Why It's So Hard to Lose Weight With PCOS

For women with polycystic ovary syndrome (PCOS), losing weight can help ease symptoms and regulate your periods. But with PCOS, weight loss is often difficult. One reason is that PCOS can cause your body to make too much insulin, which leads to a build-up of fat.

More than half of the people with PCOS are overweight. This article explains why they may struggle with those extra pounds and ways to lose weight with PCOS.

Your Body Is in Fat Storage Mode

Insulin is a hormone that transports glucose—your body’s main source of fuel—from your bloodstream into your cells, where it can be used as energy.

PCOS affects your body's secretion and use of insulin. Your cells become resistant to insulin signals, prompting your pancreas to produce even more insulin. This is known as insulin resistance or impaired glucose tolerance.

Too much insulin promotes fat storage or weight gain, mostly in your midsection.

Treatment options for PCOS are typically aimed at reducing insulin levels and involve diet modifications, exercise, medications, and/or supplements.

You’re Hungrier

As part of promoting fat storage, insulin acts as an appetite-stimulating hormone. Strong, intense, even urgent cravings are reported in women who are insulin resistant.

High levels of insulin could explain why some people with PCOS experience more hunger.

If not managed, 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 people with PCOS is abnormal hormonal regulation of appetite and the feeling of fullness.

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 people with PCOS. That encourages you to eat more and makes it difficult to manage weight.

Your Diet Is Spiking Your Blood Sugar

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 two groups of women with PCOS. Both ate the same amount of calories and consumed the same distribution of macronutrients (50% carbohydrates, 23% protein, 27% fat, 34 grams fiber).

Where they differed was the glycemic index (GI) of the foods they ate. The glycemic index indicates how much each food increases blood sugar.

The women with PCOS who followed a low-GI diet showed a three-fold greater improvement in insulin and had better menstrual regularity than the women who did not.

These findings suggest that those with high insulin levels may be able to lose more weight following a low-glycemic index diet.

You Need More Fruits and Veggies

Not eating enough fruits and vegetables can also impact weight loss.

A study found that women with PCOS who followed the Dietary Approaches to Stop Hypertension eating plan—better known as the DASH diet—showed improvements in insulin and abdominal fat loss.

The DASH diet consisted of 52% carbohydrates, 18% protein, and 30% total fats. It's 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 (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.

That's why it’s recommended that all women with PCOS get screened for obstructive sleep apnea and receive proper treatment if diagnosed.

Summary

PCOS can make your body resistant to insulin, causing your pancreas to make more the hormone. That extra insulin promotes fat storage and increases hunger, which can cause weight gain.

Other hormones that regulate hunger and fullness can also be affected with PCOS.

To help with weight loss, make sure you're getting enough sleep and eating nutritious foods. Choosing low-glycemic index foods may help.

A Word From Verywell

It can be frustrating when PCOS makes it difficult to lose weight. If you have any questions or concerns, make an appointment with your healthcare provider.

You may also consider seeking help from a dietitian with experience counseling people with PCOS.