Obesity and PCOS: An Effective Weight Management Guide

- Nicole Fong, Martin Kueh

Polycystic ovarian syndrome (PCOS) is a hormonal imbalance condition affecting women of reproductive age (15 to 49 years). It is characterised by enlarged ovaries filled with small fluid-containing sacs or cysts. This syndrome is commonly distinguished by irregular periods, excess hair growth and weight gain. Nearly 1 in every 10 women is diagnosed with PCOS worldwide. It’s estimated that anywhere from 38% to 88% of people presented with PCOS are also living with obesity.

Obesity and PCOS: The Chicken or the Egg

Irrespective of body weight status, people living with PCOS are more likely to have visceral fat. It is known as ‘hidden’ fat that wraps around the abdominal organs. Raised level of testosterone, a primarily male sex hormone, encourages the development of weight distribution. Such a phenomenon leads to visceral fat accumulation and insulin resistance. Insulin resistance is a condition where the cells dismiss signals from insulin, leading to increase blood sugar levels. 50% to 90% of women with PCOS are often insulin resistant, a significant cardiometabolic risk exacerbated by obesity.

In reverse, does obesity lead to PCOS? Yes, and here’s why. Although obesity may drive up androgen production, it does not mean it will translate to PCOS. Interestingly, the removal of androgen from the blood also speeds up. Anyhow, obesity is a recognised risk factor for insulin resistance, contributing to PCOS development. Plus, women living with obesity are more likely to have reproductive disturbances, including irregular periods and infertility. This is brought on by an imbalance in sexual hormone levels, giving rise to PCOS.

The struggle within.

The link between PCOS and obesity has biological evidence, but the surrounding stigma creates additional barriers. Women living with obesity may feel excluded from society as they fear their appearance is being judged and viewed as undesirable and less feminine, resulting in emotional strain, low self-esteem, and body dissatisfaction. These factors may cause women to delay seeking help which can worsen both physical and mental health. However, symptoms of PCOS are not a personal failure but a result of hormonal imbalance that requires medical attention and support. Through awareness and education, we can encourage women with PCOS to seek support and manage their condition effectively. Let us explore weight management strategies to help you feel your absolute best.

Weight management strategies

1. Diet

Dietary intervention is usually thought of as the first line of defence to improve weight and PCOS-like symptoms. Generally, a daily calorie burn of 500 to 1000 kcal is recommended for achieving a weekly weight loss of 0.5 to 1kg. Several dietary patterns have been suggested. A low glycemic index (low-GI) diet is a dietary pattern which recently gained popularity. Food with low-GI value is digested more slowly, thereby avoiding a surge of blood sugar levels. This diet emphasises foods such as vegetables, fruits, lentils, and kidney beans.3 

In addition to low GI, the Dietary Approaches to Stop Hypertension (DASH) dietary pattern emphasises a low-energy food intake. The added value gives a boost to the body’s defence system for PCOS.3 The Mediterranean diet is another widely acknowledged dietary model. This model promotes the traditional consumption of low-GI, unsaturated fats, fibre, vitamins and antioxidants, and moderate animal proteins. It is optimistic that the Mediterranean Diet improves inflammatory responses; however, it is still too soon to tell. No one-size-fits-all dietary solution exists, but all dietary patterns agree on avoiding added sugars and processed foods. Working with healthcare professionals can ensure informed decisions that tailor to your needs

2. Exercise

Individualised exercise is just as important as an adjunct to diet for PCOS. The optimal exercise regime plan, based on studies, is a minimum of 120 minutes of vigorous-intensity per week, which may include aerobic exercise or resistance training or a combination of both. Examples of aerobic exercise are brisk walking, cycling, or running while resistance training such as weight lifting. While exercise has many benefits for women with PCOS, greater improvements in metabolic and reproductive health outcomes are achieved when exercise is combined with dietary interventions. By incorporating both exercise and dietary modifications, women with PCOS can experience a huge change in their overall health and well-being.

3. Mindfulness and sleep health

Individuals who struggle with impaired mindfulness have been linked to the development of obesity in individuals with PCOS. Mindfulness-based stress reduction is a program that aims to increase awareness of the present moment through meditation and yoga. It has shown promising results in reducing psychological distress and improving physical health outcomes such as blood pressure and blood glucose levels, which are often affected by obesity. Additionally, poor sleeping habit is an important factor that hinders weight loss maintenance. A sleep duration of 7 to 8 hours leads to reduced overall appetite and improved daytime vitality. Therefore, practising the art of healthy sleep habits, for instance, limiting caffeine and alcohol consumption, and avoiding blue light from screens in late night, can be an important part of managing individuals living with obesity and PCOS.

4. Medical intervention

While the cornerstone of managing obesity is a lifestyle change, medical intervention can provide additional support. Metformin, an insulin sensitizer, has been prescribed to treat PCOS for nearly three decades. Not only ovarian regulation, but it also helps in weight reduction. New research has shown stronger PCOS therapeutic benefits when metformin is combined with liraglutide, but this combination also comes with greater adverse effects. Hence, it is important to discuss and weigh both up- and downsides to attain optimal outcomes.

5. Bariatric surgery

Bariatric surgery has emerged as a game-changing evolution in obesity therapy. The potential has stretched to PCOS. Studies have found that abnormal menstruation and excessive hair growth dropped from 81% to 15% and 71% to 38%, respectively, after surgery. Bariatric surgery also improves hormones for sexual and reproductive health. Overall, the peak BMI loss occurs 12 months after surgery. Despite this, the success of the surgery in achieving weight loss can vary across different demographics. Informed consideration is of paramount importance to ensure aligned values.

Conclusion

Addressing the challenge of obesity among females living with PCOS requires a multi-pronged approach. Adopting a resilient mindset is of the utmost importance to achieve this endeavour. Through empowerment and advocacy, the journey of weight management can be transformative that bring long-lasting improvement in overall well-being and health.

References

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3. Che X, Chen Z, Liu M, Mo Z. Dietary interventions: a promising treatment for polycystic ovary syndrome. Annals of Nutrition and Metabolism. 2021;77(6):313-23.

4. Patten RK, Boyle RA, Moholdt T, Kiel I, Hopkins WG, Harrison CL, et al. Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Physiol. 2020;11:606.

5. Raja-Khan N, Agito K, Shah J, Stetter CM, Gustafson TS, Socolow H, et al. Mindfulness-Based Stress Reduction in Women with Overweight or Obesity: A Randomized Clinical Trial. Obesity (Silver Spring). 2017;25(8):1349-59.

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7. Ge JJ, Wang DJ, Song W, Shen SM, Ge WH. The effectiveness and safety of liraglutide in treating overweight/obese patients with polycystic ovary syndrome: a meta-analysis. J Endocrinol Invest. 2022;45(2):261-73.

8. Yue W, Huang X, Zhang W, Li S, Liu X, Zhao Y, et al. Metabolic Surgery on Patients With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology. 2022;13.