Losing weight is hard, but it's especially challenging for women with polycystic ovarian syndrome (PCOS) - a health condition that affects 1 in 10 women between the ages of 15 and 44. Women with PCOS have a hormonal imbalance, which causes problems with the way they metabolise food, and therefore, affects their ability to lose weight. But before we dive into the best ways to lose weight with PCOS, it's important to know what the condition exactly is.
What is PCOS, anyway?
"PCOS isn't really a syndrome because it's not just one disease. It's a constellation of symptoms," says endocrinologist Dr Rekha Kumar, who specialises in weight and metabolism.
And because PCOS affects many hormones (example: oestrogen) that are responsible for a variety of bodily functions, women with PCOS may also find it hard to become pregnant. PCOS is actually the leading cause of infertility in women because the condition may cause women to stop ovulating.
What are the symptoms of PCOS?
Dr Kumar says women are diagnosed with PCOS if they meet two out of the three classic symptoms of the condition. These symptoms include having an irregular menstrual cycle, experiencing ovulatory dysfunction, showing signs of hyperandrogenism, and developing cyst in the ovaries. However, it's important to note that you don't necessarily have to have cyst in your ovaries to have PCOS. Other common signs of PCOS include:
- Hirsutism, aka having too much hair on the face, chin, and areas of the body where men usually have hair. Up to 70 percent of women with PCOS have hirsutism.
- Cystic acne on the face, particularly the chin area, chest, and upper back
- Thinning hair or hair loss
- Darkening of the skin, especially around the neck, groin, and underneath the breasts
- Skin tags in the armpits and neck area
Okay, so why does having PCOS make it hard to lose weight?
"The main cause of the problem with PCOS has to do with insulin resistance. Insulin resistance is a condition in which you're not processing carbs normally, which can interfere with weight regulation and cause fat storage," Dr Kumar explains. Basically, your body doesn't use insulin properly or doesn't make enough insulin to move glucose into cells, leaving an excess of glucose in your blood.
Many women with PCOS struggle to drop the pounds because the condition creates an imbalance in hunger hormones, causing blood sugar levels spike and crash throughout the day. "As a result, women with PCOS tend to have an eating disorder, such as binge eating and yo-yo-dieting," Dr. Kumar says.
The good news is there are plenty of safe and effective ways to lose weight while improving your insulin resistance and keeping your symptoms under control.
"The most effective way to look at weight loss for women with PCOS is as a personal journey and lifestyle change," says dietitian Lisa Samuels. "We want to foster habits that will last a lifetime by making small gradual changes that seem doable and enjoyable and that we know we’ll be able to stick with."
Without further ado, the best ways to lose weight with PCOS:
Limit refined carbs and sugar
Refined carbohydrates, such as white bread and pasta, can cause your blood sugar to rise and fall quickly, making you only hungrier for more.
"Where many women with PCOS get into trouble is when they give into the carbs they crave. Then, their blood sugar crashes, causing a vicious cycle of eating and wanting more carbs," Dr Kumar explains. "The best approach is a low-glycemic diet to stabilise insulin."
In fact, a 2019 study from Food Science & Nutrition suggests that low intakes of fibre and magnesium are associated with PCOS and hyperandrogenism. That means you should go for foods that are sources of complex carbs, such as vegetables and fruits, whole grains, and legumes. These better-for-you carbs take longer to digest because of their high-fibre content, helping to stabilise your blood sugar and keep you fuller longer.
Go for foods that are sources of complex carbs, such as vegetables and fruits, whole grains, and legumes.
So the next time you're craving noodles, go for one of these low-carb pasta alternatives. Instead of white rice, choose the brown variety, quinoa, or farro. At the same time you want to avoid added sugars you'll find in many packaged foods, pre-made smoothies and meal replacement shakes. And if you must use a sweetener, go light on honey or maple syrup.
Fill up on protein and healthy fats
You already know that protein and fat are essential for satiety, so be sure you enjoy a little bit of both with every meal and snack. "Eat consistently throughout the day and keep snacks on hand that have good amounts of protein and carbohydrates in them, for example, peanut butter and an apple, string cheese, or nuts and seeds with some dried fruit mixed in," Samuels says. Moreover, having plenty of healthy fats from avocados, fatty fish, and olive oil can also help curb hunger. "It's a good excuse to get creative with your cooking: Use less salt and try other seasonings like lemon juice, fresh herbs, and other various spices," Samuels adds.
Understand the difference between hunger and cravings
While they might feel similar, cravings and hunger are completely different. Samuels explains that hunger is a more general feeling, while cravings are usually geared toward one specific food, texture, or taste. "Cravings are more emotional or psychologically driven. They can also be driven by feelings of boredom, loneliness, or anxiety," Samuels says. On the other hand, "hunger is a physiological response to the stomach being empty," Samuels notes. If your stomach is rumbling, you have a headache or experience irritability, light-headedness, or nausea, or have trouble focusing, these are signs that you're hungry.
Prioritise a consistent exercise routine
Following a workout routine can help you stabilise blood sugar and reduce your risk for heart disease and diabetes - two conditions women with PCOS are at high risk for. Research suggests that more than half of women with PCOS will have diabetes or prediabetes before the age of 40. Studies also show that there's a strong link between having PCOS and cardiovascular disease.
Be sure to incorporate cardio and strength training into your routine, alternating days between walking, running, or kickboxing with lifting weights or doing bodyweight exercises. Aim to exercise for at least 30 minutes every day and remember to take walks throughout the day to get your blood flowing and your heart rate up. Having trouble sticking to a routine? "Take a new exercise class with a new friend, walk or job around a track, or try a new sport," Samuels says. Adding in movement you love, whether that's walking, dance, or yoga, makes it easier for you to make it a part of your lifestyle.
Ask your doctor about metformin or going on birth control
Aside from making healthy lifestyle improvements, Dr Kumar says that PCOS is often treated with a variety of medications, including metformin, hormonal contraception and spironolactone. You might be familiar with metformin, a prescription medication for treating type 2 diabetes. Metformin works to decrease the amount of glucose you absorb in your food and improves your body's response to insulin. On the other hand, hormonal birth control can help stabilise sex hormones and lower androgen levels that can cause symptoms like excess hair growth and cystic acne. Spironolactone is actually a diuretic with anti-testosterone properties that's also often used to treat PCOS.
"The main thing I think about when prescribing medications for PCOS is what is the most important thing to treat for this person. For some women it's infertility, so I wouldn't prescribe birth control but metformin or Clomid (clomiphene) to help induce ovulation," Dr Kumar explains. Moreover, Dr Kumar says that metformin can also induce weight loss, so it's not appropriate for lean women with PCOS.
"If the acne and excess hair is the bigger problem, then I would prescribe birth control with spironolactone," she says, but it all depends on the patient's health profile and what they're looking to achieve.
Practice self-care to reduce stress
Outside of diet, exercise, and medication, the best way to prevent weight gain with PCOS is to manage stress. By practicing some self-care, such as meditation, exercise, and yoga, you can help clear the mental roadblocks that are preventing you from losing weight and build willpower to overcome challenges. Reducing stress also puts you in better mind frame to make healthier decisions.
Bottom line: You can lose weight to improve your PCOS symptoms, but it doesn't just go away.
Dr Kumar says that while losing weight can greatly improve your symptoms and reduce your risk of other health conditions, it doesn't mean that PCOS goes away once you drop the kilos.
"Well-managed PCOS after weight loss can help improve symptoms, but under severe stress, women with this condition are predisposed to developing the condition again, along with being at risk for gestational diabetes, type 2 diabetes, heart disease," Dr Kumar says.