2nd Edition of International Obesity and Metabolism Conference 2026

Abstract

The aim: to study the psychosomatic relationships between eating disorders such as overeating and exogenous-constitutional obesity, and their negative impact on the reproductive system, as well as to present an interdisciplinary approach to the management of patients with ED, obesity and reproductive dysfunctions.

MATERIALS AND METHODS: the open-label observational study involved 210 patients (18-39 years old), including 168 women with menstrual irregularities and 42 men with hypogonadism. All participants were consulted by an endocrinologist, gynecologist/andrologist, who were referred to a psychiatrist-psychotherapist specializing in endocrine psychosomatics. The endocrinologist excluded secondary causes of obesity and determined the severity of endocrine disease. A gynecologist or andrologist identified reproductive dysfunctions. A psychiatrist-psychotherapist diagnosed ED by the type of overeating according to the syndromic classification and the nosological classification of ED was carried out according to the main psychopathology on the basis of the ICD-10 criteria, as well as with the help of clinical-psychopathological, clinical-anamnestic, clinical-dynamic approaches.

RESUILS:
Disorders of the reproductive system in women were characterized by the following distribution of diagnoses: polycystic ovary syndrome (PCOS, normogonadotropic amenorrhea) in 122 (73%) patients, premature ovarian failure (hypogonadotropic amenorrhea) in 46 (27%) patients. Disorders of the reproductive system identified in men were characterized by erectile dysfunction, decreased libido, ejaculatio praecox both in normogonadotropic hypogonadism (28 (67%) patients, and hypogonadotropic hypogonadism (14 (33%) patients. Sexual dysfunction was of a mixed nature and depended on the degree of obesity and the severity of mental disorder. In obesity of 1-2 degrees, polysyndromic overeating was revealed, in the structure of which hedonic and evening overeating prevailed. A clinical pattern between the onset of ED and the type of overeating was revealed. Thus, permanent overeating indicated the onset of the development of ED in childhood, compulsive overeating indicated the onset in adolescence, and hedonic overeating indicated the presence of anhedonia in the structure of affective disorders. The distribution of patients with ED in accordance with the nosological classification of psychopathology is as follows: affective (depressive) disorders were detected in 160 (76%) patients (128 women and 32 men), mixed anxiety-depressive disorder in 32 (15%) patients (27 women and 5 men), somatoform disorder in 11 (5%) patients (2 women and 9 men), schizophrenia spectrum disorders in 7 (3%) patients (2 women and 5 men). Affective (depressive) disorders are represented by recurrent depressive disorder, cyclothymia, dysthymia, proceeding according to the type of "double" depressive disorder, bipolar affective disorder (2 types). Episodes of overeating in patients with 1-2 degrees of obesity were associated with psychogenic provocation of the main psychopathology. Episodes of binge eating in patients with grade 3 obesity were associated with decompensations (more often autochthonously) of a chronic mental disorder with psychotic symptoms (recurrent depressive disorder, bipolar affective disorder, schizophrenia spectrum disorder). In obesity of the 3rd degree, more severe disorders of the reproductive system and psychopathology were revealed. A significant increase in body weight and lack of criticism during the period of weight gain was characterized by an episode of craving. Thus, in patients of the 1st and 2nd degrees of obesity, ED was found in the structure of various psychogenically provoked psychopathological disorders of mild and moderate severity, in patients of the 3rd degree of obesity - in the history of severe episodes of decompensation of psychopathology, which were associated with an increase in body weight. 

CONCLUSIONS: Taking into account the established psychosomatic links between ED and obesity with disorders of the reproductive system, of a mixed nature, a pathogenetically substantiated approach to the management of patients with exogenous-constitutional obesity, an interdisciplinary approach with the participation of an endocrinologist or therapist, a gynecologist, an andrologist and a psychiatrist-psychotherapist is indicated.