What Makes It So Hard to Lose Weight With PCOS?

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Have PCOS and struggling to lose weight? You’re not alone. Half of all women with PCOS are overweight. Advice from health care providers is to lose weight, but those with this syndrome know it’s not that easy. Here are some reasons that explain why it’s so much harder for women with PCOS to lose weight.

Your Body Is in Fat Storage Mode

Insulin is a hormone that we all need to survive. Insulin transports glucose (our body’s main source of fuel) from our bloodstream into our cells where it can be used as energy.

Since insulin is a growth hormone, too much of it promotes fat storage or weight gain, mostly in your midsection, resembling a “spare tire” above your belly button. If you are gaining lots of weight or can’t lose weight without significant changes to diet or exercise, excess insulin could be the culprit. Treatment options for PCOS are typically aimed at reducing insulin levels and involve diet modifications, exercise, and medications or supplements.

You’re Hungrier

Part of promoting fat storage, insulin acts as an appetite-stimulating hormone. High levels of insulin could possibly explain why some researchers believe that women with PCOS may experience more hunger than someone without the condition. Strong, intense even urgent cravings are reported in women who are insulin resistant. If not managed, these cravings can sabotage even the best eating habits, leading to higher calorie consumption and weight gain.

Eating often, including sufficient protein with meals, and avoiding sugary foods are all helpful ways to reduce cravings.

Impaired Appetite-Regulating Hormones

Another possible factor that could make weight loss and weight maintenance difficult for women with PCOS is abnormal hormonal influences that regulate appetite and satiety.

Levels of appetite-regulating hormones ghrelin, cholecystokinin, and leptin have been shown to be impaired in women with PCOS. Dysfunctional levels of these hormones may stimulate hunger in women with PCOS, resulting in increased food intake and difficulty managing weight.

Your Diet Is Imbalanced

If you’ve been watching your diet and still aren't seeing the pounds come off, it could be the types of foods you are eating. A 2010 study compared a low glycemic index diet to a regular, healthy fiber diet in women with PCOS. Both groups ate the same amount of calories and consumed the same distribution of macronutrients (50 percent carbohydrates, 23 percent protein, 27 percent fat, 34 grams fiber). The only difference was the glycemic index of foods. The women with PCOS who followed the low GI diet showed a three-fold greater improvement in insulin and had better menstrual regularity. These findings suggest that those with high insulin levels may be able to lose more weight following a low glycemic index diet.

Not eating enough fruits and vegetables can also impact weight loss. A study published this year in the Journal of Hormone and Metabolic Research found that women with PCOS who followed the Dietary Approaches to Stop Hypertension (DASH) eating plan showed improvements in insulin and abdominal fat loss. The DASH diet consisted of 52 percent carbohydrates, 18 percent proteins, and 30 percent total fats, and rich in fruits, vegetables, whole grains, and low-fat dairy products.

You Have Obstructive Sleep Apnea

Women with PCOS are at a much higher risk for obstructive sleep apnea compared with women without the condition. Obstructive sleep apnea occurs when there is a blockage of the upper airway that causes a lack of oxygen during sleep. This results in daytime sleepiness, high blood pressure, and weight gain.

While excess body weight is a main contributing factor to sleep apnea, high levels of androgens (male hormones such as testosterone) seen in PCOS, are believed to play a role in affecting sleep receptors. Lack of sleep is associated with insulin resistance and weight gain. The more severe sleep apnea is, the higher the risk of impaired glucose tolerance, which is why it’s recommended that all women with PCOS get screened for obstructive sleep apnea and receive proper treatment if diagnosed.

Sources:

Moran LJ, Noakes M, Clifton PM, et al. Postprandial ghrelin, cholecystokinin, peptide YY, and appetite before and after weight loss in overweight women with and without polycystic ovary syndrome. Am J Clin Nutr. 2007;86(6):1603-1610.

Kedikova SE, Sirakov MM, Boyadzhieva MV. Leptin levels and adipose tissue percentage in adolescents with polycystic ovary syndrome. Gynecol Endocrinol. 2013;29(4):384-387.

Marsh K, et al. Effect of a low glycemic index compared with a conventional diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92:83-92.

Asemi Z, Esmaillzadeh A.DASH Diet, Insulin Resistance, and Serum hs-CRP in Polycystic Ovary Syndrome: A Randomized Controlled Clinical Trial. Horm Metab Res. 2014;47(3):232-8.

Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2001;86(3):1175–1180.

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