What is PCOS? Key Points. Definition. Key Signs + Symptoms. Typical Experiences 10/29/2017

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Regina Walton
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Polycystic Ovarian Syndrome, Binge Eating Disorder, and Weight Bias Applying Weight Inclusive Approaches Rather Than Weight Normative Approaches Promotes Long Term Physical and Emotional Health Julie

1 Polycystic Ovarian Syndrome, Binge Eating Disorder, and Weight Bias Applying Weight Inclusive Approaches Rather Than Weight Normative Approaches Promotes Long Term Physical and Emotional Health Julie Duffy Dillon MS, RD, NCC, LDN, CEDRD What is PCOS? Definition Key Points» Endocrine disorder that starts in the brain» Diagnosis of exclusion» Set of symptoms that result from a hormonal imbalance» Rotterdam Criteria (2 of 3)» Oligo or anovulation» Clinical or biochemical signs of hyperandrogenism» Poly cystic ovaries» Genetic» Environmental» High weight or weight gain does not cause PCOS» Chronic condition and cannot be cured» Hormonal involvement means affects every cell of the body. Key Signs + Symptoms» Irregular, heavy, light or painful periods» Intense carbohydrate cravings» Excess body hair on chest, stomach, back and face.» Male pattern baldness, thinning hair» Weight gain, especially around the midsection» Acanthosis nigricans» Fatigue» Brain fog» Poor memory» Mood disorders» Eating disorders» Infertility Typical Experiences 1

2 Conventional Primary Treatment» Pursue weight loss» diet» exercise» pharmacology» Metformin» Birth Control» Clomid/Femara, Injectables, IVF»???? Insulin + Chronic Inflammation What is Inflammation?» Normal oxidation > Inflammation» Oxidation = rust» Inflammation = repair the corrosive hole» Inflammation normal and important.» Too much inflammation destructive to the body. Chronic Inflammation + PCOS» Women with PCOS end up in a chronic proinflammatory state» Depletes their Omega 3 levels, in particular DHA» Lacking these promotes more oxidative stress and inflammation.» Poor ovulation, mood, higher insulin levels.» Health care providers goal: help lower inflammation which will help improve health for women with PCOS. PCOS + Binge Eating Disorder Why more binge eating reported with PCOS?» Research suggests women with PCOS more likely to experience binge eating and greater food cravings.» CCK release possibly impaired leading to less satiety.» Higher testosterone connected to increased appetite compared to those without PCOS. 2

3 Why more binge eating reported with PCOS?» History of weight cycling is a predicting factor for binge eating for women with PCOS.» Cleave and Jeanes note:» Weight cycling behavior association with binge eating disorder in this population highlights the importance of realistic and sustainable weight management interventions.» What is sustainable weight management? None exist. Weight Bias Weight Bias Harms Health» 25% of health: Eating and activity behaviors» 75% of health: Genetics and social determinants of health» Evidence of weight bias found in medical care, job placement, wages, academic options» Oppression and the flight-or-fright response» Chronic oppression from systemic weight bias linked to hypercholesterolemia, hypertension, hyperinsulinemia, and hypertriglyceridemia. Weight Bias + PCOS» Weight loss = successful treatment< NO!» Research connects these high insulin levels, high testosterone, low CCK to cravings, binge eating, and higher weight.» Focusing on weight loss skips a step (or two!) and expects women with PCOS to practice eating behaviors consistent with Anorexia Nervosa. Weight Bias + PCOS» Researchers focusing on weight loss to treat these hormonal abnormalities fail to acknowledge:» No weight loss interventions (diets) have long term positive outcomes.» Restricting foods with abnormal CCK, Insulin and Testosterone leaves the body craving food because physiology gets message malnourished.» Weight loss with this hormonal dysregulation only occurs with behaviors consistent with Anorexia Nervosa. Weight Normative vs Weight Inclusive 3

4 The Problem with Weight Normative Approaches and PCOS» Diets don t work for most people.» Weight reduction diets increase inflammation.» Weight cycling linked to hyperinsulinemia, hypertriglyceridemia, hypertension.» Weight cycling predicts binge eating in women with PCOS.» When weight loss main goal, decreases healthy eating options, decreases energy available for movement and increases inflammation. Weight Inclusive Approaches and PCOS» Acknowledge weight loss is not a behavior.» Focus on tools to normalize hormone levels.» Teach how to prevent weight cycling.» Focus on interventions to normalize and heal relationship with food.» Advocate for respectful, dignified, and compassionate health care. Weight Inclusive Approaches How Do I Help Using Weight Inclusive Approaches?» Eat enough to prevent inflammation» Move away from diets» Remove the scale as a measure of progress» Insulin and Testosterone» Help heal relationship with food, body» Remove blame for PCOS and its symptoms Weight Inclusive MNT» Don t wait to use medications and supplements.» Women with PCOS probably need more protein» Morning and Evening» Help reconnect to body s wisdom» Notice fatigue to monitor if eating enough» Body will let know when ready for movement. PCOS and Intuitive Eating» Experiment»Notice»PCOS without adequate tools to help vs PCOS with adequate tools to help 4

5 Compassion + Help Advocate for Unbiased Medical Care Resources» JulieDillonRD.com/blog» PCOSandFoodPeace.com»Love Food Podcast» PCOSnutrition.com 5

PCOS Awareness Symposium Atlanta September 24 th, Preventing Diabetes & Cardiovascular Disease in PCOS

PCOS Awareness Symposium Atlanta September 24 th, 2016 Preventing Diabetes & Cardiovascular Disease in PCOS Katherine Sherif, MD Professor & Vice Chair, Department of Medicine Director, Jefferson Women