Polycystic ovarian syndrome (PCOS) is known for making weight gain hard to shift, especially around the waist, giving many women with the syndrome that classic apple shape. Not only is this excess weight frustrating and stressful, it actually worsens PCOS because fat tissue promotes insulin resistance. This causes excess insulin release, which promotes fat storage, creating a perpetuating cycle. So when the weight seems to stay no matter what you do, how do you lose weight with PCOS?
First, check your thyroid
Women with PCOS have higher rates of hypothyroidism - low thyroid function. Because the thyroid gland controls the rate of your metabolism, low thyroid function promotes fat storage. You would also feel fatigued, which may make it harder to exercise.
Have your doctor check your thyroid function with a simple blood test. If your thyroid blood test comes back normal but you are still experiencing weight gain/hard-to-shift-weight, fatigue, hair loss, constipation, heavy or irregular periods, depression, brittle nails and hair or sensitivity to the cold you could still have sub-clinical hypothyroidism (a mild version of hypothyroidism). This can be due to nutrient deficiency so see your naturopath for further investigation.
Diet matters most
When it comes to losing weight, it is actually your diet that matters the most. Although energy intake matters, I'm not talking about calorie counting here. Calorie counting can be stressful and very difficult to stick to, causing yo-yo weight loss or no weight loss at all.
When it comes to weight loss, it's not only calories that matter, it's blood sugar control. The way to control blood sugar is to consume a low-glycaemic diet that focuses on protein with every meal, healthy fats, fibre from lots of vegetables, some whole grains and a little fruit, as well as regular intake of food, with snacks between meals to stabilise blood glucose levels throughout the day. Eating in this way will also provide plenty of vitamins and minerals that help with insulin sensitivity.
Low glycaemic diets are low in refined carbohydrates (anything made from white flour, and even whole grain flours to some extent) and sugar (including that in packaged foods, sauces, fruit, dried fruit, honey and syrups). Most people will lose weight on a low-glycaemic diet. If you don't, you may need your diet adjusted further, as well as some supportive nutrients to assist weight loss - see your naturopath.
Exercise is key
Although diet matters most, exercise is needed for optimal weight loss results. Research shows that a combination of resistance exercise (like weights, resistance bands and yoga) and cardio exercise (anything that raises your heart rate - like dancing, skipping, walking, running, circuit training, aerobics, cycling) yields the best results.
Exercising for 30-60 minutes five times weekly is ideal but whatever you can do to get moving is a great start. It could even be parking further away from work so that you have to walk further to get there, taking the stairs or walking the dog further than you usually do. If you are ready for a full exercise regime, alternate resistance days with cardio days as too much cardio can push your stress hormones high, which inhibits weight loss.
As you've probably guessed, stress itself is bad for weight loss. Chronic stress causes our nervous system to over-activate, stimulating our adrenal glands to release cortisol, our stress hormone. Cortisol increases insulin and promotes fat storage so if we are stressed much of the time (even if its just that we are very busy or not getting enough sleep) cortisol is chronically elevated and weight is hard to budge. Solution = schedule in time to relax, time to sleep and time to just be (do nothing). Make it happen.
How much weight to lose
The ideal is to get your body mass index (BMI) within the healthy range, however, this can be really difficult! Research shows that losing even 5-10% bodyweight benefits reproductive and blood sugar outcomes for women with PCOS. Keeping this weight off is even better so making slow and sustainable changes by implementing the above strategies is the key long-term weight loss and reduction of PCOS symptoms.
It is equally important not to go too far with weight loss. If your BMI drops into the underweight range it can cause the body to halt ovulation.
Don't do it alone
Diet and exercise changes are much easier if you have a friend, partner or family doing them along with you. Organise to meet friends for walks, dancing, gym etc. Let your friends know about your goals and dietary changes and ask for their support when eating together. Ask your partner or family to adopt a low-glycaemic diet along with you so that there are less temptations in the house and you don't feel like you are going it alone. Their health will benefit too.
Finally, get the right healthcare team on your side. Regular sessions with a naturopath, personal trainer, or even psychologist can help you to get past any road blocks, boost your motivation to succeed and help you to get the best results.
All the best on your health journey,
Josephine Cabrall is a Melbourne based naturopath with a special interest in PCOS. She is available for consultations at Brunswick Health.