Your weight DID NOT cause your PCOS or Polycystic Ovarian Syndrome. It's sad that I still have to say this after all the new science we have about PCOS and weight. But the false belief that being overweight or having obesity causes PCOS continues. For example, I was outraged when a well know functional medicine doctor with over 2 million followers shared that PCOS people needed to simply "change their diet." But I digress.
As an integrative obesity specialist and women's metabolic health expert, I became passionate about PCOS because I met many women at my primary care practice in their 30s-50s with undiagnosed PCOS. Sadly by the time we met, they had the health consequences of untreated PCOS: obesity, metabolic syndrome, diabetes, heart disease, and more. I don't want any woman to walk around with undiagnosed PCOS or continue struggling with her weight due to ineffective PCOS treatment.
September is PCOS Awareness Month. To commemorate the month I:
Joined Dr. LJ, the Wholistic Endo Expert, on her phenomenal podcast to discuss PCOS, Weight Gain, Obesity, & Chronic Fatigue*
Hosted "PCOS & Weight: What's Really Going On?" Overcoming Obesity Club Room* *Links in the resources section
In this blog post, we'll review PCOS diagnosis and Three misconceptions about PCOS and weight.
PCOS is the most common hormonal condition in women of ages 30-50 or "childbearing age". Up to 10% of women have PCOS and don't know it. Weight gain that's difficult to control can be one of the most common symptoms of PCOS. But often, doctors and clinicians focus on the weight without digging deeper to find out why they are gaining weight. Weight gain is more than "calories in vs. calories out." The are over 100 triggers for weight gain. Time and time again, I've found when you treat the root cause of weight gain, for example, PCOS, you lose the extra weight the body is holding onto.
This brings me to misconception number one.
❌You have to be overweight to have PCOS.
This is a common misconception and honestly bias that many clinicians have. Here's how to diagnose PCOS:
Make sure there are no other causes of your symptoms. PCOS is a "diagnosis of exclusion", which means other disease conditions that look like PCOS must be evaluated before you can diagnose PCOS.
The clinical criteria for diagnosing PCOS is having two of these three symptoms:
Laboratory or clinical evidence of high androgens (i.e. hirsutism-hair on the face, chest, and back, High testosterone levels, etc )
Unpredictable or lack of menstruation ( “Oligomenorrhea or anovulation”)
Radiographic evidence of polycystic ovaries (Large follicle >10ml or more than 12 follicles 2-9mm in size)
Rotterdam Criteria, 2003
What’s “missing“ in the criteria? Notice that there is no mention of weight, BMI, or waist circumference in the PCOS diagnostic criteria.
20-40% of women with PCOS will not be overweight by the current standards of diagnosing obesity (BMI >30kg/m2 or Waist Circumference >35inches or 88cm).
However, it is important to note regardless of your weight, you are still at risk of the metabolic conditions associated with PCOS. PCOS causes high androgen levels and insulin resistance, increasing your risk of heart disease and other conditions. Insulin resistance will impact 40% of people with PCOS. Insulin resistance can put you at risk for obesity, metabolic syndrome, type 2 diabetes, and heart disease.
❌Your weight “caused” you to get PCOS.
While there is an association between the medical condition of obesity and PCOS, obesity does not directly cause PCOS. This is evident since most people with obesity do not have PCOS.
Conversely, the hormonal changes associated with PCOS can cause obesity. A PCOS and insulin resistance diagnosis increases your risk of developing obesity (defined as BMI >30 kg/m2 in the studies that researched PCOS and obesity risk). Unlike previous understandings of body weight and obesity, we now know that Your Healthy Weight is determined by more than the BMI cut-off of >30kg/m2. In Embrace You, we use a more individualized approach to determining Your Healthy Weight beyond the standard BMI tables.
❌You can’t lose weight if you have PCOS
Trying to lose weight when you have PCOS can be frustrating, especially if you aren’t given the right guidance. The old dieting weight loss model of “calories in” vs “calories out” can harm PCOS warriors. Why? For many reasons:
Food quality is more important than calories: Due to insulin resistance, we know that people with PCOS insulin resistance are more sensitive to foods high in sugar and refined carbohydrates. Ironically you may crave these foods because your body isn’t able to use the glucose (or breakdown product of sugar) very well. This leads to a vicious insulin release cycle, worsens insulin resistance, and drives weight gain. That is why optimizing your nutrition in PCOS is so important.
Changes in appetite: PCOS affects your hunger hormones. Specifically, Ghrelin, the “hunger hormone” released from gastric (stomach) cells, tells the brain you’re hungry. Normally, ghrelin decreases after eating, but in PCOS patients, ghrelin remains elevated higher than expected. This leads you to feel hungry and unsatisfied with your meals.
“Energy In” vs. ``Energy Out”: We know now that body weight regulation or, more specifically, body fat regulation depends much more than calories but actually “energy in” vs. “energy out.” PCOS impacts your energy balance in many ways that can affect your energy beyond your plate or in the gym. The impact of PCOS on your mood, relationships, and other aspects of your life can also impact your weight.
Despite all these factors, if you want to lose weight with PCOS. It’s not impossible to lose weight with PCOS. However, your weight plan has to address all the factors contributing to your energy imbalance and fit into your lifestyle. Traditional dieting forces you to focus on the scale. However, your life is more than the scale, so your weight and wellness plan has to look beyond the scale, calorie counts, and gym workouts you can’t stand. My bestselling book, Embrace You: Your Guide To Transforming Weight Loss Misconceptions Into Lifelong Wellness, equips you with your individualized strategy for your wellness-based weight and wellness journey. It also helps you to identify your team for managing your PCOS weight loss journey.
There are effective treatments for PCOS so you can live healthy and whole. PCOS is complex, so it takes working with knowledgeable experts who will address the physical, mental, and even spiritual symptoms of PCOS. Some treatments that may be used include:
Lifestyle Changes: Improving sleeping, decreasing stress, adding a supportive community, making time for self-care, and more.
Movement (aka exercise): Increasing physical activity, especially resistance training to build muscle which helps improve insulin resistance. Resources: Fitness Trainer, Physical Therapist
Nutrition optimization: Limiting inflammation-producing foods such as processed sugar. Increasing fiber and superfoods. Resources: PCOS focused nutritionist like The PCOS Dietician
Mental Health Support: It can be very stressful to go on your PCOS journey. Seek professions to help nourish your mind. Resources Life Coach, Psychologist, Therapist
Spiritual Support: Spirituality and religion often get confused. Even if you aren't "a religious person," Your spirit needs nourishment. Find ways to enhance your Spiritual Wellness C's: Connection with God, Self, Others, & Nature; Community places you belong; Charity, how you contribute to the world. Resources: Your Faith Community, Organizations, Spiritual Support, Pastor, Counselor etc
Hormonal Medications: These medications regulate your hormones to improve your menstrual cycles, fertility, acne, and more. Examples: Spironolactone, Oral Contraceptive Pills (aka "birth control")
Metabolic Medications: These medications improve your body's metabolism in various ways, such as: improving insulin resistance, regulating your hunger hormones, and increasing weight loss. Examples: Metformin, GLP-1 agonists,
You Can Overcome PCOS.
PCOS is just a condition that you have. It is not who you are. Your weight is just data. It is not who you are. You will hear many things about weight and PCOS. I hope this blog post has helped you:
❌You have to be overweight to have PCOS.
❌Your weight “caused” you to get PCOS.
❌You can’t lose weight if you have PCOS.
✅You can have PCOS at any weight.
✅You are not to blame for your PCOS.
✅You can be whole & healthy with PCOS.
Remember, you are not alone. PCOS is a complex condition that needs an expert team. You are worth the time it takes to build your team. If you need help on your PCOS weight & wellness journey, Embrace You Weight & Wellness has several solutions to help you. Start by taking your complimentary Embrace You Clarity Quiz.
The PCOS Dietician
"Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness" Sam S. (2007). Obesity and Polycystic Ovary Syndrome. Obesity management, 3(2), 69–73. https://doi.org/10.1089/obe.2007.0019
PCOS & Your Body Talks on IG
Published Articles on Stress featuring Dr. Sylvia Gonsahn-Bollie
Mental Health & Wellness Screening tools
Medical Disclaimer: Content on this page is for general information only. It is not intended as medical advice nor does it establish a doctor patient relationship between the writer and the reader.