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PCOS and Eating Disorders: Exploring the Overlap and a Weight-Neutral Approach

  • Writer: Sara Geiger
    Sara Geiger
  • Aug 15, 2024
  • 5 min read

Updated: May 6

Welcome back to my 3-part blog series on PCOS & eating disorders! If you are reading this and wondering what in the world PCOS is, you may want to read Part 1 and come back. You can expect more research and more myth-busting about diet culture!


Why Are PCOS and Eating Disorders So Connected?


Polycystic Ovary Syndrome (PCOS) and eating disorders often begin around the same time: adolescence, especially around menarche (first menstrual cycle). A recent 2024 review found that individuals with PCOS are 3 to 6 times more likely to have an eating disorder compared to those without PCOS (Lalonde-Bester et al., 2024).


These conditions often coexist due to both physiological and social factors, and both can be alleviated with specialized treatment and symptom management.. Let's break it down.


Many individuals with PCOS are told to eliminate entire food groups—like dairy, gluten, or even fruit—in an effort to reduce inflammation. While well-intentioned, these recommendations can spiral into unintentional restriction, nutrient deficiencies, and disordered eating.


Conflicting research adds to the confusion:

  • Some studies show low-fat dairy improves insulin resistance (Azadi-Yazdi et al., 2017).

  • Others link low-fat dairy to higher acne rates (Burris et al., 2013).

  • Gluten is often labeled inflammatory, but inflammation is a normal immune response—not always a sign of dysfunction (Prokopovych, 2023).

The bottom line? One-size-fits-all diets can backfire. Especially for those at risk of eating disorders, eliminating foods without medical necessity can be more harmful than helpful.


When evaluating research, it is important to assess the possible confounding variables and sample size before making bold claims. Research is so important but it's also important to recognize you may have experiences that differ from the literature. Even if research shows some people have improved PCOS symptoms with low-fat dairy, this will not be true for everyone, and you may find improvements with full-fat dairy! This is why it is so important to work with a Registered Dietitian to learn about the evidence and then try things on to see what works and doesn't work for you.


Weight Stigma and the Dieting Cycle


Many people with PCOS are placed on low-calorie diets due to persistent weight stigma in the healthcare system. One study found that women with PCOS consumed an average of just 1,400 calories per day—well below the energy needs of most adults (Phy et al., 2015). Chronic undernourishment like this can lead to:

  • Binge eating

  • Food preoccupation

  • Metabolic disruption

  • Weight cycling


I recently attended a powerful EDRD Pro webinar by Kimmie Singh, RD: Unpacking PCOS and Eating Disorders. It was so informative and affirming that I wanted to explore some of the key takeaways here on the NPN blog.


One striking point: while any eating disorder can co-occur with PCOS, research shows a particularly strong link with Binge Eating Disorder (BED). According to the Physiology & Behavior journal, up to 60% of people with PCOS may experience binge eating behaviors (Pehlivanturk-Kizilkan et al., 2024).


Several physiological factors likely contribute:

  • Disrupted hunger and fullness cues (ghrelin, leptin)

  • Insulin resistance

  • Elevated androgens

  • Low serotonin levels (Benson et al., 2009)


When the body’s natural regulation systems are thrown off, food can become both a source of emotional soothing and a way to compensate for neurochemical imbalances like low serotonin.

Because PCOS is a metabolic condition, hormones that govern appetite, energy, and mood—like ghrelin, leptin, and insulin—often don’t function as expected. This can set the stage for patterns of restriction and bingeing, not due to a lack of willpower but because the body is trying to restore balance.


The Neuropsychiatric Disease and Treatment journal captures this cycle clearly:

“Altered insulin levels may contribute to weight gain, which increases distress about weight, triggering the dieting cycle: restriction, brief weight loss, disinhibition, binge eating, long-term weight gain—and the cycle repeats.” (Krug et al., 2019)

The graphic below illustrates this feedback loop, which is common in both PCOS and eating disorders.


Figure 2: The Restriction Cycle (aka Restrict-Binge Cycle) seen in PCOS & EDs


A different, weight-neutral approach for PCOS


A weight-centric approach often harms more than helps. Body image distress and pressure to lose weight can fuel shame, restriction, and worsening symptoms. A weight-neutral approach to PCOS focuses on:

  • Symptom management

  • Lab markers

  • Sustainable behaviors

  • Protecting your relationship with food and body


In a 2024 review of 38 studies, those with PCOS were significantly more likely to have eating disorder symptoms—especially binge eating and bulimia (Lalonde-Bester et al., 2024).


We need more research that values psychological health, quality of life, and diverse body sizes—and funding that treats reproductive health as essential, not niche.


Taking a weight-neutral approach to PCOS means helping people focus on symptom management, lab improvement, and quality of life while protecting their relationship with food and body. Over time I hope we will see even more research on the psychological and physical gains of a weight-neutral approach for PCOS. And, of course, we need to promote the gravity of reproductive health beyond being “just a women’s issue!” which leads to a lack of funding and research in this area. Discrimination of race and body size seeps its way into healthcare far too often. Both PCOS and eating disorders are a snapshot of a broader fight for social justice.



Takeaway: Individualized Care for PCOS and EDs


Managing both PCOS and an eating disorder isn’t about finding a "fix"—it’s about finding what supports your well-being. That includes:

  • Gentle nutrition

  • Body respect

  • Medical care without weight bias

  • Support from professionals who understand both diagnoses


Some of my favorite PCOS nutrition experts include  Kimmie Singh, RD,  Angela Grassi, RD, and Julie Duffy Dillon, RD.


If you have any questions or want to chat about your experience, we’d love to hear from you! At New Paths Nutrition, our team of eating disorder dietitians specializes in helping you navigate PCOS nutrition and build a more peaceful relationship with food. We offer support from our Charlotte, NC office and provide virtual nutrition counseling to residents of North Carolina, South Carolina, and several other states. Reach out using our contact form to schedule an appointment, or use this link to book a discovery call if you’d like to chat first


Feel free to comment below with any of your PCOS & ED experiences. I’d love to hear your perspective!



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