woman with PCOS hiking outside

In my previous article, you learned what PCOS (polycystic ovary syndrome) is, and why you need to be concerned if you have it. In this article, we’ll focus on why it’s so difficult to lose weight when you have PCOS.

1. Elevated Insulin Levels Prevent Weight Loss

When your insulin levels are constantly high, as they are with PCOS, it is nearly impossible to lose weight. From a basic nutritional biochemistry perspective, our bodies exist in two states: fed and fasted.

  • In the “fed” state, which lasts for a few hours after eating a meal, the body works on storing all of the nutrients you just took in. Carbs are broken down to glucose, protein is broken down to amino acids, and fat is shuttled out to the body’s cells for storage.

  • In the “fasted” state, which starts several hours after eating, everything happens in reverse. The muscles burn stored glucose (glycogen) and fat is mobilized from storage and burned for energy.

The problem is that, with PCOS, your body constantly thinks it’s in the “fed” state. With your insulin and blood glucose levels always high, you’re never able to tap into your body’s energy stores, and are more inclined to store whatever you do eat as fat.

In addition, because of the insulin resistance, all that glucose in your blood can’t get into the cells where it is needed for energy. So, although there is a wealth of sugar available, your cells are literally starving—which leads to strong cravings for carbohydrates, especially sugar. No matter how strong your willpower is, eventually you’ll end up giving in…feeding your cells is a basic biological need.

2. Elevated Androgens Cause Weight Gain

High levels of “male” hormones encourage fat storage in the abdomen. So, when women with PCOS gain weight, they tend to gain it in the tummy region. And excess belly fat can increase levels of insulin and androgens, which increases fat storage—creating a vicious cycle.

This is why most conventional doctors recommend that women with PCOS lose weight—studies have shown that weight loss can lower levels of androgens in the blood.

3. A Slow Thyroid Causes Weight Gain

Women with PCOS are 4 times more likely to have Hashimoto’s Thyroiditis, an autoimmune condition of the thyroid that causes hypothyroidism.(1) Additionally, adrenal stress can lead to hypothyroidism, as the overworked adrenals signal to the thyroid to slow everything down so the body can focus on the “flight or fright” response. I don’t know about you, but most women I’ve met fall into the overstressed category!

A slow thyroid slows the metabolism, and can worsen insulin resistance and increase circulating testosterone by lowering SHBG (sex hormone binding globulin), leading to more weight gain.

If you suspect you may have hypothyroidism, it is important to get tested. Be sure to request a full thyroid panel (TSH, T4, T3, reverse T3, anti-TPO antibody and anti-thyroglobulin antibody)—TSH alone is not enough!

4. Dieting Causes Weight Gain

It is well known that diets don’t work. Studies have shown that people who diet are more than 3 times more likely to become obese than people who never dieted.(2) Additionally, 95% of people gain the weight back plus more within 5 years. A predisposition to gaining weight and encouragement by conventional doctors to lose weight makes women with PCOS more likely to have tried to lose weight by dieting. This only slows the metabolism even more.

Following a restrictive diet is not sustainable…we can only ignore our bodies’ hunger cues for so long before swinging the opposite way and eating everything in sight. For this reason, women with PCOS are six times more likely to engage in disordered eating behaviors, especially binge eating and bulimia. The overemphasis on weight loss as treatment for PCOS can lead to restricting calories and overexercising to the point of disorder. In addition, the high rates of anxiety and depression associated with PCOS go hand in hand with poor body image and feelings of guilt and shame around food.

Many of my clients have told me that their doctors don’t believe how little they’re truly eating. But when I assess their nutrition status, I find that most are subsisting on 2 meals a day, or less than 1200 calories per day, which is much too low for an adult woman of reproductive age. Does this seem familiar to you?

Additionally, prolonged periods of inadequate food consumption can lead to multiple nutrient deficiencies—I often find low vitamin D, zinc, magnesium, and omega-3 levels in my clients with PCOS. These deficiencies make losing weight even more difficult.

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So, as you can see, losing weight with PCOS is not simply a matter of eating less and exercising more. Step away from the crazy diet recommendations you hear about on social media. Believe me…it is possible to achieve and maintain a healthy weight for you without having to count every gram of food you ingest. But there’s something even more important than the number on the scale: it’s possible to actually feel better while enjoying a healthy relationship with food.

If you’re ready to start taking control of your PCOS with the help of a registered dietitian who addresses the root causes of your symptoms,

visit my online booking page here

Stay tuned for the next article in this series, where I’ll focus on nutrition & lifestyle tips for managing PCOS naturally.

Be well!

Melissa Groves, RDN, LD

IMPORTANT NOTE -> This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements. 

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