Weight gain with PCOS is the number one struggle that I hear in my practice. While it’s not exclusive for women to gain weight, it is the most prevalent with research citing anywhere from 38%-88% of women categorized as overweight or obese. This is one circumstance where being part of the club is not any fun! It’s frustrating, overwhelming, and as one client recently said it: “it’s like my body has been taken over by an alien and I have no say in anything!”

I hear you ladies and I’m here to help. In this article I’m going to break down why this might be happening to you as well as laying out the best holistic-framed solutions to help you take back control over your body. I’m going to share the protocol that I use in my practice that has helped hundreds of women learn how to work with their body to improve body composition, create a better relationship with food, and yes, even lose fat (and most times weight). 

Before we get into that let’s break down exactly what PCOS is and how you know if you have it.

What is PCOS

PCOS or Polycystic Ovary Syndrome, is complicated. Basically, it’s an imbalance in reproductive hormones, specifically androgens (male hormones) produced by the ovaries. It’s not just testosterone, hormone balance is not specific to just one hormone- these powerful messengers are interconnected throughout the entire body- which is why weight loss is so challenging. The name PCOS comes from the usually small cysts that can form on the ovaries, but not all women will have those. 

The condition affects multiple systems in the body, going far beyond reproductive health. PCOS can impact metabolism, insulin processing (also known as insulin resistance), and inflammation levels throughout the body. Common symptoms include irregular periods, excess facial and body hair growth (hirsutism), acne, weight gain, and difficulty losing weight. While the exact cause isn’t fully understood, factors such as genetics, excess insulin, and chronic inflammation appear to play significant roles. Currently diagnosis PCOS ranges from doctors proclaiming “yup! Sounds like PCOS” to actual testing which is less prominent- and more frustrating. 

As with most things, early detection is best, but diagnosis at any point can help with peace of mind. The current diagnostic criteria is somewhat vague, but does fit a specific set of guidelines.

Clinical Diagnostic Criteria for PCOS

According to the Rotterdam criteria, which are the most widely accepted diagnostic guidelines, PCOS is diagnosed when a person has at least two of the following three criteria:

1. Irregular or absent menstrual periods (oligomenorrhea or amenorrhea)
2. Clinical and/or biochemical signs of excess androgens (hyperandrogenism)
3. Polycystic ovaries on ultrasound (12 or more follicles measuring 2-9mm in diameter, or increased ovarian volume >10mL)

Before making a PCOS diagnosis, healthcare providers must rule out other conditions that can cause similar symptoms, including:

• Thyroid disorders
• Elevated prolactin levels
• Congenital adrenal hyperplasia
• Cushing’s syndrome

The diagnostic process typically includes:

• Physical examination
• Medical history review
• Blood tests to check hormone levels
• Pelvic ultrasound

In my experience, PCOS is a chicken-egg situation where thyroid disorders, weight gain, and other metabolic disorders like diabetes are generally identified first but possibly not where it started. I’ve worked with more than a handful of women where they struggled to control blood sugar for quite some time only to find out years later that they have PCOS. 

Why Does PCOS Cause Weight Gain?

Insulin Resistance and Fat Storage

About 70% of women with PCOS deal with the frustrations of insulin resistance. When our bodies don’t respond properly to insulin, it’s like having a broken thermostat for our blood sugar. This doesn’t just make us crave carbs like crazy – it actually makes our bodies more likely to store fat, especially around our middle.

The effects of insulin resistance go beyond just weight gain. When our cells become resistant to insulin, it means:

• Our cells can’t efficiently use glucose for energy
• Extra glucose gets stored as fat
• Our bodies produce even more insulin to compensate
• This excess insulin triggers our ovaries to produce more testosterone

But here’s the good news – there are several evidence-based strategies to improve insulin sensitivity:

• Time your meals: Eat at regular intervals to prevent blood sugar spikes and crashes
• Start with protein: Begin each meal with protein to slow down glucose absorption
• Move after meals: A 10-15 minute walk after eating can help your muscles use glucose more effectively
• Consider supplements: Inositol, berberine, and chromium (with healthcare provider approval) may help improve insulin sensitivity

One of the most effective approaches is to practice “glucose pairing” – always eating carbohydrates alongside protein, fiber, or healthy fats. For example:

• Apple + almond butter
• Brown rice + lentils
• Sweet potato + grilled chicken

These combinations help slow down glucose absorption and prevent the sharp insulin spikes that can worsen PCOS symptoms.

Hormonal Imbalance

Did you know that gut health is directly connected to hormone balance? Think of your gut as the control center for many of your body’s functions. When it’s not happy, your hormones aren’t happy either.

What happens in PCOS is like a domino effect:

• Poor gut health → inflammation → hormone imbalance → harder to lose weight
• Hormone imbalance → insulin resistance → more sugar cravings → gut issues
• And round and round we go!

Hormones are all interconnected and influence each other, making it like trying to unravel Christmas tree lights. Have you ever spent hours trying to find that one bulb that will magically turn on the whole strand? That is what is happening with PCOS- reproductive hormones influence hormones that manage metabolism, and metabolic hormones influence reproductive hormones. Other hormones can get involved too, making it really hard to know what is the underlying cause of weight gain. 

Inflammation

Talk about buzz words, inflammation is the topic of the decade. Chronic low-grade inflammation is another one of those hidden situations happening in PCOS that contributes to challenges with weight loss and maintaining weight. Short term inflammation is actually a good thing- it helps the body heal, but when an inflammatory state is the norm the benefits become the beginning of dis-ease. 

The relationship between inflammation, PCOS, and weight gain creates a complex cycle that can be challenging to break:

• Inflammation triggers insulin resistance: Chronic inflammation can interfere with insulin signaling, making it harder for cells to respond to insulin properly
• Insulin resistance promotes inflammation: When cells become resistant to insulin, this can trigger more inflammation throughout the body, creating a feedback loop
• Weight gain increases inflammation: Fat tissue, especially around the abdomen, produces inflammatory compounds called cytokines
• PCOS worsens inflammation: The hormonal imbalances in PCOS can increase systemic inflammation, which in turn makes weight loss more difficult

Slower Metabolism

There is evidence that women with PCOS simply have a lower metabolic rate, meaning that they burn fewer calories in general. That means that the typical recommendations to “eat less and move more” to create a calorie deficit is basically meaningless. If a 40-year old woman without PCOS needs 60 minutes or more exercise a day to just maintain her weight, what does that look like for someone with PCOS? How is she expected to fit that into her day? 

Let’s look more closely at why women with PCOS often experience a slower metabolism, hint: it’s due to several interconnected factors:

• Hormonal Imbalances: Higher levels of androgens and irregular estrogen/progesterone ratios can affect the body’s metabolic rate
• Insulin Resistance: When cells don’t respond properly to insulin, the body becomes less efficient at converting food into energy
• Mitochondrial Dysfunction: PCOS can affect the function of mitochondria (our cells’ energy powerhouses), leading to reduced energy production and slower metabolism
• Muscle Mass Impact: Hormonal imbalances can make it harder to build and maintain muscle mass, which is crucial for a healthy metabolic rate

This metabolic slowdown creates a challenging cycle:

• Lower energy expenditure → fewer calories burned at rest
• Reduced thermal effect of food → fewer calories burned during digestion
• Decreased exercise efficiency → fewer calories burned during physical activity

😢 Understanding these metabolic challenges helps explain why traditional calorie-counting approaches may need to be adjusted for women with PCOS. It’s important to focus on metabolic health through hormone balance, rather than just reducing calories.

Lastly, all of these factors play into the relationship with food, which is why it’s not uncommon for women with PCOS to experience a challenging relationship with food. 

The Complex Emotional Connection to Food

Women with PCOS often develop a complicated relationship with food that goes beyond simple dietary choices. The constant struggle with weight management, combined with hormonal imbalances and metabolic challenges, can create a perfect storm for disordered eating patterns.

Research suggests that women with PCOS are at significantly higher risk of developing disordered eating behaviors, with studies indicating that approximately 30-50% of women with PCOS experience some form of disordered eating pattern – a rate much higher than in the general population.

Several factors contribute to this challenging relationship with food:

• Hormonal Influences: Irregular hormone levels can affect appetite, cravings, and mood, making it harder to maintain consistent eating patterns
• Metabolic Frustration: The difficulty in losing weight despite strict dieting can lead to cycles of restriction and binge eating
• Emotional Impact: The stress of managing PCOS symptoms can trigger emotional eating as a coping mechanism
• Body Image Issues: Common PCOS symptoms like weight gain and acne can affect self-esteem and body image, potentially leading to restrictive eating behaviors

Common disordered eating patterns in women with PCOS include:

• Binge eating disorder (BED)
• Restrictive eating
• Cyclical dieting (“yo-yo” dieting)
• Emotional eating

⭐If you’re struggling with disordered eating patterns, it’s essential to work with both a mental health professional and a registered dietitian who understands PCOS. Recovery involves addressing both the physical and emotional aspects of your relationship with food.

A Holistic Approach to Losing Weight with PCOS

As you probably already know, losing weight with PCOS is hard. Many of today’s treatment plans involve medications like birth control or GLP-1’s, even anti-depressants, but those don’t treat anything, they simply reduce the symptoms and for many women that is a great place to start. Medications can be helpful tools, but they aren’t the whole picture. If you and your doctor have decided on a medication management plan it’s important to ask how long you’ll be taking the meds, what is the plan to reduce or even discontinue the dose, are there side effects that you should be concerned about, and so on. In addition to medications, implementing a holistic plan to reduce or eliminate the root cause of weight gain is the key to long term success. 

Creating a comprehensive wellness plan

Long term weight loss begins with short term planning. There are three areas to start with to see the best results: nutrition, fitness, and lifestyle. In my practice I take a seasonable approach to nutrition and lifestyle planning, creating flexible plans that change over the course of the year and are adaptable to different seasons of a woman’s life- because nothing stays the same, including your daily schedule. 

While no two plans are exactly the same, here are some places to focus first: 

Getting started is as simple as: 

1. Incorporating an anti-inflammatory eating pattern tailored to your needs. 
2. Prioritizing daily movement you enjoy. Consider different activities for different times of the year. 
3. Finding underlying patterns that are sabotaging your success and working to address them. 
4. Getting a good planning system down. In Ayurveda, the daily routine is called dinacharya and it’s the foundation of health and wellness. 

The complex nature of PCOS means there will need to be a personalized approach to treatment, but with consistency and understanding the underlying imbalances weight loss is possible with PCOS. 

Want to work with me? Learn more.