Maintaining a healthy weight isn't always easy. However, it can be especially challenging for those who are living with polycystic ovary syndrome (PCOS).
Polycystic ovary syndrome is a hormonal condition that affects around 6-13% of women between the ages of 15 and 49.
PCOS can cause infertility, irregular periods, excessive hair growth and more. It’s also associated with several health conditions that can make it hard to lose weight, like insulin resistance and high blood sugar. In fact, studies suggest that between 38-88% of women with PCOS have been diagnosed with obesity or overweight.
However, you may be able to lose weight with the right treatment plan. Read on to learn why PCOS causes weight gain and how to lose weight with PCOS, from lifestyle changes to medication options.
Understanding why PCOS causes weight gain
Polycystic ovary syndrome often leads to weight gain because it can trigger insulin resistance, high blood sugar, increased levels of androgen (a male sex hormone) and more. These conditions disrupt your metabolism, appetite, and fat storage.
Insulin resistance occurs when your body isn’t responsive to insulin. Insulin is a hormone that helps your body convert glucose (from food) into energy.
This resistance makes it hard for your body to move sugar out of your blood, which leads to high blood sugar levels. High blood sugar can cause your body to start storing more fat, especially around the stomach. It can also trigger strong hunger cravings, and can contribute to the development of Type 2 diabetes as well.
Insulin resistance can also cause increased androgen hormone levels, and vice versa. Androgens also signal your body to store more fat.
Together, these metabolic and hormonal imbalances can interact and intensify one another. But while weight management with PCOS can be difficult, it is possible to lose weight with the right approach. Losing just 5% of your body weight can jumpstart progress by boosting your metabolism and improving how your body uses insulin.
Can you lose weight fast with PCOS?
Yes. Research suggests you see improvements in PCOS symptoms, weight, and metabolic health within 3 to 6 months of consistent changes to your nutrition and physical activity levels. Medication may support or speed up your progress as well.
The right care plan will depend on your symptoms and medical history, and should always be personalized to you.
Nutrition, exercise and medication options for PCOS weight loss
A combination of diet, exercise, and medications can help support PCOS weight loss and improve symptoms. You’ll find guidance on each of these options below:
Nutrition guidance for weight loss with PCOS
A healthy diet can support weight loss by improving insulin sensitivity and stabilizing your blood sugar levels. Research shows the following strategies may be especially helpful for targeting symptoms of PCOS:
- Eat smaller meals and snacks throughout the day. When you go too long without eating, your blood sugar starts to dip, leading to low energy and intense food cravings. Experts say that eating about every 4 hours can help prevent those swings. More balanced energy levels make it easier to stick to healthy eating habits and avoid binging.
- Focus on sustainable, realistic changes to your diet. Rather than making sweeping changes across your diet, begin with a few simple ones. A great place to start is cutting back on refined carbohydrates, like white bread, sweets, and processed snacks. People with PCOS struggle to break these foods down into sugar, leading to blood sugar spikes. Instead, choose complex carbs your body can process effectively, like whole grains, starchy vegetables, and beans.
- Eat foods that are high in fiber and protein. High-fiber foods help keep you full for longer and slows blood sugar spikes (which can cause cravings for unhealthy foods). Protein builds muscle and also helps you feel full, which can prevent overeating.
Some of the best foods for PCOS weight loss include:
- Lean protein such as chicken, eggs, or omega-3-rich fish like salmon
- Healthy fats such as olive oil, nuts, and seeds
- Whole grains like brown rice, quinoa, and sorghum
- Beans and legumes
- Fruits and non-starchy vegetables (like leafy greens, broccoli, peppers, tomatoes, and mushrooms)
- Plenty of hydration, ideally water
Foods that can slow down PCOS weight loss include:
- Refined carbohydrates (like white bread, white rice, and sugary cereals)
- Fried foods and processed snacks
- Foods high in saturated fats (like butter, margarine and red meat)
- Sugary drinks and alcohol
A diet that meets many of these nutritional needs for weight loss is the Mediterranean diet. Its emphasis on whole foods and balanced meals makes it a common PCOS diet recommendation for weight gain.
Exercise guidance for weight loss with PCOS
Not all workouts are created equal when it comes to losing weight with PCOS. Studies show high-intensity workouts are the most effective at reducing insulin resistance, improving heart health, and supporting fat loss.
When paired with a healthy diet, the following exercises are most effective for losing weight with PCOS:
- Aerobic exercise (cardio): Brisk walking, running, swimming, cycling, dancing.
- Resistance/strength training: Squats, lunges, push-ups, dumbbell or resistance band exercises.
- High-intensity interval training (HIIT): Short bursts of sprinting, jumping, cycling.
An analysis of 19 studies on women with PCOS suggests that at least 120 minutes of vigorous activity per week may be the most effective weight loss approach. This breaks down to just under 25 minutes a day, five days a week.
Experts say this can lead to the greatest improvements in waist size and body mass index (BMI). These are two indicators that you're losing weight in the right areas.
If you’re struggling to keep up with more challenging workouts, start slow. Doing 150 to 300 minutes of moderate exercise a week, like brisk walking or cycling, can also be effective in managing your weight with PCOS. Just remember to stay consistent.
Medication options for weight loss with PCOS
Your healthcare provider may prescribe medication to support your weight loss efforts with PCOS. The type of medication prescribed and dosage will depend on your symptoms and medical history. Here are some of the most common medications for PCOS weight loss:
- Metformin (Glucophage) is an oral medication for Type 2 diabetes. It is sometimes prescribed off-label to treat insulin resistance caused by PCOS. Long-term metformin use has been associated with up to 6.2% average weight loss in some individuals with PCOS. Metformin helps treat PCOS weight gain and symptoms by lowering the amount of sugar your liver makes. It also helps your body use insulin and energy more effectively, which can reduce fat storage. Metformin may also potientially help regulate menstrual cycles and support ovulation in people with PCOS.
- GLP-1 agonist medications are prescribed for Type 2 diabetes and weight loss. However, their off-label use is growing increasingly popular for people who are struggling to lose weight with PCOS. Examples of GLP-1s include liraglutide (Victoza, Saxenda), semaglutide (Ozempic, Wegovy), and tirzepatide (Zepbound, Mounjaro). These medications may help treat PCOS weight gain and symptoms by helping your body release insulin when blood sugar is high. They also reducing hunger and cravings by slowing how quickly food leaves your stomach. However, more studies are needed to fully understand the long-term effect of GLP-1 agonists on PCOS symptoms. It’s important to speak with your doctor to determine if they are appropriate for you.
- Orlistat (Xenical, Alli) is an oral medication that works by blocking the absorption of fat in the gut. Research shows that people with PCOS experienced an average weight loss of around 7% over 24 weeks while taking Orlistat. Orlistat works to treat PCOS weight gain and symptoms by helping to block fat absorption from the food you eat. It may also potentially helping improve cholesterol levels and support ovulation indirectly.
Finding the right medication can take time, and your provider will work with you to develop the best treatment plan for your individual needs. The goal isn’t just weight loss, it's about helping your body find better balance with PCOS.
How Sesame can help
If you are struggling with PCOS weight loss, a provider on Sesame may be able to help.
Through Sesame’s PCOS subscription, you can select a licensed provider who will build a personalized treatment plan tailored to your weight loss needs and long-term health goals. This includes video visits, unlimited provider messaging, lifestyle recommendations, prescriptions for weight loss medications if appropriate and more.
Ready to get started? Explore our PCOS subscription today.
