Why do I have trouble losing weight?

PCOS is a syndrome, not a disease, which means that there are a collection of symptoms that can manifest themselves. Difficulty in losing weight is one, and it is essential to try and maintain a good lifestyle to prevent the other symptoms from manifesting. One of the more common symptoms is insulin resistance. Another is sex hormone imbalances (excess testosterone, reversed levels of FSH and LH). Both of these things can cause weight issues, for different reasons, having both physical and psychological effects on appetite and blood sugar. You have to be fully committed to lose weight and it is a good idea to go and see a dietitian who specialises in this area. Often it is the psychological barrier to losing weight, despite the hormonal imbalances which don’t help – and this is why you need the guidance of a professional who can help you with guidelines and monitor your progress. Your body is so complex and you have to learn how to make healthier lifestyle choices..
If you do have insulin resistance, or full-blown diabetes, your doctor will have informed you. He might have put you on medication and you should be on a low-GI diet. It is mainly avoiding simple carbohydrates like white sugar, bread, pasta and rice, being careful not to eat processed products like biscuits cakes, chocolates and lollies. Portion sizes of all the foods you eat must be watched. Exercise is essential and should be done daily – preferably about an hour.
You should find that generally your symptoms from polycystic ovaries improve with weight loss.
Pregnancy might occur without medical intervention – you should discuss this with your doctor. Women with Polycystic Ovarian Syndrome often do not menstruate regularly, but I with weight loss this often changes. Some women get put on birth control pills to regulate their menstrual cycle.
Losing weight really lessens the symptoms of PCOS. Many women are able to get pregnant without medical intervention after losing weight. Weight loss often regulates insulin resistance and hormone imbalance.

Most women at some point have to contend with weight gain. But for women with polycystic ovary syndrome (PCOS), losing weight can become a constant struggle. PCOS occurs when the ovaries don't make enough hormones for the eggs to fully mature. Instead of releasing a mature egg during ovulation, some of the follicles in the ovaries turn into fluid-filled sacs called cysts. More than six out of every 10 women who have PCOS are also overweight. The good news is that women with PCOS can actually win the struggle against weight gain. If you have PCOS, certain lifestyle changes can help you shed kilos and reduce the disease's severity.

PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition called insulin resistance can cause insulin and sugar ( glucose) to build up in the bloodstream. High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hair growth, acne, irregular periods and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape. Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions.

No matter what the cause, weight gain can be detrimental to your health. Women with PCOS are more likely to develop many of the problems associated with weight gain and insulin resistance, including:
Type 2 diabetes
High cholesterol
High blood pressure
Sleep apnea
All of these conditions can lead to heart disease. In fact, women with PCOS are four to seven times more likely to have a heart attack than women of the same age without the condition.
Experts think weight gain also helps trigger PCOS symptoms, such as menstrual abnormalities and acne.

Losing weight not only can help you look better – it can also make you feel better. When you have PCOS, shedding just 10% of your body weight can bring your periods back to normal. It can also help relieve some of the symptoms of polycystic ovary syndrome. Weight loss can improve insulin sensitivity. That will reduce your risk of diabetes, heart disease, and other PCOS complications.
To lose weight, start with a visit to your doctor. The doctor will weigh you and check your waist size and body mass index. Body mass index is also called BMI, and it is the ratio of your height to your weight. Your doctor may also prescribe medication. Several medications are approved for PCOS, including birth control pills and anti-androgen medications. The anti-androgen medications block the effects of male hormones. A few medications are used specifically to promote weight loss in women with PCOS. These include:
Metformin (Glucophage). Metformin is a diabetes drug that helps the body use insulin more efficiently. It also reduces testosterone production. Some research has found that it can help obese women with PCOS lose weight.
In addition to taking medication, adding healthy habits into your lifestyle can help you keep your weight under control:
Eat a high-fiber, low-sugar diet. Load up on fruits, vegetables, and whole grains. Avoid processed and fatty foods to keep your blood sugar levels in check. If you’re having trouble eating healthy on your own, talk to an accredited practising dietitian.
Eat four to six small meals throughout the day, rather than three large meals. This will help control your blood sugar levels.
Exercise for at least 60 minutes a day on most, if not all, days of the week.
Work with your doctor to track your cholesterol and blood pressure levels.
If you smoke, get involved in a program that can help you quit.

I am also a PCOS sufferer, the only way I have managed to loss weight is through exercise (recently at Curves) and drinking 2 litres of water per day…. In the last 4 months I have lost nearly 12 kgs and 45 cm from this. I am 48.

 Previously I have tried, Jenny Craig, Weight Watchers, all types of other diets and even through a personal trainer with our local sports shop and this did not work either.. 

Having PCOS can make it more difficult to lose weight but doesn't mean it is impossible, just that it might be slower than in women without the condition.  As Arlene explained, the reason for this is insulin resistance, which is the underlying problem in PCOS.  When the body's insulin doesn't work properly, you product more insulin to overcome the insulin resistance, and high insulin levels make it easier to store fat and harder to burn. 

The key to losing weight is making lifestyle changes which improve how your insulin works. This includes:
* increasing exercise - aim for at least 30-40 minutes most days but preferably up to 1 hour to help with weight loss.  If you are able to, build in some higher intensity intervals and weights.
* increasing incidental activity - look for opportunites to move more (eg parking further away, taking the stairs rather than the lift etc)
* reducing sedentary time by taking regular breaks from sitting where you can
* getting enough sleep - aim for 7-8 hours/night
* eating a well balanced diet based around lots of vegetables and salads, wholegrains, legumes, fruit, moderate amounts of lean protein and small amounts of healthy fats
* limiting portion sizes to reduce your total energy intake and avoiding energy-dense foods and fluids (eg sugar sweetened drinks, high fat/high sugar snack foods, fast foods etc)

It is important not to overly restrict your diet or to lose weight too quickly if you are trying to concieve - a weight loss of 1-2kgs per month is good.  Losing just 5-10% of your weight can significantly immprove your PCOS symptoms and fertility.  Optimising your lifestyle and weight prior to conception is really important and can reduce the risks to you and your baby in pregnancy, including the chances of developing gestational diabetes which is more common in women with PCOS.

The Jean Hailes Foundation have some good information on the lifestyle management of PCOS http://www.managingpcos.org.au/lifestyle-and-pcos.   You may also be interested in my book on diet and pregnancy, which specifically focuses on managing blood glucose levels and weight in preconception and pregnancy and is particularly relevant if you have PCOS.  It also includes eating guidelines and recipes. http://bumptobabydiet.com/.

It can be difficult to manage your weight when you have PCOS. It is currently not clear if there are any biological factors that could lead to women with PCOS having more difficulties with weight management. However, research has suggested that hormones involved in controlling appetite and hunger aren't regulated properly in some women with PCOS. If this is the case, it may mean that some women with PCOS are more likely to gain weight and have more difficulty losing weight.  Weight loss is best achieved through a combination of lifestyle changes – a healthy diet and physical activity. It is not always easy to make changes to your lifestyle so that you eat more healthy foods and make exercise a regular part of life. Learning and understanding about goal setting can be helpful along with how to make changes to your behaviour. For further information and advice, talk to an accredited practising dietitian (APD) and/or your doctor.