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Why I'm not losing weight when I'm doing everything right for PCOS

Why I'm not losing weight when I'm doing everything right for PCOS

Laurence Annez, CNP | June 9, 2021 | Women's Health
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You might be taking the supplements, eating clean, and exercising yet the weight just won’t seem to budge, what gives?! If you’ve ever felt this way… you are not alone. 

Obesity affects up to 80% of women with PCOS and is a common side effect of the syndrome. But why is it so hard to lose weight with PCOS? As a nutritionist, I get this question all the time, and I see so many women miserably counting their calories and exercising for hours with little to no success. So does this mean you just have to try harder? 

Weight gain can be a symptom of inner imbalances and once understood, we can make real progress with our health but also sustainable weight management. When it comes to sustainable weight loss, getting to the root of the issue is key in order to maintain a healthy weight over the long term. 

The calories-in, calories-out approach is unfortunately too simplistic because hormones have a significant impact on weight, making weight loss a real challenge at times. But why does weight loss seem like such a struggle with PCOS? There are several factors that play into the weight equation and PCOS that make losing excess weight more challenging. 

Below are 5 common overlooked reasons you may not be losing weight with PCOS: 


What does stress have to do with weight gain? Well when the stress response is activated, the body responds by releasing the stress hormone cortisol and transitions into “fight or flight” mode. The body is designed to handle stress in acute instances, but this response becomes damaging when it is chronic, which is very much the case for most of us in our busy society. 

Chronic stress can wreak havoc on blood sugar balance, which is a vital component to weight loss as it decreases insulin sensitivity and disrupts the uptake of glucose into the cell. Cortisol also breaks down muscle mass and increases blood sugar. This essentially means less energy is accessing the cell and more fat is being stored, resulting in weight gain, cravings, fatigue, and increased appetite. These cravings tend to be for foods high in fat and sugar, which promote insulin resistance and fat storage (again). It’s a vicious cycle. 

It’s important to remember that stress isn’t just mental and emotional, but also physical and chemical. Many people don’t realize that under-eating and over-exercising are actually forms of stress on the body and more impactful for women of reproductive age. If you find yourself doing intense workouts every single day, feeling drained or depleted after workouts, and notice your strength or stamina declining, you most probably are overtraining! This is why taking regular breaks, implementing rest days, and changing up your exercise routine is essential. 

Under-eating may sound like a good idea to lose weight, but when the female body is chronically underfed, changes in metabolism and hormones start to occur and the body may be more inclined to hold onto fat as a survival mechanism. As a result, the body may downregulate certain hormonal systems such as lowered thyroid and sex hormone output and increased cortisol output, a disaster for weight loss. 

If this sounds like you, the answer may actually be to do the opposite of what you have been doing. I recommend a daily stress management practice to all of my PCOS clients. Reducing stress will in turn help blood sugar balance and hopefully keep the cravings for unhealthy foods away.  

For stress management tips, check out 5 Yoga Poses for Stress Relief or 5 Ways to Decrease Stress

Insulin resistance 

Insulin is a hormone that ushers blood sugar out of the blood and into the cell to be utilized for energy. As the name implies, insulin resistance means the cells no longer respond to the insulin. When cells stop responding to insulin, sugar continually circulates in the bloodstream, triggering more insulin to be secreted. 

Chronically elevated insulin levels also lead to increased androgens and inflammation in PCOS which additionally drives weight gain. It also results in blood sugar crashes, increased fat storage, energy crashes, and more cravings. When insulin is chronically elevated you are in fat-storing mode, not fat-burning mode. 

So what can you do about insulin resistance? It’s essential to practice good blood sugar balancing by eating a balanced meal of fats, protein, and complex carbohydrates at regular intervals, typically every 3-4 hours. Avoid foods that can worsen insulin resistance such as refined sugars and flours, artificial sweeteners, alcohol, and processed foods.

Looking for natural ways to regulate your cycle? Check out our ebook Healthy You, Healthy Cycle to read science-backed tips just for you.

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Hormone imbalances 

Imbalanced hormones are a prime reason why women may have more difficulty losing weight than men, even with ideal diet and exercise. Female hormones are quite complex, and balancing your hormones is essential if you want to maintain a healthy weight. Many hormones are involved in weight loss, such as thyroid hormones, cortisol, progesterone, and estrogen, which is why it’s important to monitor and address your hormone levels regularly. 

Low thyroid function is a common hormonal imbalance, especially with PCOS. In fact, hypothyroidism and PCOS have similar symptoms and can mimic each other, and those with PCOS are more likely to have. The thyroid has a significant role in maintaining a healthy weight as it is in charge of regulating the metabolism. When the thyroid starts to slow down, it can also cause a metabolic slowing. This is why hypothyroidism often results in symptoms such as stubborn weight gain. 

Estrogen dominance, common in PCOS due to high rates of anovulation, also promotes fat storage and usually occurs around the hips, butt, and thighs. This consequently results in low progesterone levels. Progesterone increases body temperature and metabolism, and also supports the production of thyroid hormone. Conversely, low progesterone may encourage weight gain and promote the utilization of stored fat for energy. This is why it’s vitally important to address ovulation, the key event for hormone production during the menstrual cycle. It’s essential to have progesterone and estrogen working in harmony to avoid any symptoms that come with hormonal imbalances, such as weight gain. 

As discussed, insulin and leptin resistance are also very common hormonal imbalances among PCOS women and will impact the ability to lose weight by increasing fat storage, hunger and cravings, which may often be uncontrollable. 

Chronic inflammation 

Chronic low-grade inflammation is characteristic of PCOS and a central factor in the pathogenesis of the syndrome. This means that there is a constant state of inflammation going on in the body which creates damage to tissues. 

Chronic inflammation drives weight gain but excess weight can also promote inflammation, which results in a vicious cycle. When the fat cells expand beyond capacity, they release inflammatory chemicals into the bloodstream. This promotes a state of inflammation and oxidative stress in the body which can cause disruptions in hormones, damage tissues, and increase the risk of chronic disease. 

So what came first, inflammation or weight gain? Though weight loss can bring down inflammation, they both feed each other which means you will need to address where this inflammation is coming from to achieve long-term weight management. The good news: Inflammation is primarily linked to diet and lifestyle factors which means we have the power to do something about it! 

Examples of foods that cause inflammation are sugary beverages, refined carbohydrates (white bread and pastries), red meat, processed meats (hot dogs), and fried foods.  Omega 6 fatty acids, commonly found in vegetable oils (canola, safflower, corn, peanut oils), are needed for normal growth and development and contribute to the type of inflammation that helps you heal. But a key factor when consuming Omega 6 fatty acids is to balance them out with Omega 3 fatty acids found in walnuts and fatty fish like salmon. Without enough Omega 3s to balance the Omega 6s, a pro-inflammatory response and consistent inflammation is created.

For more information about what to eat or avoid, check out:

Download eBookGut health 

People with PCOS have been shown to have a lack of diversity of beneficial microbes in the gut. What does this have to do with weight loss? A collection of our good gut microbes, known as the estrobolome, are responsible for breaking down and metabolizing excess estrogen. If there is any sort of dysbiosis (imbalance) in the gut you may be more likely to experience estrogen dominance due to poor clearance of estrogens. 

Dysbiosis may also promote weight gain as certain pathogenic bacteria are associated with obesity. These bacteria promote inflammation, alter macronutrient absorption, and storage, and increase insulin resistance. Bacterial composition may also impact appetite, cravings, mood, and elimination time. 

In addition, the gut plays an important role in thyroid hormone production as many nutrients vital for the thyroid gland must be absorbed through the intestinal tract. What’s more, the conversion of the inactive thyroid hormone T4 into its active form T3 takes place in the gut which means our microbiome does play an important role in metabolism and hormone balance as well. 

What you eat will make the biggest impact on your gut health, so it’s time to pay attention to what is on your plate! Including prebiotic and probiotic foods in your diet may help to promote a favorable gut environment and a healthy microbiome. Prebiotic foods are a type of fiber that help to promote the growth of beneficial microbes in the gut and these may include leafy greens, berries, asparagus, garlic, onions, leeks, bananas, apples, and oats. Probiotics, on the other hand, are live bacteria found in food that provide beneficial effects on health. Probiotic rich foods include tempeh, miso, natto, sauerkraut, kefir, and pickled vegetables.

As you can see, weight loss isn’t as straightforward as calories-in, calories-out. It doesn’t have to be such a struggle once we understand the mechanisms at play and learn to work with our bodies. Let’s approach weight loss as a symptom rather than a condition and work on becoming healthier rather than punishing our bodies. 

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About the author:

Laurence Annez is a certified nutritional practitioner and health & life coach specializing in PCOS. She helps women overcome their PCOS symptoms by teaching them how to understand their bodies so they can show up as the healthiest and happiest versions of themselves. She does this using nutrition, lifestyle, and mindset changes that address the root cause. Her mission is to show women that they too can take control of their health and thrive with PCOS. https://www.laurence-annez.com/

References +

Mcculloch, F., n.d. 8 steps to reverse your PCOS - a proven program to reset your hormones, rep.

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