Losing weight with PCOS can be a frustrating process — there’s something I wish someone told me when I first started trying. PCOS is a condition that causes the body to stop ovulating and making eggs, which leads to fertility issues, irregular periods and a wide range of physical and mental health struggles such as depression and anxiety.
Chances are, if you have Polycystic Ovary Syndrome, losing weight is on the top of your “to-do” list. That’s no surprise. Obesity affects one in three women and the higher a woman’s BMI, the greater her risk for diabetes, heart disease and cancer. And PCOS only exacerbates these risks. I could go on, but I think you get the picture. In this article, we discuss how to lose weight with PCOS and develop a plan for getting to your goal weight without starving yourself or resorting to crash diets like the Atkins diet or liquid diets that work in the short-term but sabotage your long-term weight loss goals.
How To Lose Weight With PCOS
Between 4 and 20% of reproductive-age women have polycystic ovarian syndrome (PCOS). Patients with PCOS often find it’s much harder to lose weight than it is for those without PCOS—and much easier to gain weight unintentionally. If you have PCOS and are trying to lose weight, you may feel frustrated that you’re doing everything “right” while the scale isn’t budging.
Family medicine physician Dr. Michelle Ayazo is certified by the American Board of Obesity Medicine and specializes in helping patients manage their weight. Because weight and PCOS are so interconnected, Dr. Ayazo emphasizes that patients need a whole-body approach to treat symptoms and see long-term results in the long term. Her goal is to help patients find personalized ways to make good health part of their lifestyle starting from their very first visit.
In this blog, Dr. Ayazo dives deep into how weight and PCOS are interconnected, how patients can manage both, and how a physician can help.
First, why is it so hard to lose weight with PCOS?
Polycystic ovarian syndrome (PCOS) is an endocrine disorder that affects hormones. Hormones are responsible for a lot of bodily processes that impact weight—including when we feel hungry, how our bodies use food for energy, our stress levels, and more.
Unfortunately, there’s a lot we don’t know about PCOS and all of the different ways this condition makes it harder to lose weight. Scientists are still studying the causes of PCOS and the best ways to treat it.
However, we do know that losing even a little weight has been shown to improve PCOS symptoms. To help on your journey to good health, Dr. Ayazo recommends following these steps for success.
Step 1. Be patient with your progress
Losing weight is challenging with PCOS, but not impossible. It may take you longer to lose weight than someone without hormonal imbalances. While slow progress can feel discouraging, a healthy lifestyle has benefits you may not notice right away.
Even if you don’t lose a significant amount of weight, healthy eating and exercise can reduce your risk of developing long-term health issues, like diabetes and heart disease. In conjunction with medication, a balanced diet and regular activity plan can also help improve some common complaints of PCOS, like heavy periods, acne, excess hair growth, and fertility problems.
Step 2. Exercise regularly
The official recommendation is that adults participate in at least 150 minutes of physical activity a week, which is about 30 minutes each weekday. Physical activity is important for all aspects of your health and wellbeing—including weight management.
Studies indicate that people with PCOS have a tougher time losing weight with exercise than people without PCOS. But, while weight loss may be slower, exercise still has powerful full-body benefits and can relieve many symptoms of PCOS.
If it’s hard to move more and sit less, try these tips:
- Find activities that you enjoy. Exercise doesn’t need to feel like a chore, and there isn’t one single exercise that’s the “best.” Instead, focus on activities that are fun to you, whether that’s playing a team sport, jogging with an audiobook, or hiking with friends on the weekend.
- Build a routine. Making physical activity a key part of your routine can turn it into a habit rather than a chore. Still, don’t stress about doing the same activity every day for the same length of time—allowing some flexibility into your routine can keep things from getting stale.
- Remember that even a little bit counts. Doing 5 or 10 minutes of activity is better than doing nothing at all. If you can’t get in your daily recommended 30 minutes, a quick walk or yoga break still has benefits over staying sedentary. Always take the opportunity to be active when you can.
Step 3. Balance your diet
There isn’t one diet that works for everyone. Instead, experts recommend people looking to lose weight focus on eating more protein, vegetables, and healthy fats while reducing sugars and carbs.
Many PCOS patients struggle with insulin resistance and elevated blood sugar, so making these changes can also reduce the risk of developing type 2 diabetes.
Here are some healthy eating tips:
- Eat protein and vegetables first. Eating protein and veggies before carbs can help lower your blood sugar more than eating carbs first. On their own, carbs can cause blood sugar to spike for a while—and then crash later on, which can lead to overeating.
- Cut back on carbs, but don’t cut them out entirely. There’s evidence that eating fewer carbs can help people with PCOS lose more weight and improve their metabolisms. Thankfully, low-carb doesn’t have to mean no-carb. In addition to eating protein and veggies first in a meal, switch to whole-wheat pastas and breads, which are good sources of dietary fiber and other nutrients.
- Find ways to cope with cravings. Many people with PCOS experience intense food cravings and face issues with binge eating. Cravings can often feel impossible to control, but there are ways to reduce them. A doctor or therapist can work with you to find ways to cope with urges to eat and help figure out what triggers your cravings.
Step 4. Don’t over-restrict calories or over-exercise
Extreme diets and intense exercise sessions may seem like the path to quick results, especially if you’re frustrated with slow weight loss. But these “get slim fast” plans can actually cause more harm than good.
First, cutting out too many calories per day can put you at risk of nutritional deficiencies, which have whole-body health consequences. Research also confirms that extreme calorie-cutting ends with most people regaining weight, especially for those who return to poor eating habits.
Second, over-exercising can have negative consequences, too. One study showed that exercising without eating changes didn’t lead to as much weight loss as expected. Too much exercise can also put you at risk for injury, especially if you push yourself past your physical limits.
While healthy eating and regular exercise are essential for weight loss, take the slow and steady option to see long-lasting results.
Step 5. Consider medication
Though there isn’t a cure for PCOS, some medications can help manage symptoms. Medication often works best in combination with other lifestyle changes, like exercise and healthy eating. Some commonly prescribed medications include:
- Blood sugar medication. Patients with PCOS are often at a higher risk of developing prediabetes, which can turn into type 2 diabetes if left untreated. If your blood sugar is high, your doctor might recommend medication to help combat insulin resistance. Metformin is the most common medication for lowering blood sugar.
- Oral contraceptives (birth control). Oral contraceptive pills can help regulate hormones, which can reduce irregular periods and excess hair growth. They won’t cause weight loss, but the right birth control pill can be part of a robust treatment plan for managing PCOS.
- Weight management medication. The FDA has approved several different drugs to help people lose weight in combination with a healthy diet. Your doctor might recommend weight management medication if you haven’t had success with just diet and exercise alone.
Additionally, if your PCOS or weight contributes to feelings of depression or anxiety, your doctor may recommend seeking mental health help. While mental health treatment (such as seeing a therapist or taking antidepressants) won’t cause weight loss, it can help improve your overall quality of life and help you better cope with stress.
Why It’s So Hard to Lose Weight With PCOS
If you have polycystic ovary syndrome (PCOS) and find it hard to lose weight, you are not alone. More than half of people with PCOS are overweight.1
Advice from healthcare providers is to lose weight, but those with this PCOS know it’s not that easy for a variety of reasons—some of which stem from the syndrome itself.
This article explains the reasons why it’s so much harder to lose weight with PCOS.
Your Body Is in Fat Storage Mode
Insulin is a hormone that transports glucose—your body’s main source of fuel—from your bloodstream into your cells, where it can be used as energy.
PCOS affects your body’s secretion and use of insulin. Your cells become resistant to insulin signals, prompting your pancreas to produce even more insulin. This is known as insulin resistance or impaired glucose tolerance.
Too much insulin promotes fat storage or weight gain, mostly in your midsection.2
If you gain lots of weight or can’t lose weight without significant diet or exercise changes, excess insulin could be the reason.
Treatment options for PCOS are typically aimed at reducing insulin levels and involve diet modifications, exercise, medications, and/or supplements.3
As part of promoting fat storage, insulin acts as an appetite-stimulating hormone. Strong, intense, even urgent cravings are reported in women who are insulin resistant.
High levels of insulin could explain why some people with PCOS experience more hunger.
If not managed, cravings can sabotage even the best eating habits, leading to higher calorie consumption and weight gain.
Eating often, including sufficient protein with meals, and avoiding sugary foods are all helpful ways to reduce cravings.
Impaired Appetite-Regulating Hormones
Another possible factor that could make weight loss and weight maintenance difficult for people with PCOS is abnormal hormonal regulation of appetite and the feeling of fullness.
Levels of appetite-regulating hormones ghrelin, cholecystokinin, and leptin have been shown to be impaired in women with PCOS.4
Dysfunctional levels of these hormones may stimulate hunger in people with PCOS. That encourages you to eat more and makes it difficult to manage weight.
Your Diet Is Spiking Your Blood Sugar
If you’ve been watching your diet and still aren’t seeing the pounds come off, it could be the types of foods you are eating.
A 2010 study compared two groups of women with PCOS. Both ate the same amount of calories and consumed the same distribution of macronutrients (50% carbohydrates, 23% protein, 27% fat, 34 grams fiber).5
Where they differed was the glycemic index (GI) of the foods they ate. The glycemic index indicates how much each food increases blood sugar.
The women with PCOS who followed a low-GI diet showed a three-fold greater improvement in insulin and had better menstrual regularity than the women who did not.
These findings suggest that those with high insulin levels may be able to lose more weight following a low-glycemic index diet.
You Need More Fruits and Veggies
Not eating enough fruits and vegetables can also impact weight loss.
A study found that women with PCOS who followed the Dietary Approaches to Stop Hypertension eating plan—better known as the DASH diet—showed improvements in insulin and abdominal fat loss.6
The DASH diet consisted of 52% carbohydrates, 18% protein, and 30% total fats. It’s rich in fruits, vegetables, whole grains, and low-fat dairy products.
You Have Obstructive Sleep Apnea
Women with PCOS are at a much higher risk for obstructive sleep apnea compared with women without the condition.7
Obstructive sleep apnea occurs when there is a blockage of the upper airway that causes a lack of oxygen during sleep. This results in daytime sleepiness, high blood pressure, and weight gain.
While excess body weight is a main contributing factor to sleep apnea, high levels of androgens (hormones such as testosterone) seen in PCOS, are believed to play a role in affecting sleep receptors.8 Lack of sleep is associated with insulin resistance and weight gain.
The more severe sleep apnea is, the higher the risk of impaired glucose tolerance.
That’s why it’s recommended that all women with PCOS get screened for obstructive sleep apnea and receive proper treatment if diagnosed.
Polycystic Ovary Syndrome (PCOS) and Weight Gain
Why does polycystic ovary syndrome cause weight gain?
PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition — called insulin resistance — can cause insulin and sugar — glucose — to build up in the bloodstream.
High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hair growth, acne, irregular periods — and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape.
Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions.
What are the risks associated with PCOS-related weight gain?
No matter what the cause, weight gain can be detrimental to your health. Women with PCOS are more likely to develop many of the problems associated with weight gain and insulin resistance, including:
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Sleep apnea
- Endometrial cancer