Overcoming PCOS Weight Loss Challenges

If you have polycystic ovary syndrome (PCOS) and struggle to lose weight, you are not alone. In the world of women’s health, PCOS is a common endocrine disorder, affecting between 6% and 12% of women. It is the most common cause of anovulatory infertility in women and has been linked to a variety of other notable symptoms.¹ While weight loss with PCOS may be slower and may require medical support, it is possible and can improve many of these symptoms.

Research suggests PCOS can lead to an increased risk of obesity, insulin resistance, type 2 diabetes, cardiovascular disease, depression, sleep apnea, metabolic syndrome, and uterine cancer. While the syndrome can manifest differently between individuals, common symptoms of PCOS include irregular menstrual cycles, ovarian cysts, abnormal hair growth, severe acne, and acanthosis nigricans. Certain lifestyle changes can support weight loss and reduce the disease’s severity.

{{mid-cta}}

How Does Having Polycystic Ovarian Syndrome Affect Quality of Life?

The cause-and-effect relationship between polycystic ovary syndrome, obesity, and insulin resistance is not fully understood within the field of endocrinology. Research on PCOS is still in its early stages. However, researchers believe PCOS is likely due to having a genetic predisposition combined with lifestyle choices.²

No matter the cause, PCOS can significantly affect one’s quality of life. PCOS is more than just irregular periods. It has been linked to an increased risk of heart disease, high blood pressure, diabetes, and endometrial concerns.

Most women with PCOS, even those at a healthy weight, experience some degree of insulin resistance.³ So, what is insulin resistance, and how does it relate to the hormonal imbalances associated with PCOS?

Insulin resistance occurs when the body’s cells don’t respond to the insulin hormone as well as they should. After consuming carbohydrates, the pancreas releases insulin to shuttle glucose from your bloodstream into your cells. However, when the body can’t utilize the hormone properly, glucose levels continue to rise despite high levels of insulin in the bloodstream. This poor blood sugar control can lead to an increased risk of developing type 2 diabetes.

Elevated insulin levels can also cause the body to produce higher amounts of androgens, or male hormones. Androgens, like testosterone, can cause increased abdominal fat, LDL (bad) cholesterol, and fatty acids.³ Unfortunately, increased visceral fat can further increase insulin resistance and worsen blood glucose control. 

What’s Different About the Approach to Losing Weight When You Have PCOS?

Weight loss, even 5% of your body weight, can improve insulin sensitivity and reduce androgen levels.^{3, 4} However, weight loss for women with PCOS can be more complex than for women without the condition. Feedback loops drive increased androgens and insulin levels, making losing weight more difficult. However, successful weight loss can reduce the symptoms associated with PCOS.³

High insulin levels tell your body that plenty of nutrients are available. Instead of breaking down stored glycogen and fats, your body stores nutrients.  

Insulin resistance makes it more difficult for glucose in the bloodstream to enter cells, which can be used for energy. So, even though plenty of glucose is available, body cells signal the brain that they need more nutrition. Your brain responds to these signals by increasing hunger and cravings, especially for carbohydrates. 

Women with PCOS also have lower levels of the peptide hormone ghrelin, a hormone that regulates appetite and body weight. Ghrelin levels decrease after a meal to tell your brain you are full and satisfied. Women with PCOS have lower fasting ghrelin levels and lower reductions in ghrelin after eating. The result is less satiety, more hunger, and weight gain.⁵

Women with PCOS deal with cravings, excess hunger, blood sugar spikes, and insulin resistance. Avoiding simple carbohydrates and monitoring your body’s response to nutrients and exercise can be critical. Still, there’s no one-size-fits-all PCOS diet, so it’s essential to seek guidance from a registered dietitian nutritionist.

<div class="pro-tip"><strong>Learn More: </strong><a href=ozempic-for-pcos>Does Ozempic Really Help With PCOS?</a>.</div>

5 Tips for a Healthy PCOS Diet 

Losing weight with PCOS starts with lifestyle modifications, but additional support may be needed using insulin-sensitizing and anti-androgen medications. Other medical conditions may result from or contribute to PCOS. Following a PCOS diet or meal plan can support a healthy metabolism and sustainable weight loss. 

Consider these tips for designing a PCOS-friendly eating plan that’s rich in complex carbs, healthy fats, lean protein, and fiber:

1. Reduce Carbohydrate Intake

In a crossover study, women with PCOS, obesity, and insulin resistance followed a three-week diet containing 40% carbohydrates, 45% fats, and 15% protein. This was followed by a three-week diet containing 60% carbohydrates, 25% fats, and 15% protein. Blood sugar levels were similar on both diets, but daily insulin concentrations were 30% lower on the lower carbohydrate, higher fat diet.⁶ Two clinical trials showed similar results.⁷

Some experts suggest replacing calories from carbs with proteins. Increasing protein in your diet can help stabilize blood sugar, increase feelings of fullness, and reduce cravings.⁸

2. Choose Low-Glycemic Foods

The glycemic index measures how much a food raises blood sugar.

• High glycemic foods (70-100) cause higher spikes in blood glucose more quickly
• Medium glycemic foods (50-69) cause lower spikes
• Low glycemic foods (20-49) cause the lowest spikes or none at all

In one study, women with PCOS consumed a diet rich in low-glycemic foods for 12 weeks, followed by their regular diet for 12 weeks. Insulin sensitivity improved when they consumed foods with a low glycemic index.⁹  

3. Increase Fiber Intake

High-fiber foods can help you feel fuller for longer with fewer calories. Choose whole grains over refined grains. Researchers found that the average daily intake of whole-grain fiber contributed 15.3% to the American diet. Adults should consume between 25 and 35 grams of fiber daily, a recommendation that only 3% of the population meets.¹⁰

In one study, the diets of women with PCOS were compared with those without. There was an inverse relationship between dietary fiber intake and total body fat. Increased fiber intake can improve body composition and glucose metabolism.¹¹

4. Eat More Fermented Foods

In one study, gut bacteria diversity was reduced in women, especially those with PCOS, compared to men. Correlations between some strains of bacteria and androgen levels suggest that gut bacteria may also play a role in weight gain.¹² Although the research is not robust enough to make a recommendation, ask your healthcare provider whether probiotics and fermented foods may be beneficial. 

5. Consider Supplements and Medication

While it’s possible to meet your nutrient needs through whole foods alone, supplements can cover any potential nutrient deficiencies. Some research suggests that supplements like myoinositol and carnitine may support weight loss. Myoinositol increases insulin sensitivity. However, current studies do not show that it has any significant benefit for treating insulin resistance. 

There are very few FDA-approved medications for treating symptoms of PCOS, leading many prescribers to use medications off-label. 

Metformin is used to treat type 2 diabetes mellitus but may help with insulin resistance by increasing insulin sensitivity.¹³ Prescription medications that increase insulin sensitivity may also help with weight loss. Still, more research is needed.¹⁴

What to Avoid if You Have PCOS and Want to Lose Weight

PCOS is a complex disorder. There is no one-size-fits-all solution. It is easy to get frustrated when you are eating healthy and exercising and still aren't losing weight. Keep in mind that a healthy diet and exercise benefit your overall health. 

Avoid refined carbohydrates. Besides causing blood sugar spikes, they can cause inflammation and worsen insulin resistance. 

Don't restrict your diet too much or under-eat. Calorie restriction may cause short-term weight loss, but it is not sustainable and can cause other health conditions. 

Lack of sleep and increased stress can lead to weight gain, undermining your efforts. Instead, try mindfulness, yoga, spending time outdoors, and breathing exercises to help manage stress. 

More Tips for Overall Wellness When Having PCOS

Lifestyle factors outside dietary changes can also influence hormone levels and improve quality of life. Consider these additional tips for managing PCOS symptoms and maximizing overall health:

1. Treat Obstructive Sleep Apnea

Obstructive sleep apnea is characterized by recurrent episodes of complete or partial airway obstruction while you sleep. It leads to intermittent low levels of oxygen and frequent nighttime awakenings. People with obstructive sleep apnea have an increased risk of insulin resistance. 

Obstructive sleep apnea is more common in women with PCOS. A longitudinal study showed that women with PCOS have a 2.26 higher risk of developing obstructive sleep apnea than women without the condition, regardless of body mass index (BMI) or age.¹⁵

Symptoms of obstructive sleep apnea include:

• Snoring
• Excessive daytime sleepiness
• Morning headaches
• Awakening at night, gasping or choking

If you have symptoms of obstructive sleep apnea, contact your healthcare provider for treatment options. Improving sleep can help with weight loss. 

2. Take Care of Your Mental Health

PCOS symptoms can cause many women to struggle with anxiety and depression. In one study, women with PCOS reported higher levels of anxiety, depression, and negative self-image than women without the condition.¹⁶ Other studies show similar results.^{17, 18}

Anxiety and depression can sabotage your attempts to make lifestyle modifications that lead to successful weight loss. Medications used to treat anxiety and depression can also contribute to weight gain, but some options don’t. 

If you have anxiety or depression, contact your healthcare provider for treatment options.

3. Increase Physical Activity

Increasing physical activity throughout the day can help improve:¹⁹

• Weight management
• Fasting insulin levels
• Blood pressure
• Cardiovascular health
• Mood
• Sleep quality
• Reproductive function

In one study, women with PCOS who performed progressive resistance exercise for four months had reduced androgens and fasting glucose.²⁰ Fasting glucose levels are your glucose levels first thing in the morning. Impaired fasting glucose is a sign of insulin resistance. 

Overexercise can negatively affect ovulation and reproduction. Aim for 150 minutes of moderate-intensity exercise each week.²¹ Choose activities you enjoy and incorporate them into your daily schedule.

• Both cardio and resistance exercise can help reduce abdominal fat and increase insulin sensitivity. 
• Cardio can improve sleep, reduce anxiety, and improve mood. 
• High-intensity interval training (HIIT) involves short bursts of high-intensity exercise followed by lower-intensity recovery. HIIT can help with weight loss and insulin sensitivity.

<div class="pro-tip"><strong>Also Read: </strong><a href=pcos-meal-plan>PCOS Meal Plan:7-Day Nutritional Bliss</a>.</div>