Women with PCOS are at risk for emotional and uncontrolled eating at midlife: a population-based cohort study

Abstract

Structured abstract

Objective: To investigate eating behavior domains –emotional, uncontrolled, and cognitive restraint eating– in women with polycystic ovary syndrome (PCOS) with different PCOS phenotypes and women without PCOS at midlife.

Design: A prospective cohort study. Eating behavior domains were assessed at age 46. Predictors of eating behaviors were evaluated using variables collected at ages 31 and 46.

Subjects: Women identified as having PCOS (n=251) at age 31 using the updated Rotterdam criteria were compared to women without any PCOS criteria (n=935). The PCOS population comprised women with the classic A+B-phenotype (hyperandrogenism and oligomenorrhea, with or without elevated anti-Müllerian hormone, n=60), C-phenotype (hyperandrogenism and elevated anti-Müllerian hormone, n=84), and D-phenotype (oligomenorrhea and elevated anti-Müllerian hormone, n=86).

Exposure: The main explanatory variables for the eating behavior domains were PCOS, body mass index, a history of weight loss attempts, a perception of being overweight, and psychological distress.

Main outcome measures: Revised Three-Factor Eating Questionnaire-18 scores for eating behavior domains.

Results: Compared to women without PCOS, women with PCOS exhibited higher scores for emotional (33.1±27.8 vs. 39.0±29.9, p=0.005) and uncontrolled eating (26.7±18.2 vs. 30.7±19.4, p=0.003) but no difference in cognitive restraint (46.6±18.6 vs. 45.9±18.5, p=0.563) at age 46. Emotional and uncontrolled eating scores were higher in the A+B-phenotype compared to women without PCOS, while uncontrolled eating scores in the C-phenotype were higher than in women without PCOS and the D-phenotype. At age 46, the perception of overweight was an independent predictor of emotional eating among women with PCOS (B=11.96 [95% confidence interval [CI]: 2.81–20.29], p=0.008), while a history of weight loss attempts was a predictor of uncontrolled eating (B=6.06 [95% CI: 1.05–10.83], p=0.015). Among women with PCOS, higher psychological distress at age 31 was a significant risk factor for scoring in the highest quartile of emotional (adjusted odds ratio [aOR]: 2.85 [95% CI: 1.19–6.85], p=0.019) and uncontrolled eating (aOR: 4.37 [95% CI: 1.77–10.80], p=0.001) at age 46.

Conclusion: Women with PCOS at midlife showed a high tendency for unfavorable eating behaviors. Our findings emphasize the need for sensitivity in weight management counseling and addressing psychological distress to prevent unfavorable eating in this population.