another 10 to 15 years would inform the care of women with PCOS across the lifespan.
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