September is Polycystic Ovary Syndrome (PCOS) awareness month. PCOS is a very common condition which affects between 12-21% of cisgender women and transgender/gender diverse people with ovaries during their reproductive years, with around 21% of First Nations people in this group being impacted. For many people diagnosed with PCOS the automatic recommendation from their medical team is to lose weight, or to prevent weight gain. This recommendation can however be highly problematic, so let’s explore the rationale behind weight loss advice for PCOS, and whether this is helpful management strategy (spoiler alert: it’s not!).

Summary of PCOS

Symptoms of PCOS may include irregular or absent menstrual periods, fatigue, excess hair growth on the face and body, hair loss on the scalp and difficulties with fertility. Contrary to popular belief, you do not need to have cysts on your ovaries to have PCOS, however this is a common symptom
Hormones play a big role when it comes to PCOS symptoms. People with PCOS often have higher levels of androgens including testosterone, as well as insulin resistance which means that our bodies are not able to use insulin to get glucose from our blood into our cells as effectively
PCOS can cause chronic inflammation which can further disturb our hormones and increase risk of chronic health conditions including cardiovascular disease. Other factors that are common in PCOS and can increase inflammation include poor sleep and stress
PCOS is also linked with a range of mental health conditions including depression, anxiety and eating disorders
There is currently no cure for PCOS, however there are a range of options for managing PCOS symptoms and for enhancing quality of life

PCOS and weight

A significant proportion of people with PCOS live in larger bodies or report struggling to ‘manage’ their weight. Folks with PCOS often report that they find it hard to lose weight but very easy to gain it. One of the contributing factors to this is high levels of insulin and insulin resistance. Insulin is a growth hormone, so high levels tend to cause increases in weight.

One of the most common recommendations for PCOS management is to lose weight, often without taking peoples previous weight history into account. PCOS treatment guidelines often recommend reducing weight to improve PCOS symptoms and related biomarkers (i.e. blood test results such as testosterone or blood glucose), however sustained weight loss is very challenging and in many cases not possible, including for those with PCOS.

The good news? Other management strategies that don’t require weight change can be very effective in improving symptoms and biomarkers. And let’s not forget that people in bodies of all sizes can have PCOS, so it’s very important that weight loss not be focused on as a ‘one size fits all’ treatment.

Do weight loss diets work for PCOS?

Diets are unhelpful for the majority of people with PCOS for a number of reasons:

Diets don’t work for the absolute majority of people. 95-97% of people who engage in dieting to lose weight regain most or all of the weight within 2-5 years. 2/3 of those people gain more weight, and end up with a higher weight than where they started. For the majority of people of diet, this results in weight cycling with weight trending upwards over time. Weight cycling can increase the risk of chronic conditions such as cardiovascular disease.
Dieting increases the risk of developing an eating disorder. Eating disorders and disordered eating are common in PCOS, and dieting behaviour can add further fuel to the fire by creating an environment of restriction and preoccupation with food, weight and shape. Restrictive eating patterns or cutting out certain foods can actually increase the risk for binge eating – due to the all or nothing cycle which is stimulated by food restriction. This is often followed by an ongoing restrict-binge cycle, which creates an unhelpful eating pattern and relationship with food which can evolve into an eating disorder.
Some PCOS diet plans recommend cutting out entire food groups to manage PCOS. This can increase the risk of nutritional deficiencies, and as with any other restrictive diet can increase fixation on food and either further restrictive eating, or responsive binge eating episodes.
Insulin resistance is a common symptom of PCOS. With insulin resistance comes high insulin levels in the blood, which can impact our hunger and fullness signals because it stimulates our appetite. People with insulin resistance often report experiencing intense food cravings, particularly for foods rich in carbohydrates. This is because your body is not able to use the insulin in your body effectively to transport glucose from your blood into the cells, so it can literally feel like you are starving. The extreme hunger and food cravings often lead to binge eating episodes, which can then further increase insulin levels – and so the cycle continues.
What about carbs? You wouldn’t be alone in thinking that reducing your carbohydrate intake will prevent high insulin levels or insulin resistance. On the contrary - the stress experienced when following a restrictive diet can increase inflammation, which is actually linked with insulin resistance. Most people who have tried low carb diets find them to be too restrictive and ultimately unsustainable long term. Our bodies need carbohydrates from our food because carbs provide every cell and organ in our body with the energy they need to function. You know that pounding headache you get when you’ve eaten a low carb meal or haven’t eaten for a long time? That’s your brain screaming out for glucose. Low carb diets can lead to low energy, brain fog and mood changes, and also create a high risk of binge eating episodes.

So, if not dieting for PCOS what can I do instead?

Discuss treatment options with your GP. There are a range of different medications, supplements and treatments that may help with managing your PCOS symptoms. It could also be helpful to see a reproductive specialist as part of your PCOS treatment team for more specialised advice and treatment options.
Eating regular meals and snacks can assist to improve insulin sensitivity, regulate blood glucose levels and help to support energy levels. Giving your body adequate and consistent fuel can also help to regulate appetite and reduce binge eating.
See a Dietitian who specialises in PCOS nutrition using a non-diet and weight inclusive approach. The Dietitian will be able to tailor recommendations to manage your PCOS symptoms and to support you to improve your relationship with food.
Find a way to move your body that’s comfrotable, accessible and enjoyable for you. Movement is linked with improve insulin sensitivity, mood and sleep quality, as well as reducing long term risk related to chronic health conditions.
Managing your stress levels can assist with reducing inflammation and improving overall mental health and wellbeing. You could also consider seeing a Psychologist to assit with developing healthy emotional coping and stress management strategies.
Get enough sleep! Inadequate or poor quality sleep can increase inflammation, and feeling tired can contrinute to binge eating, so don’t underestimate the power of getting a good night’s sleep.