PCOS and Eating Disorders: A chat with an eating disorder coach #115

Do I have a problem?

Hello everyone,

I hope you are doing well. Today’s article is a collaboration with Jane Pilger from The Peaceful Eater, a publication dedicated to helping women build a better relationship with food.

Jane has just released her book, “The Binge Eating Breakthrough: Why Food Isn't the Problem (and What Really Is),” and she is joining us today to discuss this sensitive yet essential topic: eating disorders and disordered eating.

Women with PCOS are at a higher risk of eating disorders. Given we are told to lose weight at each corner, I am not surprised. If you have been dieting in your life, this article is for you.

I want this article to act as a guiding light to recognise the patterns of disordered eating and what to do when things go too far.

It will take you into Jane’s experience with eating disorders, my near encounter with one and how dieting can impact this risk.

If you are someone who suffers from an eating disorder and you are worried it might trigger unwanted anxiety or depressive feelings, please consider skipping it.

If you or someone you know is struggling with an eating disorder, please seek help. In the UK, contact Beat, the UK's leading eating disorder charity, at 0808 801 0677 or visit www.beateatingdisorders.org.uk. In the US, reach out to the National Eating Disorders Association (NEDA) helpline at 1-800-931-2237 or visit www.nationaleatingdisorders.org for support and resources.

Jane, why did you dedicate your career to this topic and write your latest book?

“I struggled with an eating disorder for over 25 years. The disordered eating really escalated when I went away to college. I still vividly remember my first binge - sitting on the floor of my college dorm room, surrounded by empty candy bar wrappers. I had received a care package full of candy and ate every last piece. I don’t remember the binge itself but I remember recognizing what I had done and the shame and disgust that I felt towards myself.

I spent decades trying to stop. I went to countless therapists, read books, listened to podcasts and went through two rounds of Intensive Outpatient Treatment at a local eating disorders treatment center. I would have periods of “success” when the binging and restricting would subside, but it would always come back.

The key for me was learning about the nervous system and learning how to develop safety and trust with myself, my body and with food. Once I learned about this inner work, my outer responses and behaviors began to shift.

I remember reading so many books to try to overcome my own battles with food. I decided to write the book I wish I had when I was struggling the most.

The goal of the book is to help you see your challenges with food in a new way. So many people focus only on the food and they try to change what they are eating or how much they are eating. But food is rarely the problem. It’s a symptom, a sign that something else is going on that needs to be addressed. The book is called The Binge Eating Breakthrough, but it’s not just for people who binge. If you don’t feel peaceful around food, there will be something useful for you inside the book.”

What is the best way to describe an eating disorder?

“I am not a licensed professional and I don’t consider myself to be an expert in all forms of disordered eating. My work is based upon my lived experience and the experience of working with hundreds of clients and a significant amount of training and education. My official diagnosis was EDNOS (eating disorder not otherwise specified - now called OSFED - other specified feeding or eating disorder) as I had both restrictive and binge eating tendencies along with orthorexia and body dysmorphia.

I don’t reference specific manuals or definitions of disordered eating, but overall I would say that disordered eating exists when a person’s relationship with food is interfering with their day to day enjoyment and appreciation of life. If it feels like food takes up a lot of brain space, time and energy, it is likely that you are dealing with disordered eating.

Here is a link to an article from the National Eating Disorders Association describing the difference between disordered eating and eating disorders.”

Women with PCOS are at higher risk of disordered eating. It is thought that the prevalence of Binge Eating Disorder can be as high as 42% and Bulimia Nervosa of up to 12%. This is down to our hormone dysregulation (insulin resistance, excessive testosterone, cortisol and leptin) which increases our appetite and lowers our feeling of fullness.

Consider becoming a paid subscriber to access more in-depth information on PCOS. Your body deserves the best care, guided by reliable advice.

What is the difference between Binge Eating disorder and Bulimia Nervosa?

“With binge eating the general description is eating large amounts of food, in a short period of time, more than is usually eaten in one sitting, often with a sense of a loss of control and often followed by shame. There is often no attempt to compensate for the excess consumption.

With bulimia there is an attempt to compensate for the binge eating episodes. This might come in the form of exercise, laxatives, diuretics or vomiting.”

In my 3 years experience working in weight management, I saw a lot of women we thought were on the verge of an eating disorder but they didn’t notice.

What are the signs that I may have a problem with food?

Increased time, attention and focus on food, weight or body size. Constant thoughts about what to eat, when to eat, how much to eat. Morality around food - seeing foods as “good” or “bad” or seeing yourself as “good” or “bad” based upon what or how much you are eating. Not going out for fear of not being able to control what is in your food. Fear of eating. Fear of gaining weight. Feeling high levels of anxiety and fear around mealtimes.

I remember having a close encounter with binge eating. I was in university on a counting calories keto diet. Sundays were my “cheat days”. I remember vividly going to the shop downstairs and buying all my favourite foods and eating them all at once as if I have never seen food in my life. That continued for a while till I somehow snapped back into realising that was harmful. Unfortunately women with PCOS are told to lose weight all the time, leading to dieting and restriction. In addition, there is a negative impact on our body image due to the weight, acne and excess hair.

Firstly, how does body image affect the risk of eating disorders?

Negative body image and disordered eating often go hand in hand. When you think you need to change your body in some way in order to be acceptable or approved (a message we receive throughout our lives), it makes sense that you would resort to anything in order to shrink or change your body.

Many people who struggle with disordered eating are trying to make their bodies look like something that isn’t possible for their given body. Kind of like a bulldog wanting to look like a greyhound. No matter what the bulldog does or how much it eats or doesn’t eat, it’s not likely to look like the greyhound.

And, can repetitive dieting cause eating disorders?

Yes. When you have been on diets in the past the nervous system remembers it as starvation. It’s job is to keep you alive, so it will do anything possible to make sure you don’t starve again. This is why it gets harder and harder to “stick with” a diet after you’ve been on several. Your brain knows what’s coming and won’t let you go through that again. Ever just thought about losing weight and then found yourself eating a lot of food? That’s why.

Another risk factor that women with PCOS have is anxiety and depression. This is down to quite a few factors including stress levels, hormonal imbalances, vitamin D deficiency. For example, a recent study showed that for 1 unit increase in insulin resistance (HOMA-IR measurement), there was a 6% increased odds of having a depression diagnosis.

What is the relationship between mental health and eating disorders?

Many people who are struggling with anxiety, depression, or other mental health concerns turn to food for the dopamine and short term relief that certain foods provide. Once that pattern has been repeated a few times, the brain will make that connection and send a craving when those feelings occur. Sometimes food can be a way to escape from feelings that otherwise feel like too much to bear.

What should someone facing difficulties do? What are your principles of care?

As I say in the book, food usually isn’t the problem. The problem is what is happening under the hood. It could be one of 8 reasons that I see usually leads people to disordered eating. You can read about the 8 reasons and solutions here.

The principles I use in working with clients spell out STUCK. Safety, Trust, Understanding, Connection and Kindness. These are the key components for anyone who is struggling. Learning how to create safety within yourself (and being that source of safety for a client in the meantime), learning how to develop self trust, understanding your behaviors, learning how to connect with yourself and your body (including all of your internal parts) and being fiercely kind with yourself.

Recovering from disordered eating is a process that takes time and intention, but it is absolutely possible. It’s a journey best done with support. For people who don’t have support, my hope is that this book can be a source of support and guidance for anyone who is struggling.

You can find Jane and her work on her Substack below:

My only wish is that your relationship with food is gentle, comes from a place of love, and is nourished to help your condition. I am a Nutritionist; I have my fair share of food shame. I had to learn to treat my food choices with kindness, honour the seasons of life, and approach them from a place of love and care. This is why I have a little hate for diets and anyone who imposes a specific way of eating on people. You can’t impose a strict view of food choices. This relationship with something that keeps us alive needs the respect and care it deserves. Connect to your body, and allow yourself to discover the beauty of eating healthy from a place of love.

I thank Jane for sharing her story and showing us what happens when this relationship with food is not nurtured.

See you next Sunday,

Francesca

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1. Advances in Nutrition (Bethesda, Md.), 15(4), 100193. https://doi.org/10.1016/j.advnut.2024.100193

Dokras, A., Stener-Victorin, E., Yildiz, B. O., Li, R., Ottey, S., Shah, D., Epperson, N., & Teede, H. (2018). Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertility and Sterility, 109(5), 888–899. https://doi.org/10.1016/j.fertnstert.2018.01.038

Lalonde-Bester, S., Malik, M., Masoumi, R., Ng, K., Sidhu, S., Ghosh, M., & Vine, D. (2024). Prevalence and etiology of eating disorders in polycystic ovary syndrome: A scoping review. Advances in Nutrition (Bethesda, Md.), 15(4), 100193. https://doi.org/10.1016/j.advnut.2024.100193

Disclaimer: We are all unique in our ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please consult your healthcare provider further about your health needs.