It's not as impossible as it may seem.
By Colleen de Bellefonds, Nikhita Mahtani and Andi Breitowich
Published: Jan 12, 2023
Luis Alvarez//Getty Images
Living with polycystic ovary syndrome (PCOS) can feel overwhelming. The condition may have caused some changes in your body—your cycle may be off, your acne may seem like it’s getting worse, and you may have gained weight. And while it may seem tough to lose weight, you’re not alone and there are little tweaks you can make to your lifestyle can make your PCOS weight loss journey a bit easier.
PCOS is one of the most common causes of female infertility and affects up to 12 percent of women of reproductive age in the U.S., according to the CDC. The condition results from an imbalance of reproductive hormones and causes the body to produce too many androgens, or "male hormones." The higher levels of androgens makes weight gain around the waist more likely because abdominal fat decreases responsiveness to insulin, a hormone that helps your body process sugar.
“Insulin is similar to a key, and this key is what allows sugar from your blood into your cells,” says Kim Shapira, RD, a nutritional coach at Trimly and the author of This is What You’re Really Hungry For. “When the cells stop recognizing the key, our pancreas releases more insulin and we get a buildup of sugar in our blood, which affects the functioning of our ovaries and ovulation,” like issues with egg development and release.
A woman without PCOS typically immediately starts burning fat for energy until she eats again, but women with PCOS do not burn fat first thing because they’re programmed to save it instead, explains Daniel Dumesic, MD, a professor of reproductive endocrinology and infertility at UCLA who specializes in PCOS. And because those pesky androgens are linked to insulin resistance, they can cause you to store more fat instead of burning it. That's why some people with PCOS complain they have a hard time losing weight no matter what they do.
Unfortunately, weight gain caused by PCOS can negatively impact your health because it increases the risk of diabetes, liver disease, heart disease, and stroke, says Shapira. But maintaining a healthy weight or even reducing your weight by five to 10 percent can help decrease the likelihood of developing these conditions and avoid other complications, adds Christa Brown, RDN, who works with women who have PCOS. The goal is to find physical activities and foods that can help prevent weight gain.
So yes, losing weight can be tricky when you have PCOS, but it’s not impossible—as long as you have the right information and a good support system. Here are 16 ways, according to experts, to make weight loss with PCOS a little less stressful.
1. Try a low-carb diet on for size, and up your protein.
It should be said that no one diet is the magic fix for women with PCOS—and that the type of diet you choose is less important than whether you're able to stick with it long-term. “There’s no evidence that one diet is better than another, so compliance is critical,” says Dr. Dumesic.
That said, low-carb diets tend to work well for women with PCOS, because they tend to be insulin-resistant. “Lowering carb content lowers insulin levels, which can help with weight loss,” says Caroline Apovian, MD, an adjunct professor of medicine and pediatrics in endocrinology, diabetes, nutrition and weight management at the Boston University Chobanian and Avedisian School of Medicine.
That means you'll have to eat more protein; Dr. Apovian suggests a diet with 1.5 grams of protein per kilogram of your ideal body weight—about 90 grams of protein a day if your goal is 130 pounds (or about 60 kilograms). Feel free to eat as many non-starchy veggies as you want (leafy greens, green beans, and carrots are all on the menu) and two to four servings of fresh fruit, but make sure to skip sugary juices.
At the beginning of your weight-loss journey, Dr. Apovian suggests eliminating grains entirely. If you need grains to keep up your diet, you can slowly add back up to two servings a day (one slice of whole-grain bread, one cup of oats, one cup of brown rice, one cup of whole-wheat pasta, etc.).
If you still have trouble losing or at least maintaining your weight following a low-carb diet, you may need to work with a doctor to adjust your calorie intake, says Lori B. Sweeney, MD, an endocrinologist and associate professor of medicine at Virginia Commonwealth University Health System.
"Women with PCOS need an average of 400 fewer calories a day than women who don't have PCOS—and any excess calories go to fat storage," she previously told WH. But that's not free rein to start slashing cals—a doctor can help you figure out how to cut back in a healthy way.
2. Exercise first, eat later.
Exercising right before a meal can help rev your metabolism so you end up storing more carbs as energy than fat, according to Dr. Sweeney. And working out on the regular trains your body to use up extra glucose stores in your body, which can help keep your insulin levels down, says Maria Horstmann, a National Academy of Sports Medicine-certified trainer who specializes in working with women living with PCOS.
Women with PCOS should focus on high-intensity interval training, which utilizes short, intense bursts of energy, Horstmann previously told WH, while Dr. Apovian and Dr. Dumesic both recommend any type of cardio that gets your heart rate up.
While you're at it, you may want to incorporate more strength training into your fitness routine too. Because muscles use glucose for energy, building more muscle can only improve insulin sensitivity and metabolic health, explains Dr. Dumesic.
3. Focus on fiber.
Getting lots of fiber means you feel fuller for longer on fewer calories. Plus, complex, high-fiber carbs won’t raise your blood sugar (and lead to more food cravings) the same way simple, sugary carbs do.
Adding more fibrous foods to your plate may be particularly beneficial if you have PCOS. A diet with more fiber was linked to less belly fat and insulin resistance in women with PCOS, one study showed.
The American Heart Association recommends every woman get at least 21 to 25 grams of fiber per day. Adding whole grains, leafy vegetables, legumes, squash, and sweet potatoes, for instance, should all help up your fiber uptake. If you're still not getting there, try adding a fiber supplement to a protein shake or smoothie in the morning.
4. Add healthy fats to your plate.
Healthy fats can also keep you full, especially if you're trying to keep carbs to a minimum. Women with PCOS who ate a diet higher in fat lost more more weight over eight weeks than women with PCOS who ate a diet lower in fat, per a 2015 study in the Journal of Nutrition. Try adding 200 calories of healthy fats to each meal, suggests Alisa Vitti, the founder of integrative hormonal center Flo Living, like two tablespoons of olive oil or half an avocado per meal.
5. Eat more fermented foods.
Women with PCOS may have less healthy gut bacteria than women without the condition, which may be another reason that they struggle with weight gain. Making efforts to add more healthy bacteria to your system could help.
Even for women without PCOS, emerging studies suggest that adding probiotics to your diet can help with weight loss (although more research is needed to know for sure what the benefits of probiotics are). Vitti suggests adding one fermented food (which naturally contains the good bacteria your gut needs) to your diet per day, as well as taking a probiotic supplement.
6. Reduce your caffeine intake.
Sorry to be the bearer of bad news, but “caffeine actually has a huge effect on hormone levels,” says Vitti. Studies have shown that increased caffeine intake can interfere with ovulation and increase stress hormones, which can lead to hormonal disorders.
Cutting out caffeine is probably best, but it's totally understandable if that's not realistic. If you want to keep having caffeine, Vitti says to enjoy it after putting something else in your stomach (to reduce its impact on your blood sugar) and to try to limit yourself to one serving or cup a day.
7. Eliminate added sugars.
“I suggest women eliminate added sugars because it raises their blood sugar substantially, which then leads to a crash and even worse hunger levels, as well as cravings,” says Vitti. This is true for everyone, but for women with PCOS, sugar and insulin spikes are larger, meaning they’re even hungrier after consuming processed sugar, research shows.
If you're craving something sweet, try having a piece of fruit that's also high in fiber to balance out the sugar content.
8. Practice mindful eating.
If you're regularly scarfing down a sandwich while driving and talking on the phone, and feeling too full later, you could probably benefit from being more mindful about your eating habits. Sitting down for specified meal times, eating slowly without distractions, and truly savoring your food can help you be more in tune with your hunger levels. It is a simple way to practice portion control and avoid overeating, which helps with weight loss.
9. Make sure you're eating enough.
One the other hand, being hyper-focused on dieting and limiting your calories can also lead to overeating later on. “If you overly restrict your calories or eliminate food groups, the body's very refined internal messaging and biofeedback is going to secrete ghrelin, otherwise known as the hunger hormone,” says Vitti. “In that case, you're going to eat more calories. At night you might find yourself finishing a bag of chips and being like, ‘Wow, how did I finish that whole bag?’”
Long-term calorie restriction can actually slow down your metabolism over time and modify the way your hormones operate, which is why you should never go below 1,200 calories per day in your effort to drop weight.
10. Keep stress in check.
Easier said than done, we know. But, “Stress increases cortisol levels, which is linked to weight gain,” explains Vitti. Chronic stress can cause you to store more fat in your stomach area, so trying to control that stress—whether through deep breathing, meditation, yoga, sleep, or other forms of self-care—can only help.
11. Consider a supplement.
“I recommend a few supplements very strongly for women with PCOS,” says Vitti. “Vitamin C, selenium, N-acetylcystine, and alpha-lipoic acid gently support the liver to improve its ability to break down extra estrogen in the body, which women with PCOS have.”
These supplements also help improve metabolism, and myo-inositol specifically has been shown to help women with PCOS lose weight due to its ability to help with insulin sensitivity. Just remember to always speak with your doctor before adding any supplements to your routine to make sure they won't interfere with any other conditions you have or medications you take.
12. If you have sleep issues, don't ignore them.
One common side effect of PCOS is sleep apnea, which disrupts your rest at night. Lack of shuteye causes weight to go up because it messes with hormones controlling hunger and fullness, says Dr. Apovian. Try to get at least seven hours per night, and talk to your doctor if you think you might be suffering from sleep apnea.
Your doctor might sign you up for a sleep study to confirm the diagnosis and, if you do, prescribe a continuous positive airway pressure device (CPAP), a mask you’ll wear while you sleep that gently blows air into your airway to keep it open.
13. Try to find an A+ support system.
Women with PCOS are more likely to have depression and anxiety, says Dr. Dumesic, which can make it even harder to lose weight. (It's tough to work up the motivation to prepare healthy meals and work out if you're feeling happy, let alone if you're dealing with symptoms of depression—be gentle with yourself.)
If you think you might have symptoms of a mental health issue, check in with a mental health professional. “It’s important to have a good support system. You have to get your mindset aligned with your goals to accomplish weight loss,” he says.
14. Sign up for a pilates class.
Pilates is a great way to increase muscle mass and help the body burn calories beyond your workout, which can improve insulin sensitivity and overall muscle tone, says Brown. Resistance training allows sugar to enter the cells and body, versus storing it as fat, which in turn helps with weight loss, explains Brown.
Plus, pilates is considered a mind-body exercise that can also reduce stress. “Stress releases a hormone called cortisol that is needed, but not in excess, and cortisol likes to bring sugar from the muscles into the blood, causing an increase in blood sugar that starts the insulin resistance and hyperinsulinemia (high amounts of insulin in the blood) cycle,” she adds.
15. Get your steps in.
Logging your steps has major health benefits such as improved heart fitness, blood pressure, and cholesterol, but getting 10,000 steps a day is also a great tool for managing PCOS symptoms and helping with weight loss. “Exercise uses sugar as fuel, and it's like a built-in blood sugar regulator,” Shapira explains.
Whether you use a wearable or an app on your phone to keep track, check how many steps you’re averaging per day, and find the time to hit at least 10,000 (or about five miles). “You don't have to be perfect, you just have to be intentional,” says Shapira. “Make it a goal and try for a little more each day." She suggests going for a moderate stroll every time you eat: five minutes before and five minutes after a meal.
16. If you're still struggling, ask your doctor about other medication options.
Metformin, a medication used to regulate glucose levels and insulin sensitivity, can be prescribed if you're still having trouble keeping your weight in check or struggle with prediabetes. “By better regulating sugar, it subtly affects your appetite and can help with weight loss, although not everyone loses weight,” says Dr. Dumesic. Metformin decreases the amount of sugar you absorb from foods and increases your sensitivity to insulin to help keep your appetite in check.
Other, more powerful drugs made specifically for weight loss may help too if diet and exercise aren't working. Many of these weight-loss drugs, like a medication called Saxenda, are particularly well suited for women with PCOS since they're prescribed to people with higher levels of abdominal fat, says Dr. Dumesic.
But keep in mind, these drugs are typically a last resort. "They’re very strong medications. They have to be given under doctor supervision and are recommended for only six months at a time,” says Dr. Dumesic. They also come with a whole slew of side effects like nausea and diarrhea, and can be very dangerous for an unborn baby if you accidentally conceive while taking it.
Colleen de Bellefonds
Colleen de Bellefonds is an American freelance journalist living in Paris, France, with her husband and dog, Mochi. She loves running, yoga, and wine, and is very particular about her baguettes.
Nikhita Mahtani is an NYC-based freelance journalist covering primarily health and design. She graduated with an M.A in Magazine Journalism from New York University and loves to debunk popular health myths. Her idea of wellness includes a sweaty spin class, wine with loved ones, and experimenting with new recipes in the kitchen.
Andi Breitowich is a Chicago-based writer and graduate student at Northwestern Medill. She’s a mass consumer of social media and cares about women’s rights, holistic wellness, and non-stigmatizing reproductive care. As a former collegiate pole vaulter, she has a love for all things fitness and is currently obsessed with Peloton Tread workouts and hot yoga.