Losing weight with PCOS can feel overwhelming and at times discouraging. Understanding the complex interplay between weight, genetics, insulin and PCOS symptoms is complicated. Polycystic ovary syndrome (PCOS) is not just about fertility issues; it can affect various aspects of a woman’s health, from hormones to mental health.
A PCOS diet, weight loss and physical activity won’t make PCOS go away, but can help reduce the symptoms. In this comprehensive guide, we will delve into the world of PCOS symptoms and explore effective strategies for losing weight with PCOS while managing the challenges posed by this syndrome.
What Is PCOS?
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 5% to 10% of women of reproductive age. It is characterized by infertility, hormonal imbalance and metabolism problems. Women with PCOS usually start showing symptoms as they enter puberty, particularly with weight gain.
The exact cause of this metabolic and hormonal disorder is unclear. However, it’s probably a combination of certain genetic and other factors, such as inflammation and too much insulin.
“This condition is under diagnosed, with 5% to 10% of women not aware of it until they face fertility issues,” explains Hillary Wright, registered dietitian and author of “The PCOS Diet Plan: A Natural Approach for Health for Women with Polycystic Ovary Syndrome.”
Symptoms of PCOS
PCOS is a spectrum disorder, meaning that its symptoms occur on a continuum and may appear more intensely in some people than others. PCOS can affect any woman of reproductive age and has several symptoms, which include:
- Cysts on one or both of the ovaries.
- Body hair on the chest, stomach and back.
- Higher levels of androgen, or male, hormones.
- Insulin resistance.
- Irregular periods.
- Mental health issues like anxiety and depression.
- Ovaries that develop collections of fluid called follicles.
When making a diagnosis of PCOS, your doctor typically looks for you to meet at least two of these three criteria:
- Irregular menstrual periods. This means you are not getting your period on a regular cycle every month.
- Cysts on your ovaries, which are visible on a pelvic ultrasound. These are solid or fluid-filled pockets on your ovaries.
- High levels of the hormone androgen in your blood.
PCOS and Insulin Resistance
Insulin helps our bodies process glucose, or sugar. Insulin resistance is a genetic tendency. When you have insulin resistance, your body doesn’t process insulin properly, which can lead to weight gain. Being significantly overweight and carrying that weight around the belly region is the number one risk factor for insulin resistance, along with a lack of physical exercise.
Insulin resistance is a cornerstone of the development of PCOS, and some believe that this is because of the close relationship between PCOS, insulin resistance and obesity. However, while it is closely associated with being overweight and insulin resistance, not all women with PCOS are overweight.
Obesity or overweight affects between 38% and 88% of women with PCOS.
“The majority of women with PCOS have some insulin resistance. Like many aspects of the disorder, PCOS and its relationship with insulin resistance require more research to be fully understood,” says Wright, who is also Director of Nutrition at the Wellness Center at Boston IVF.
While it’s unclear whether weight gain or insulin resistance comes first in a person with PCOS, studies, like the one published in Nutrients in 2021, have shown that maintaining a healthy weight can reduce unwanted PCOS symptoms.
Wright encourages her clients to view physical activity, not as a calorie burner, but as a natural means of sensitizing cells to be more receptive to insulin.
If you have PCOS and a body mass index of more than 25 – indicating you’re overweight – your health provider may prescribe metformin, says Dr. Endrika L. Hinton, a reproductive endocrinologist and co-director of the Uterine Fibroid Center at Greater Baltimore Medical Center in Baltimore.
Metformin is a medication commonly prescribed for people with diabetes. The use of metformin for PCOS helps to address the metabolism problems associated with the disorder, Hinton says. If you have PCOS, you may receive other treatments for your symptoms.
Alternatively, inositol is a well tolerated dietary supplement that is often recommended along with folic acid to enhance insulin sensitivity.
What Triggers Weight Gain in People With PCOS?
The hormonal imbalance that PCOS triggers cause some women to report having intense food cravings, due to the overproduction of insulin, and never feeling full or satiated, due to the underproduction of hormones like ghrelin, cholecystokinin and leptin, which regulate hunger.
It is a vicious cycle with PCOS. With insulin resistance, the body often stores fat in the abdominal region – which puts a person at higher risk for heart disease and Type 2 diabetes.
“Insulin resistance encourages the storage of fat in the belly fat, which in turn aggravates insulin resistance,” Wright says. This creates a chain reaction of gaining weight, which worsens insulin resistance, which goes on to further worsens the symptoms of PCOS.
This chain reaction between insulin resistance, belly fat and weight gain with PCOS makes weight easier to gain – and harder to lose it.
In addition, high stress, poor sleep and a sedentary lifestyle can all lead to weight gain, particularly in women with PCOS.
“In women with PCOS, these lifestyle factors become compounded and can make weight gain happen even more quickly,” says Maude Morin, a registered dietitian at JM Nutrition, in Ontario and New Brunswick, Canada, a firm that specializes in nutritional interventions for women’s health concerns.
Tips for Losing Weight With PCOS
There is not a specific PCOS diet that works best for everyone.
“There is no one way to manage PCOS, just like there’s no one way to lose weight,” Wright says.
Lifestyle change, including a healthy diet and regular physical activity, is the first line of treatment for the management of women with PCOS.
Wright recommends consulting a registered dietitian nutritionist who specializes in women’s health for a personalized approach. “I focus on a lifestyle plan that is individualized to the woman, includes a healthy diet, plenty of exercise, including strength training two to three times per week, stress reduction and sleep,” she adds.
Wright advises her clients to ignore the scale and focus on managing symptoms and insulin resistance by adopting a healthy lifestyle. “Women with PCOS who are overweight can be healthy. Losing as little as 5% to 10% of their weight will improve their insulin resistance, which in turn is beneficial for their fertility and their overall health.”
Weight loss tips:
- Plan meals in advance and stock your kitchen with healthy options.
- Focus on feeling better and less on the numbers on the scale.
- Choose carbs carefully, both in terms of quality and quantity.
- Build new habits that are sustainable, one at a time.
- Add physical activity to your daily routine. The current federal guidelines recommend 150 minutes of moderate heart-pumping exercise each week. That could break down to 30 minutes, five times a week, or you could do it in smaller chunks.
- Manage stress with exercise, yoga, meditation or quiet walks.
Foods to Eat With PCOS
Many dietitians find success in controlling PCOS symptoms with a plant-forward diet. This may include eating more whole grains, fruits and vegetables, seafood or plant-based proteins like legumes and nuts, and eating little red meat, refined carbohydrates and processed foods.
Some people may praise a keto diet (a type of low-carb diet) or intermittent fasting, but that’s only anecdotal. If you have PCOS and want to make healthier food changes, you should rely on some of the basics of healthy eating.
“Basically, women with PCOS have a greater incentive to eat the way all of us should be eating,” Wright says, referring to the basics of healthy eating as outlined in the federal Dietary Guidelines for Americans.
High fiber foods
High fiber foods, such as whole grains, beans, fruits and vegetables, fill you up faster because it takes longer for the body to process it. The daily fiber recommendation for adults is generally 25 grams for a 2,000-calorie diet. To help boost your fiber intake, choose brown rice instead of white rice and whole-wheat bread instead of white bread.
High fiber foods also provide you with complex carbohydrates that are healthier for the body instead of refined carbs that your body will turn quickly into sugar. Avoiding too many carbs, especially refined carbs, is important when you have PCOS. That’s because carbohydrates break down into glucose, and because women with PCOS have a greater risk of developing diabetes, they should avoid overeating refined carbohydrates.
Foods high in omega-3 fatty acids
These foods can help fight inflammation and provide healthy fats. Good sources for omega-3 fatty acids include fatty fish like salmon and herring, walnuts and chia seeds..
Our body needs fat, but not the unhealthy kind that most of us regularly eat in sweet treats and processed foods. Healthy fat food sources include avocados, olives and oils such as olive oil, says registered dietitian nutritionist Rahaf Al Bochi, who’s a spokesperson for the Academy of Nutrition and Dietetics and owner of Olive Tree Nutrition LLC in Atlanta.
In a 2021 review of PCOS, eating more protein led to positive results. Nuts, nut butters, lean meats, fish, soy and beans are good protein sources.
Include probiotics such as yogurt, cheese, kimchi, sauerkraut and other fermented foods to boost the healthy organisms in your gut microbiome.
“These healthy compounds help detoxify, are anti-inflammatory and provide a significant protection for immunity,” says Wright.
More fruits and vegetables
These are often low in calories and full of fiber and antioxidants, which can help fight inflammation. Non-starchy vegetables and fruit such as leafy greens, mushrooms, berries, peppers, tomatoes and avocados are good choices, Al Bochi says. Most people should get at least four to five servings of fruits and vegetables each day.
Foods to Avoid or Limit With PCOS
- Ultra-processed foods such as crackers, chips, cookies, cakes and sweetened beverages.
- Added sugars. Sneaky sources of added sugar include tomato sauce, salad dressing and certain condiments.
- Red meat and processed luncheon meat.
- Refined carbohydrates like white rice, bread and pasta.
- Fried foods such as french fries, fried chicken and bacon.
PCOS Diet Meal Plan
Focus on sustainable habits that you can live with 80% of the time, says Wright. Focus on plant-forward, whole foods, omega-3 rich seafood. Limit red meat, ultra-processed refined carbs and added sugars.
Here is a sample daily meal plan from Wright’s book that provides approximately 1,800 calories, 108 grams protein and 37 grams fiber:
- Oatmeal with walnuts, fresh orange and skim milk.
- Pineapple and nuts.
- Whole-wheat tortilla with hummus, turkey, cheese, lettuce and tomato.
- One pear.
- Peanut butter and whole-wheat crackers.
- Salmon with carrots.
- Broccoli with cheese.
- Brown rice.
- Skim milk.
What Are the Risks Associated With PCOS-Related Weight Gain?
As many as four in five women with PCOS struggle with obesity, according to the American College of Obstetricians and Gynecologists. PCOS does not go away after the reproductive years.
Being overweight or obese when you have PCOS can put you at greater risk for other serious health problems, including:
- Gestational diabetes if you get pregnant.
- Type 2 diabetes.
- Heart disease.
- High blood pressure.
- High cholesterol.
The significance of PCOS lies in the magnitude of associated risk factors for serious health problems including infertility, metabolic dysfunction, Type 2 diabetes, cardiovascular disease, high blood pressure, psychological problems, obesity and more.
In fact, more than 50% of women with PCOS develop Type 2 diabetes by age 40, the Centers for Disease Control and Prevention reports.
Among women with PCOS, roughly 70% have abnormal elevated cholesterol and fats in the blood, and 34% to 46% have metabolic syndrome associated with the development of cardiovascular disease and Type 2 diabetes
Just as important as the weight itself, is where the weight is stored on the body. With insulin resistance, the body often stores fat in the abdominal region – which puts a person at higher risk for heart disease and Type 2 diabetes.
Many women suffer from the frustration and challenges of weight loss, infertility and PCOS. By following a healthy, plant-forward, Mediterranean style diet – most of the time – along with regular physical activity, you can improve insulin sensitivity, lose weight and enhance fertility and overall health.
Since weight gain complicates PCOS and poses additional health risks, a commitment to a healthier diet and moving your body more can make a positive impact on PCOS. Lifestyle changes may not lead to meeting weight loss goals but they will definitely be effective in regulating insulin and balancing hormones. Even a 5% to 10% weight loss can improve PCOS symptoms, as well as enhance overall health.