What is PCOS?
Before we get into why you don’t need to lose weight let’s talk about what PCOS is. Polycystic Ovary Syndrome is an endocrine condition that affects around 1 in 5 people with ovaries. As PCOS is a syndrome, which means that there isn’t a specific set of symptoms that, but rather there are various symptoms that people with PCOS, may or may not, experience.
Symptoms that people with PCOS may experience are:
Darker hair, thick coarse hair, hair growth on chin, neck, face and other areas (hirsutism)
Irregular or lack of periods, irregular or lack of ovulation
Difficulty getting pregnant or reduced fertility
Oily or acne prone skin
Alopecia (hair loss or thinning of the hair
Difficulty losing weight
Mood disorders, such as depression and anxiety
If you are reading this and feel like you share some of the above symptoms, it may be worth consulting your GP.
To find out whether you would have PCOS the standard procedure is the Rotterdam criteria, where two of the following three criteria:
Have an ultrasound to see whether there are any cysts on the ovaries
Track periods or use blood tests to see whether you are regularly ovulating and have a regular menstrual cycle
Look for signs of excess testosterone. Signs of excess testosterone can be from physical signs (facial hair, hair loss or thinning and acne) or blood tests.
Unfortunately for many, they don’t even have the opportunity to have a diagnosis, and the procedure can be draining. Many GPs prescribe weight loss and expect the symptoms to go, or only see PCOS as a real problem if someone is struggling to get pregnant. Until someone has difficulty getting pregnant, it's often just thought of as something people have to learn to live with. This is such a problem and the way PCOS is dealt with generally desperately needs revising. This is because a lack of PCOS management can lead to: increased risk of some cancers, lack of fertility, insulin resistance and along with that this increases risk of type 2 diabetes and increased risk of cardiovascular disease.
Recommendations for weight loss
As previously mentioned PCOS diagnosis can be a long and gruelling process, not to mention people may be suffering with the host of mental health disorders that often accompany PCOS. If this wasn’t enough, people are bombarded with recommendations of weight loss to lessen these symptoms. This is particularly challenging for someone in a larger body, because it can feel like health professionals are blaming them for their condition. Not to mention the struggle of people in larger bodies being told to eat less, move more… Ground breaking guidance, thanks GP!
This is the sad reality for many, as unfortunately weight loss is considered the first line of treatment for PCOS. This is despite the knowledge that weight loss is often harder for people with PCOS and weight loss often isn’t sustained long-term.
Reasons weight loss can be harder for people with PCOS
People with PCOS often experience insulin resistance, which causes increased levels of insulin in the body. As increased insulin is linked with increased hunger and weight gain- it makes it harder to lose weight for people that have this insulin resistance (1,2).
PCOS more than likely involves a hormone imbalance and this has been known to implicate hunger hormones. (3).
People with PCOS often have elevated levels of cortisol, and this is associated with high levels of stress. As stress is linked with weight gain this can make weight loss harder for people with PCOS.
Why weight loss won't cure PCOS
The recommendation for weight loss to manage PCOS is weight stigmatising. There are a lot of ways to manage PCOS which do not relate to weight loss, so the idea that weight loss is perceived, by many GPs, as the only answer is beyond me.
Countless studies have found those who lose weight regain it all within 5 years (4). So, basically while weight loss might help your PCOS in the short-term, it isn’t likely to last.
Weight loss or trying to lose weight can put immense emotional pressure on the individual, and as someone with PCOS is already likely to be stressed from the PCOS, more stress just isn’t needed.
Dieting increases the likelihood of disordered eating. This means people have an unhealthy relationship with food and so may binge, be preoccupied with food or have food rules.
What is the answer?
So, we have touched on why weight loss isn’t the answer, but what is? These suggestions that will follow will most likely go against what your GP is telling you, but your management is led by you, not your GP. So ask yourself how do you want to manage your PCOS? Some GPs can offer prescriptions so this may be a possibility for you, so medical management should be discussed with them.
Manage your stress
This might sound easier said than done but there are some things you can make part of your routine that will make you better equipped to handle stress.
Getting enough sleep is essential for you to better manage stress. People live with different sleep patterns, some can thrive on 6 hours, I myself need about 8 minimum, so find out how much sleep you need.
Another way to achieve better sleep is to limit intake of caffeinated drinks after midday. This might sound too early to you but caffeine can stay in our system for up to 12 hours, so it's worth limiting if we want to achieve better sleep.
Another sleep tip: try and limit screen time before bed and better yet, keep your phone in another room at night.
Practicing mindfulness isn’t for everyone but it can be a great tool to manage stress. There are plenty of apps out there that can help you with this. It doesn’t need to be a class.
Taking up journaling can also be a good way to work through what has happened through your day. Writing your thoughts and feelings down is a great way of getting them out there.
2. Get a better relationship with food
This is again easier said than done and to work out what your relationship is like it’s worth answering a few questions first and if you find any of these questions describe you and you want help with your relationship with food contact Shannon for a consultation. It is worth working on your relationship before any nutritional recommendations are followed, otherwise you might find it all overwhelming.
Do you currently eat enough and regularly? It might be hard to know this so a better way to think about it would be asking yourself do you feel that you have satisfied your hunger when you go to bed? If not then it’s likely you haven’t eaten enough during the day. Aim for three meals a day with snacks in between (2-3) and if this sounds difficult for you, it might be worth consulting a professional to work on your relationship with food with you.
Do you honour your hunger? To put this more simply do you eat when you are hungry or do you try and suppress these hunger signals. If it’s the latter you should focus on trying to eat when you are hungry.
Do you often eat for emotional reasons? Emotional eating is commonly reported with PCOS, but this isn’t something to fear. Emotional eating is perfectly fine, but it doesn’t always solve the problem we were emotionally eating for. Adding other activities into our self-care toolkit means that we don’t’ only rely on food to comfort us. This could be as simple as reading a book or talking to a friend.
3. Nutrition for PCOS
There is vast amounts of nutrition-related research into managing PCOS, so I would be here all day if I went on about all of it. Instead I’ll cover parts which I think are important for you to know.
Carbs are often demonised, but in reality you need them as part of a healthy diet. Carbs should be paired with fats and protein. So, don’t listen to all this cut out carbs nonsense.
You may know there are different types of fats, but what you might not know is there are two fats that are especially important in people with PCOS. These are monounsaturated (MUFA) and polyunsaturated (PUFA) fats. Sources of MUFA fats come from seeds, nuts and avocado, and sources of PUFA fats are oily fish and chia seeds.
Don’t cut out food groups
It often gets thrown around that people with PCOS should cut out gluten, dairy, sugar and probably any other thing that makes life enjoyable. Good news for you. I am here to tell you that this isn’t necessary, because the only reason that this was ever suggested is the association of these foods and weight gain. However, as we said earlier weight loss is NOT needed, so don’t go chucking out the doughnuts!
Movement is great for the mind and body, but this doesn’t have to be a HITT workout, just something you enjoy. My favourite kind of movement are long walks, but it could be swimming, running, or dancing around your kitchen!
How do I get help?
If you do find yourself being diagnosed with PCOS or want to work on your relationship with food then please reach out to Shannon for a consultation. I hope this post has given you the tools you need to manage your PCOS without going on a diet. Side not: Even if it’s claiming not to be a diet, it’s probably a diet. Even though the main aim of this post is to educate you on PCOS, the tips I have given for PCOS also apply to all people. Getting enough sleep, having a good relationship with food and managing your stress are things we could probably all do with!
Huge thanks to Bethany Tripp for this contribution. Beth is an MSc Nutrition and Behaviour Change student who is interested in non-diet approaches, nutrition communication, and offering people advice for common health concerns, without prescribing to weight loss and cutting out foods. Find Beth on Instagram @nutri_beth
1. Stepto, N.K., Cassar, S., Joham, A.E., Hutchison, S.K., Harrison, C.L., Goldstein, R.F. and Teede, H.J., 2013. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic–hyperinsulaemic clamp. Human reproduction, 28(3), pp.777-784.
2. Cassar, S., Misso, M.L., Hopkins, W.G., Shaw, C.S., Teede, H.J. and Stepto, N.K., 2016. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic–hyperinsulinaemic clamp studies. Human reproduction, 31(11), pp.2619-2631
3. Japur, C.C., Diez-Garcia, R.W., de Oliveira Penaforte, F.R., das Graças Pena, G., de Araújo, L.B. and de Sá, M.F.S., 2019. Insulin, ghrelin and early return of hunger in women with obesity and polycystic ovary syndrome. Physiology & behavior, 206, pp.252-258.
4. Mai, K., Brachs, M., Leupelt, V., Jumpertz-von Schwartzenberg, R., Maurer, L., Grüters-Kieslich, A., Ernert, A., Bobbert, T., Krude, H. and Spranger, J., 2018. Effects of a combined dietary, exercise and behavioral intervention and sympathetic system on body weight maintenance after intended weight loss: results of a randomized controlled trial. Metabolism, 83, pp.60-67.