Guest blog by Dr Claire Pettitt PhD MSc RD from CP Nutrition
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“One thing I wish people knew about PCOS: That weight isn’t always the most important factor when it comes to managing PCOS“
After struggling with irregular periods, mood swings and cravings, acne, excess hair growth and weight gain, you’ve finally been diagnosed with PCOS. Although it may be good to finally have an answer to what has been going on with your body, it can also feel like an overwhelming diagnosis. PCOS is a complex condition and symptoms can present differently in every individual, though we tend to see that many people with PCOS will have high androgen levels (male type hormones), insulin resistance and low-grade inflammation.
Despite the complexity of the condition, more often than not the first line advice is ‘to lose weight’ (closely followed by ‘change your diet’ and ‘take the pill to regulate your cycle’). In fact, weight management tends to be the main focus of treatment for PCOS, however as a PCOS Dietitian, as well as someone who has PCOS myself, I wish people knew that ‘weight isn’t the most important factor’ when it comes to managing PCOS.
As simple as it sounds, just advising weight loss and sending someone on their way really isn’t too helpful as we all know that losing weight is just not that easy! Studies have shown us that weight loss is hard whoever we are, and this is especially true for someone with PCOS. Both insulin resistance and high androgens (male hormones) can lead to weight gain, and we also see that those with PCOS may have higher levels of other hormones such as leptin (Houjeghani 2012) which can lead to leptin resistance which in turn leads to insulin resistance and weight gain! A vicious cycle!
Focusing solely on weight loss as the only treatment can also lead to an obsession with dieting and heading down the path of yoyo dieting and weight cycling. We know that this is the case for many people with PCOS as studies suggest around 60% of those with PCOS are on a diet, and 60% of those with PCOS experience binge eating behaviours, and up to 35% have disordered eating (Jeanes, 2017, Lee, 2017, Karacan 2014). There is also a link between PCOS and mental health issues such as anxiety and depression with 45% experiencing anxiety and 34% depression.
In addition to all this we know that for the most part, diets don’t actually work. You may have heard the statistic that 95% of diets fail? Well although this is originally based on an old and very small study (100 people were included), there has been a multitude of studies since then trying to identify the best diet for weight loss, and although for some people weight loss is achievable, it is more often than not short lived, and the lost weight is often regained, if not more. This weight cycling has been associated with increased insulin levels (not good for those with PCOS) and studies also show that dieting is actually a strong predictor of weight gain (Mann 2007, Field 2003) and is an important predictor of new eating disorders (Patton 1999). So all in all dieting may not always be the best option.
You may well be thinking ‘well if weight loss isn’t the most important thing, then what should I be doing?’, well, I would encourage you to flip the script and instead of focusing on what you remove or restrict in your diet, focus on what to add in. The key to knowing what to add in starts with understanding your condition and what is driving your PCOS. Find a healthcare practitioner who will take the time to explain the ins and outs of PCOS to you, go through your test results and symptoms so you can use these are markers of success rather than solely focusing on weight. Weight is not a behaviour, so it is not something we can directly change. Focus on health behaviours in your control – find ways to move your body which you enjoy (regular exercise can improve insulin sensitivity and reduce hormone levels), get enough fruits and veggies in your diet (the antioxidants and fibre will help reduce inflammation), include wholegrain and high fibre carbohydrates (these will help keep your blood sugars under control and reduce insulin resistance). These are just some examples of ways you can nourish your body to help manage your PCOS rather than fixate on a certain number on the scale in the pursuit of weight loss as the only solution.
Download my free guide all about which 𝟓 𝐅𝐨𝐨𝐝𝐬 𝐭𝐨 𝐈𝐧𝐜𝐥𝐮𝐝𝐞 𝐭𝐨 𝐒𝐮𝐩𝐩𝐨𝐫𝐭 𝐲𝐨𝐮𝐫 𝐏𝐂𝐎𝐒 which focuses on what to include in your diet, not what to restrict.
References
NHS. Overview Polycystic Ovary Syndrome https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
Houjeghani S, Pourghassem Gargari B, Farzadi L. Serum leptin and ghrelin levels in women with polycystic ovary syndrome: correlation with anthropometric, metabolic, and endocrine parameters. Int J Fertil Steril. 2012 Jul;6(2):117-26. Epub 2012 Jun 19. PMID: 25493169; PMCID: PMC4258240.
Jeanes YM, Reeves S, Gibson EL, Piggott C, May VA, Hart KH. Binge eating behaviours and foodcravings in women with Polycystic Ovary Syndrome. Appetite. 2017 Feb 1;109:24-32. doi:10.1016/j.appet.2016.11.010. Epub 2016 Nov 4. PMID: 27825940.
Lee I, Cooney LG, Saini S, Smith ME, Sammel MD, Allison KC, Dokras A. Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril. 2017 Mar;107(3):796-802. doi: 10.1016/j.fertnstert.2016.12.014. Epub 2017 Jan 16. PMID: 28104244.
Karacan E, Caglar GS, Gürsoy AY, Yilmaz MB. Body satisfaction and eating attitudes among girls and young women with and without polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2014 Apr;27(2):72-7. doi: 10.1016/j.jpag.2013.08.003. PMID: 24602301.
Mann, T. et al. (2007).Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62(3): 220-233.
Field, A,E. et al (2003). Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics,112:900-906. [Free Full Text http://pediatrics.aappublications.org/content/112/4/900.long ]
Patton, G. C., et al. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. British Medical Journal, 318:765-768. [Free Full Text http://www.bmj.com/content/318/7186/765?view=long&pmid=10082698 ].
BDA, 2022. Polycystic Ovary Syndrome (PCOS) and diet: Food Fact Sheet[online]. Available from: https://www.bda.uk.com/resource/polycystic-ovary-syndrome-pcos-diet.html Accessed 28 August 2022.
Verity - The PCOS charity 