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

Abstract

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. 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. 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). 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. Revised Three-Factor Eating Questionnaire-18 scores for eating behavior domains. 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. 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.