Women with PCOS often struggle with their weight because they have higher levels of male hormones and their bodies are less sensitive to insulin. But there are certain lifestyle changes and treatment options available to help you maintain a healthy weight and effectively treat your PCOS.
Felice Ramallo, MSCN, RD, LD, and Lead Dietitian at Allara, the comprehensive care women’s health platform designed to serve women with Polycystic Ovary Syndrome (PCOS) provides us answers to FAQ’s regarding PCOS & weight loss/management in this article.
Explain the connection between PCOS & the use of insulin in the body. Testing for body weight.
PCOS shares many of the same genes as insulin resistance and type 2 diabetes.
Insulin resistance is the desensitization of the body’s cells to insulin, the hormone that tells our cells “hey, blood sugar has risen, please accept some glucose into your cell.” Blood sugars naturally should rise after eating, then insulin is released so that our cells can utilize that nutrition.
Fat cells don’t become resistant as other cells do, so they may accept more glucose, becoming fuller and fluffier, while the rest of the body’s cells may think that the body is hungry, because nothing told them there was glucose available.
Individuals with insulin resistance may find that it is harder to lose weight or lose fat. Additionally, PCOS is also typically accompanied by elevated androgen levels, which can also make fat or weight loss more difficult.
How does Lack of sleep affect body weight issues especially in the case of females with PCOS?
Lack of sleep, for anyone, is a major predictor of resistance to weight loss. Sleep is when all of the body’s reparative and regenerative processes happen. While inflammation itself can be very intangible, it shows up in various ways, from increasing cholesterol to worsening insulin resistance. Sleeping well means a reduction in the inflammatory pathways happening throughout the body. It gives all of your systems a chance to clean up any waste or inflammatory products that might have come up during the day. In turn, your body can use your waking hours to better function, thus boosting your metabolism, and allowing you to get through your day with enough energy to make healthy meals, work out, etc. Additionally, lack of sleep is also associated with worse cravings and more extreme hunger, which can contribute to weight gain over time.
I recommend aiming for 7-9 hours per night of a consistent bedtime routine.
With the increasing predominance of PCOS, when is the right time a female should get her reproductive hormone tests done? How often should the tests be repeated?
PCOS occurs in 1 in 10 people with ovaries/women globally. Luckily, it is gaining more and more awareness. Any time at least some of these symptoms come up, I would recommend getting a hormone panel run at the OB/GYN’s office:
- irregular or missing period
- unexplained infertility (i.e. trying to conceive for a year without success)
- excessive acne
- excessive hair growth on the body, face, or neck
- hair loss or thinning of hair on the head
- increased skin tag growth
- appearance of skin darkening and/or thickening around the neck, armpits, or groin
- unexplained rapid weight changes
Reproductive hormone tests should be repeated as often as one’s provider recommends. However, they can be expected to be retested every 6-12 months.
How does heredity play a role in the case of PCOS, fertility & bodyweight?
Heredity plays a major role in PCOS and body weight. In terms of general fertility, there are a lot of components that play into that: environment, medications, lifestyle, etc. Fertility isn’t as strongly hereditary as PCOS and bodyweight.
Approximately 20-40% of those with PCOS have a mother or sister with the condition. Additionally, PCOS shares many of the same genes as type 2 diabetes, resulting in more than half of people with the condition developing T2DM by the time they are 40 years old.
Bodyweight, similarly to fertility, is affected by so many facets of one’s life. There are isolated genes that can predispose someone to carry more fat or affect the distribution of fat on the body. Additionally, there are genes that affect muscle development, growth, and shape. Bone density can also affect weight and is determined by a mixture of genetic, environmental, and lifestyle factors. Interestingly, some at-home DNA tests can even suggest whether you will be heavier or lighter than the average person at your height!
Diet Pattern that works against the body. Foods to Avoid & add to the diet.
According to nutritionist Felice Ramallo, “There are no specific foods that should be avoided in the diet. How one eats is just as, or more, important than the exact foods one eats, if the aim is the management of a healthy weight and improvement in PCOS symptoms. When I say that, I mean that it is extraordinarily important to eat in accordance with our bodies’ signals. It doesn’t end at eating when you’re hungry, stop when you’re full. It incorporates listening to and learning from all of the messages.” She goes on to add, For example, cravings: sometimes they simply mean “I want that cookie, or I want some chips,” and I’d say go for it. You are more likely to overindulge and damage your relationship with food the longer you avoid it. However, sometimes cravings also mean that you could be over-restricting a certain food, not getting enough calories or carbohydrates in a day, or you are beginning to experience insulin resistance.
Beyond that, these are my recommendations for what to include more of:
- Home-prepared foods – The more food cooked at home, the better opportunity to choose higher quality ingredients like lean meat, whole grains, non-starchy vegetables, herbs, spices, etc. Meals cooked at home typically have lower saturated fats and sodium, too.
- Aim for non-starchy vegetables to make up about ½ of your plate or meal volume. One of the quickest options is a plain side salad of mixed greens with homemade dressing. Raw or cooked vegetables are great options, and feel free to add dips or dressings (especially homemade ones) like yogurt-based ranch, hummus, etc. Examples of non-starchy vegetables include lettuces, broccoli, cauliflower, brussels sprouts, cucumber, zucchini, eggplant, asparagus, etc.
- This goes along with my general recommendation to incorporate plenty of fiber in the diet. Carbohydrates have been demonized lately, but one of the best sources of fiber are whole grains. I suggest having whole grains with at least 2 meals or snacks per day. Some options include whole grain bread or pasta, quinoa, brown/black/wild rice, sorghum, millet, popcorn, etc.
- Nutrient-rich fats should be included regularly in one’s day. The #1 healthiest fat is extra virgin olive oil. I recommend using it to make homemade dressings, or to top cooked foods in sauces such as chimichurri. Adding nuts and seeds throughout the day is an easy way to increase healthy fats. Additionally, some foods, like avocado and egg, have nutrient-rich fats as well.
- Plant-based proteins offer more than protein. They are often a source of a variety of micronutrients, like vitamins, minerals, and fiber, that increase overall diet quality. Some of my favorites include beans, lentils, and tofu. Even for meat-eaters, I would recommend switching it up with plant based protein at least 2 or 3 days per week.
Tips to handle food cravings.
The first step to handling food cravings is actually having them. That is the only way for them to go away. Yes, there are strategies that silence them for a short period of time, but eventually, when they can no longer be avoided, a binge will happen. If this is a new concept for you, you may find that you want your sweets or cravings all of the time when you give yourself permission to eat them, but after a couple of weeks, the novelty will wear off, and you will finally feel that your cravings no longer control you.
Here are my top tips for including sweets in the diet:
- Eat sweets as close to the meal as possible. That way, the protein, fat, and fiber from the meal can help slow down the speed at which carbohydrate or sugar can enter the body.
- Consider adding fruit and nuts to the dessert plate. I typically recommend making ½ of the plate fruits; ¼ of the plate nuts, fat, or protein; and using the remaining ¼ for the sweet. Then, if you still want more, have it.
Types of exercise and lifestyle modifications that have served women well to manage their hormones & healthy weight.
The best type of exercise for any woman is movement that you enjoy. Some people respond best to classic cardio, like running. Other people feel best with slow weighted workouts or bodyweight exercises like stretching or yoga. Combination strength and endurance workouts, like HIIT, can also work for some individuals. I always suggest trying out new types of movement and seeing how it impacts sleep, mood, and general energy levels. The best barometer for finding the ‘perfect workout’ is listening to your body.
In terms of getting enough movement for general health and weight management, general guidelines suggest a minimum of 150 minutes of moderate to vigorous activity each week. This could be any movement that causes heavier breathing and a moderate increase in heart rate. The time could be broken up any way that works for you.
As for other lifestyle modifications, the sleep and nutrition strategies I discussed above are some of my highest suggestions. However, don’t forget about mental health. It is important to get mental and emotional well-being taken care of. For some people, that means therapy and medications, but most of us would simply benefit from scheduling in some self-care or ‘me-time’ regularly each week or before bed.
According to you, how hard is it to lose weight with PCOS? (support with scientific studies)
It can be incredibly difficult to lose weight with PCOS. We know concretely that dieting or intentional calorie restriction is associated with weight gain in the long term. Those with PCOS often also have an extensive dieting history. This could be due to a variety of factors brought about by being told that weight loss is the only solution for symptom improvement, body insecurities, or other pressures to lose weight.
PCOS in and of itself is also recognized as causing weight gain, irrespective of dietary intake or nutrition status. Some of the underlying genes associated with PCOS also predispose individuals to weigh more, which cannot be easily manipulated by diet alone. It is important to focus on healthy lifestyle behaviors as a whole, as they are what improve PCOS symptoms, labs, clinical markers, and can help achieve the 5-10% weight loss recommended for symptom improvement.
With that being said, PCOS is also associated with a metabolism that is better at downregulating at any sign of food scarcity. In simple terms: if you have PCOS and restrict your food, your body is better at slowing down your metabolism to match the lower amount of energy (calories) available. Even in the typical population, calorie restriction causes a reduction in metabolic rate (metabolism).
What’s the solution? Focus on healthy behaviors, like a balanced diet, adequate exercise, and good mental health and stress management. Following those patterns will yield better health and weight management in the long run.
About the author: Felice Ramallo, MSCN, RD, LD, and Lead Dietitian at Allara, the comprehensive care women’s health platform designed to serve women with Polycystic Ovary Syndrome (PCOS). She completed her BS of Nutrition at Syracuse University and went on to complete an MS of Clinical Nutrition and dietetic internship at the University at Buffalo.