how treat 18 yr old girl with binge eating disorder, PCOS, obtrusive food

Recommended treatment for the 18-year-old girl:

• First, confirm the diagnosis of polycystic ovary syndrome (PCOS) by ensuring she has both clinical or biochemical hyperandrogenism plus ovulatory dysfunction, recognizing that ultrasound diagnosis is generally avoided in adolescents due to common multifollicular ovaries at this age NICE CKS.
• Address her amenorrhoea by investigating other causes (e.g., thyroid, prolactin, premature ovarian failure) with relevant blood tests before attributing it solely to PCOS NICE CKS.
• Advise lifestyle interventions as the first step, including healthy balanced diet and weight management if overweight, as weight loss can improve PCOS symptoms and menstrual irregularities NICE CKS,NHS Polycystic ovary.
• Given her binge eating disorder and intrusive food thoughts, psychological treatment focused on binge eating disorder (BED) should be offered as per NICE guidance, ideally using binge-eating-disorder-focused guided self-help or cognitive behavioural therapy (CBT-ED), which addresses binge frequency and emotional triggers without targeting weight loss explicitly NICE CKS,NICE NG69.
• Medication should not be used as sole treatment for BED but can be considered adjunctively if psychological therapies are insufficient NICE NG69.
• GLP-1 receptor agonists (e.g., Saxenda or Plaobes) are indicated for weight management in adolescents aged 12 and above with obesity (BMI ≥30 kg/m2 for adults using international cutoffs) and body weight above 60 kg, adjunct to healthy nutrition and increased physical activity SmPC Plaobes,SmPC Saxenda. These agents have also demonstrated clinically meaningful reductions in hunger and weight in paediatric and adult populations SmPC IMCIVREE.
• Before initiating GLP-1 receptor agonists, assess the patient's BMI and weight status to ensure she meets criteria; they are not licensed for primary treatment of BED or PCOS but may assist in weight-related symptom management especially if obesity is present SmPC Plaobes,SmPC Saxenda.
• Because of her amenorrhoea, hormonal treatments such as combined oral contraceptives may be considered to manage menstrual irregularities and reduce hyperandrogenism symptoms after ruling out contraindications NICE CKS,NHS Polycystic ovary.
• In summary, collaboration between eating disorder specialists, endocrinologists, and gynaecologists is essential to manage her complex comorbidities, addressing physical and mental health together, monitoring psychological state and metabolic complications, and tailoring therapy carefully NICE NG69. GLP-1 receptor agonists may be used if obesity criteria are met, alongside psychological therapy for BED and appropriate PCOS management NICE CKS,NICE CKS,NICE NG69,SmPC Plaobes,SmPC Saxenda.