One of the pieces of PCOS that I find intriguing, but which really is not well studied, is what is happening with appetite. This is such a crucial piece of the picture, because it doesn't really matter what ANY expert, medical, nutritional, whatever…tells you that you SHOULD be eating, if your appetite hormones are not supporting the advice.
In order for us to better understand what is happening, and therefore derive effective solutions for this problem, we need to toss a couple of assumptions we have about women with PCOS.
It may not be valid to assume that women with PCOS overeat simply because of emotional issues. (Note: I did NOT say there is NO emotional eating, but I suggest that it may be but one of the pieces of the puzzle.) It seems that the primary assumption on the part of many professionals is that once you lose weight, it is a sign that your appetite and intake are back in balance.
As I interview more women with PCOS, I'm learning that even lean women with PCOS struggle with appetite. A very common scenario, it seems, is to do everything right--eating, activity, sleep, stress management…and some days, despite all the effort, appetite seems to take on a life of its own.
If the experts aren't acknowledging this, some of the more strong-willed cysters may be able to learn to ignore these inappropriate hunger and fullness signals. In other words, the only tool they have to combat obesity is detached, restrictive eating. And if they own up to that with their caregiver, they may be diagnosed with an eating disorder.
Nowhere in there is there room for a physiological explanation.
Leptin, ghrelin, insulin, cholecystokinin, and endocannabinoids…all hormones affecting appetite, have been found to be out of balance with PCOS.
Given this and the stories that are accumulating in my files, it simply does not seem appropriate to advocate for an intuitive eating model as the therapy or the goal. It may be achievable over the long run, but it is not fair to recommend a paradigm that assumes that appetite mechanisms are intact, when in fact they are not.
I encourage you to share your observations with whoever is helping you. I have some work to do to collect more of the references and write about this phenomenon, so you have more science to support your advocating for yourself. It is coming.
For today, I just wanted to introduce the thought and encourage the dialogue. The more we hear from you, the more we can look for explanations and solutions.