“Women with PCOS typically have an imbalance in sex hormones, hunger hormones, as well as insulin resistance,” says Vandana Sheth, RDN, a spokesperson for the Academy of Nutrition and Dietetics and a dietitian in private practice in Los Angeles. “All of these factors can make losing weight very challenging.”
While it is possible to be healthy even while carrying some extra pounds, women with PCOS have an increased risk of diabetes and heart disease–risks that may be worsened by being overweight.
PCOS is also a leading cause of infertility in women, and being overweight doesn’t help your odds. Research has shown that each point higher on the body mass index you climb above 28 adds a year to your “age,” fertility-wise, says Mark Perloe, MD, a reproductive endocrinologist with Shady Grove Fertility Atlanta. “If your BMI is 38 and you’re 30 years old, your chances [of getting pregnant] are similar to a 40-year-old.” (Losing just 10 to 15 pounds can improve your chances, but it’s not entirely clear if you can restore your fertility to “normal,” Dr. Perloe adds.)
So how do you lose weight safely with PCOS? If you have the condition and want to shed pounds, here are some common-sense approaches.
Strict diets are too likely to backfire, says Julie Dillon, RD, a dietitian who works with people with PCOS in North Carolina. When a diet fails, your best intentions can deteriorate into a vicious cycle of losing weight, gaining it back, and losing it again. But yo-yo dieting can hurt your health: Recently, it was linked with double the risk of heart attack, stroke, or death in people who already had coronary artery disease in a study in the New England Journal of Medicine. Women with PCOS already have a higher risk of heart attack, high blood pressure, high cholesterol levels, and stroke.
Instead, center your healthy eating plan around anti-inflammatory foods, as women with PCOS have chronic, low-level inflammation. That means avocados, nuts, fish, olive oil, and green tea. Many of these foods are also components of the much-touted Mediterranean diet (really more of a lifestyle), which has repeatedly been shown to reduce the risk of heart disease, cancer, and Alzheimer’s, among other benefits.
A Mediterranean diet is also relatively low in calories and contributes to stable blood sugar. “What we look for is a low-glycemic-index diet,” says Richard Legro, MD, interim chair of the department of obstetrics and gynecology at Penn State Health Milton S. Hershey Medical Center. “We are trying to avoid exacerbations of rapid rises in glucose and/or rapid rises in insulin because those tend to be perturbed anyway in women with PCOS.”
Another surefire way to avoid spikes or crashes in blood sugar is to eat regularly throughout the day. Prolonged periods without eating will only increase your urge to binge, so, counterintuitive as it may seem, eat more often to lose weight with PCOS. That means every three to four hours–except, of course, when you’re sleeping, says Dillon. “I like to start with three square meals,” she says, “and if you need to eat more, you need to eat more.”
Learning to listen to your body is also crucial, Dillon adds. Try to zero in on when you’re really hungry and when you’re full. Turn to exercise or another outlet when you’re tempted to eat out of boredom or stress. “It’s moving away from hating their body and learning to listen to what it needs,” Dillon says.
Some women with PCOS report intense cravings for carbs, sometimes leading to the urge to shun them entirely, says Angela Grassi, RD, founder of the PCOS Nutrition Center in Bryn Mawr, Pennsylvania. But avoiding all carbs might actually set you up for more cravings, leading you to eat more carbs of the not-necessarily-“good” variety.
Be choosy about your carbohydrates. “Eat balanced meals with a little bit of carbs like whole grains,” says Grassi, who has PCOS herself. Stay away from processed, high-glycemic-index carbs like crackers, candy, and soda. Instead, select whole grains like brown rice or quinoa or fiber-filled sources of carbs like potatoes, vegetables, and fruit, all of which help control blood sugar.
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Exercise is good for all of us–even if weight loss isn’t your goal. But for women with PCOS, physical activity doesn’t just help your body burn calories. It can also increase insulin sensitivity and decrease insulin resistance, says Sheth, which can help stave off diabetes.
It might help to focus on the behavior of exercising a few times a week rather than the number on the scale, Dillon says. “Weight is not a behavior, and I encourage women to focus on behaviors,” she says. “Notice which ones help energize and the ones that don’t. Notice which behaviors are sustainable.”
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Get enough Zzs
People who skimp on sleep are more likely to be overweight, and inadequate sleep can also affect insulin resistance. “Aim for seven to nine hours of restful sleep every night,” says Sheth. “Start with a calming bedtime routine, and go to sleep earlier,” she recommends.
If you’re spending enough hours in bed but still waking up tired, talk to your doctor. Research has found that women with PCOS are not only more likely to feel sleepy during the day, they are also more likely to have obstructive sleep apnea, a condition in which breathing stops periodically throughout the night. Being overweight or obese increases your risk for sleep apnea, which in turn makes you more likely to develop type 2 diabetes and heart disease. “Treating apnea may also help with weight loss,” says Dr. Perloe.
Stress can make so many things worse, weight being one of them. When we’re stressed, we tend to make poorer eating decisions, and our bodies also might store more fat than when we’re calm. Women with PCOS tend to have a high baseline level of anxiety, Sheth says, which could contribute to weight concerns. “Finding ways to better manage stress with regular activities on a daily basis such as meditation, breathing techniques, yoga, and journaling can be very helpful,” she says.
“Some people still feel [weight-loss surgery] is too extreme,” Dr. Legro says, but if you’ve been unsuccessful with your attempts to shed pounds in the past and you’re significantly overweight, it may be an option. PCOS is a condition that lowers the threshold for bariatric surgery to a BMI of 35 or more, Dr. Legro explains, whereas typically candidates must have a BMI greater than 40.
It’s still a serious decision you’ll need to talk over in-depth with your doctor. You'll also have to maintain a stable weight for six months beforehand and be free of certain other underlying health issues, Dr. Legro adds.
Bariatric surgery can be effective at reducing the type of abdominal fat that increases other health risks, Dr. Legro says. Some experts also believe weight-loss surgery can help control blood sugar levels in people with type 2 diabetes.