Updated: Jan 31
After PCOS diagnosis, your doctor might have told you:
“lose the weight and your PCOS will be ok.” Or “Go lose some pounds and then come back”
I usually sigh when I hear that!
I have seen many clients with PCOS fearing food, hating their bodies, and following fad diets, cutting out whole food groups (especially carbs), and still… not losing a pound. They feel frustrated and angry: “What is going on?”
In this week’s blog, I’ll answer this question.
Before we start, know that:
PCOS does not only affect bigger women.
Your extra weight is not the cause of PCOS.
Also, weight loss is not considered a cure for PCOS.
PCOS and Body Weight
Weight gain is one of the most frustrating issues that come with PCOS. Women living with PCOS may notice rapid unwanted weight gain, especially in the mid-section of their bodies.
Studies have shown that about 50% of women living with PCOS are considered “overweight” or “obese” based on BMI, with the other half being women with a “normal” BMI (Diamanti-Kandarakis & Dunaif, 2012).
but why does weight gain come with PCOS?
Your genes play a role in determining your weight. It is thought that women with PCOS have a genetic predisposition of weight gain (Harris & Cheung, 2006; Vrbikova & Hainer, 2009) and more inflammation, which is associated with weight gain and insulin resistance ((Diamanti-Kandarakis & Dunaif, 2012).
2. It starts in the Brain
Weight regulation is complex in everyone’s body. It starts in the brain. The hypothalamus, which is in the brain controls hormones responsible for appetite regulation and more.
Additionally, there is a hypothalamic–pituitary–ovarian axis, which gets affected in PCOS starting from the hypothalamus to pituitary gland to the ovaries (Pasquali, A Gambineri, U Pagotto, 2006).
3. PCOS messes with your hormones
Your hormonal system (the endocrine system) is connected. PCOS creates a hormonal imbalance, where not only your sex hormones may get affected by PCOS, but other hormones too.
Insulin is a hormone important for carbohydrate metabolism. About 70% of women with PCOS have insulin resistance, which means that the body is not using insulin effectively. As a result, the body produces more insulin. Insulin is also a fat storage hormone and leads to food craving.
Androgens are male hormones that are imbalanced in most women with PCOS. Excess androgen (e.g. testosterone) in women:
increases fat production
stores fat in the abdominal area
increases insulin production. (Vrbikova & Hainer, 2009)
c. Appetite/satiety hormones
Hormones such as ghrelin that is responsible for hunger is higher in individuals with PCOS. They also have leptin (satiety hormone) resistance, and lower cholecystokinin (helps with satiety) (Harries & Cheung, 2006).
Environment Effect and the Socioeconomic Factors
Let’s not ignore the external factors that affect weight and people’s behaviours. With PCOS and all what goes on with it, those factors still affect weight.
The effect of Diet Cycling and focus on Body Weight
Dieting and restricting leads to disordered eating and actually weight gain. Yes, you read this right!
Is weight loss in PCOS possible?
Weight loss may happen for some individuals, but let’s reframe it to the root cause of the symptom of weight gain. Is it Insulin resistance? Leptin resistance? Low sleep? Cost of food? Inability to plan for meals? Etc.
Note that intentional weight loss attempts increase risk of weight gain and weight cycling (as opposed to non-weight focused interventions).
Disordered eating and eating disorders risk
Research shows that individuals with PCOS are at increased risk of disordered eating and eating disorders, particularly bulimia nervosa and binge eating disorder (Lee et al., 2017).
The intense pressure to lose weight with PCOS, combined with the biological changes making weight loss extremely difficult, often leads to individuals engaging in more “extreme” methods of trying to lose weight (*aka disordered eating behaviours*).
For this reason, the misguided recommendation to simply lose weight to manage may actually do more harm than good when it comes to overall health and wellbeing.
Ditch the diet mentality and embrace intuitive eating practice
If weight is not within our direct control, and focusing on the number on the scale may actually do more harm than good, where do we go from here? Fortunately, there are many non-diet approaches that can be used to help manage PCOS, such as intuitive eating.
Intuitive eating is a self-care eating framework that focuses on ditching the diet mentality, reconnecting with your body’s inner wisdom such as hunger, fullness, and satisfaction, and learning to eat in a way that makes your body feel and perform its best (both mentally and physically).
Intuitive eating looks different for everyone, however with PCOS it may include exploring many of the non-diet lifestyle interventions discussed in my second blog article. I will have a post about intuitive eating in the future!
If you live with PCOS and are thinking about weight loss, work with me!
I am a weight-inclusive registered dietitian. I practise Health at Every Size and incorporate intuitive eating principles. At the same time, I have the training as a bariatric educator.
If you want to learn more in the area of food peace and PCOS, I recommend Julie Duffy Dillon’s work.
This blog was written with the beautiful contribution of my dietitian colleague, Willow Landen, RD.
Willow is a weight-inclusive registered dietitian practicing in Saskatoon, SK. As a certified intuitive eating counsellor, she specializes in helping individuals from chronic dieting and disordered eating, so they can rediscover the pleasure of food.
Diamanti-Kandarakis, E., & Dunaif, A. (2012). Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocrine reviews, 33(6), 981-1030.
Harris, C., & Cheung, T. (2008). The ultimate PCOS handbook: Lose weight, boost fertility, clear skin and restore self-esteem. Conari Press.
Lee, I., Cooney, L. G., Saini, S., Smith, M. E., Sammel, M. D., Allison, K. C., & Dokras, A. (2017). Increased risk of disordered eating in polycystic ovary syndrome. Fertility and sterility, 107(3), 796-802.
Pasquali, R., Gambineri, A., & Pagotto, U. (2006). The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG: An International Journal of Obstetrics & Gynaecology, 113(10), 1148-1159.
Vrbikova, J., & Hainer, V. (2009). Obesity and polycystic ovary syndrome. Obesity facts, 2(1), 26-35.