Why Is It So Hard To Lose Weight With PCOS?
If you have PCOS and are having difficulty losing weight, you aren’t alone! This is the most common complaint I hear from my patients with PCOS. It can be so frustrating to try diet after diet, along with exercise, and get minimal results while you see others around you losing weight on the same program. It can take forever to lose a few pounds. And it seems that you can regain it in a week! It’s even worse when your doctor says “you really should lose some weight”. It’s not like you don’t know that or aren’t already trying. Having a weight problem and PCOS often go hand and hand. But it doesn’t mean it’s your fault or that you are doing something wrong. Your weight is based on many factors, including genes, your unique metabolism, gut microbiome, endocrine disruptors in food and the environment and just having PCOS. PCOS in itself can actually be contributing to weight gain and/or difficultly losing weight. There are several possible reasons why it can be more difficult to lose weight with PCOS, some research-based and others are theories.
7 Reasons why it can be so hard to lose weight with PCOS
Women with PCOS may have slower metabolisms than women without PCOS. Your metabolism is based on your basal metabolic rate, physical activity and everyday movement as well as the calories you burn digesting food (thermogenesis). Your basal metabolic rate (BMR) is how many calories your body needs just to function. Compare this to laying on a couch all day! This includes breathing, circulating blood, keeping your heart beating, etc. On average, your BMR represents 60%–70% of energy and plays the greatest role in your metabolism. This study showed that women with PCOS, particularly those with IR, had a significantly decreased BMR. Women without PCOS were found to have an average BMR of 1,868 calories. Women with PCOS who were not insulin resistant had a BMR of 1590 calories. And women with PCOS who were insulin resistant had a BMR of 1116 calories. This is huge difference. The good news is that exercise, especially weight training, can help increase metabolism. (pic: canva) (Georgopoulos et al, 2009)
Reduced postprandial thermogenesis
Thermogenesis usually makes up 5-15% of how many calories you burn in a day.(Westerterp KR 2004) Postprandial thermogenesis has been shown to be reduced in PCOS. This study showed the greater the insulin resistance, the greater the reduction in thermogenesis.(Robinson et al, 1992)
Effects of insulin
We know that obesity worsens insulin resistance, but it’s also believed that insulin resistance can contribute towards obesity. Insulin is a storage hormone and wants to store carbs, protein and fat. The more insulin your body secrets, the more likely it is that you will store excess body fat. And since the majority of women with PCOS are insulin resistant, this means that you are secreting more insulin. This in turn can contribute to greater fat storage. (Erion et al, 2017)
Problems with appetite regulation
Have you have been told, “just eat when you are hungry?” Well this doesn’t work so well for many people – including those with PCOS – because you may always feel hungry. Our appetites are controlled by a complex system of hormones, including those that make us feel hungry (ghrelin) and those that make us feel satiated (leptin and CCK). Research is suggesting women with PCOS may have an impairment with appetite regulation hormones.- One study showed that women with PCOS have a reduced secretion of CCK, a satiety hormone, after meals. Impaired CCK secretion may play a role in the greater frequency of binge eating and weight gain/difficulty losing weight in women with PCOS. (Hirschberg et al, 2009)
– This older study down on women with PCOS suggests a disturbance in the appetite regulating feedback system in the interaction between leptin and NPY (neuropeptide Y). (Baranowska et al, 1999)
– This study concluded that women with PCOS have reduced postprandial CCK secretion and deranged appetite regulation associated with increased levels of testosterone. Impaired CCK secretion may play a role in the greater frequency of binge eating and overweight in women with PCOS. (Hirschberg et al, 2004)
Increased carb cravings
The majority of my patients with PCOS report carb cravings, usually for sugary or white carbs. Not only do these foods pack in calories, but they can worsen insulin resistance, which can lead to weight gain in itself. Women with high androgen levels independent of PCOS status were found to have greater cravings for high-fat foods and carbohydrate-rich foods and possibly a greater intake of these foods (Lim et al, 2012).Higher rates of anxiety, eating disorders and mood disorders may lead to more emotional eating. This isn’t “proven” but in my experience, it’s an issue for some women.
Women with PCOS, especially if obese, have been found to have increased incidence of sleep disorders. Inadequate sleep has been linked to weight gain. Researchers believe that a lack of sleep alters the release of two hormones that help your body to regulate feelings of hunger. When you don’t get enough sleep, your body releases more ghrelin, which stimulates appetite, and release less leptin, which suppresses appetite. In addition, fatigue produced by limiting sleep may reduce physical activity and thus energy expenditure (Pate et al, 2006) and (The Bronfenbrenner Center for Translational Research)
I didn’t write this blog post to depress you, but rather to show that it can be more difficult for some women to lose weight with PCOS. It doesn’t mean you’re doing something wrong. But that being said, it’s NOT IMPOSSIBLE by any means! I’ve been specializing in nutrition for PCOS for over 15 years and majority of my patients have been able to lose weight. The trick will to find what works for you and make the plan be realistic and something you can live with. Stay tuned for more blog posts on tips to help you lose weight with PCOS.
I especially love problem-solving, whether it’s helping women defeat issues plaguing them for years, helping a busy executive find practical ways to get heart healthy, or providing tips to help you reverse diabetes. That’s why I’m on a constant quest to expand my knowledge by staying on top of the latest research.