Weight - management & treatment

An important goal is to be as healthy as you can. For women who struggle with their weight it is best to focus on not putting on more weight at first, rather than losing weight. Over time, you may find ways to lose weight but first focus on maintaining your current weight.

Do women with PCOS have a greater risk of being overweight?

Women with PCOS generally have higher rates of weight gain and are at higher risk of developing unhealthy weight with up to 60% having unhealthy weight. Some research suggests that hormones involved in controlling appetite and hunger aren't regulated properly in some women with PCOS.

Benefits of weight loss with PCOS

Even a small weight loss will help improve the symptoms of PCOS. Weight loss can restore the normal function of the ovaries and result in normal hormone production. This can in turn lead to improvements in symptoms of PCOS, such as excess facial or body hair growth, acne, scalp hair loss and menstrual regularity.

A large number of research studies have shown that reducing weight by 5-10% can:

• reduce insulin resistance by about 50%
• restore ovulation
• regulate menstrual cycles
• improve fertilityreduce pregnancy complicationsimprove health during pregnancy
• improve the health of a child during pregnancy
• improve emotional health (self-esteem, anxiety, depression)
• reduce risk factors for diabetes and heart disease.
  

Lifestyle

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 a regular part of your life. Learning and understanding about setting goals and behaviour changes can be helpful so you can maintain changes over time.

Evidence shows that women with PCOS who develop a support network are more likely to make, and stick to, lifestyle changes.

A support network can be made up of a number of people such as health professionals (for example, a GP, psychologist, dietitian, exercise physiologist, personal trainer), as well as social support, such as family or friends.

For further information and advice, talk to an accredited practising dietitian (APD) and/or your doctor or visit our webpage on PCOS & healthy living.

Being overweight

With PCOS, excess weight is more likely to be concentrated around the abdominal (stomach) region. This gives you an 'apple' shape. Women without PCOS tend to be a 'pear' shape, with weight concentrated around the hips, buttocks and thighs.

Being overweight, and especially having a high amount of abdominal obesity, is associated with:

• a higher risk of insulin resistance (a state where the body doesn’t use the available insulin effectively to help keep the glucose levels stable – the insulin produced is not working properly)
• problems with infertility
• a higher risk of type 2 diabetes
• a higher risk of cardiovascular disease, including high blood pressure, heart disease and stroke
• psychological challenges.
  

Importance of waist circumference

Waist measurement is an indicator of unhealthy weight. A simple way to assess your abdominal weight is to measure your waist circumference. The recommended waist circumference is less than 80cm for adult women. Women with a larger waist measurement are more at risk of developing health problems related to unhealthy weight.

To measure your waist circumference accurately:

• Place a tape measure directly on your skin, or on no more than one layer of tight clothing, horizontally halfway between your lowest rib and the top of your hipbone (roughly in line with your belly button)
• Breathe out normally
• Take the measurement
• Make sure the tape is snug, without squeezing the skin.

Measuring your BMI

Another way to measure if you are overweight is to calculate your BMI (Body Mass Index). You calculate your BMI as your weight (in kilograms) divided by your height (in metres) squared (height x height).

For example, Sally weighs 90kg and is 167cm (1.67m) tall. She has a BMI of 32.3:

Weight (kg) ÷ Height (m) squared = BMI
90 ÷ (1.67 x 1.67) = 32.3

When you know what your BMI is, you can look at the table below to find out which weight category you are in. You will see that Sally’s BMI of 32.3 would place her in the obese category.

Better health channel has a BMI calculator to help you work out your BMI if you need it.

Your BMI is only one measure of your weight. If you are unsure if your BMI increases your risk of health problems, please discuss this with your doctor.

Medical management & surgery for weight loss

Some women with PCOS may need medical assistance to help with weight loss.

Surgery to assist weight loss

Weight-loss surgery is generally considered only if you meet certain criteria, including:

• you have a BMI (body mass index) greater than 40 and have tried unsuccessfully to lose weight via non-surgical methods for at least 6 months
• you have a BMI greater than 35 and other medical problems, such as diabetes or heart disease, and have tried unsuccessfully to lose weight via non-surgical methods for at least 12 months.

Types of surgery

There are two main types of surgical procedures, both of which make your stomach much smaller. A smaller stomach means you feel full after eating only small amounts of food, so you eat less and therefore reduce energy intake and lose weight.

The main surgical procedures are:

• Gastric sleeve surgery – where most of the stomach is removed (a major operation)
• Gastric bypass – where a smaller stomach pouch is made from the stomach, and the intestine is joined to it (a fairly major operation)
• Gastric banding – where the size of the stomach is reduced by a band being placed around the upper part of the stomach (a minor procedure done via keyhole surgery).

Things to consider

Although weight loss can improve many of the symptoms of PCOS there are some important things to consider about surgery, including:

• the risk of vitamin and mineral deficiencies: since food intake is reduced after surgery and food absorption is affected, vitamin and minerals can become deficient (eg, iron, folate and iodine)
• timing and pregnancy: it is not recommended for women to become pregnant until their weight has been stable for 12–18 months after weight-loss surgery
• appropriate contraception: effective contraception after surgery is important as fertility can improve but pregnancy is not recommended until 12–18 months after surgery
• potential post-operative complications
• cost: the procedure is expensive and it is very rarely available in public hospitals in Australia. Costs might be partly covered by private health insurance.

Discuss the risks and benefits of weight-loss surgery with your doctor to help determine if it is the right option for you.

Weight-loss medications

There is no evidence that weight-loss medications are any more effective than having a healthy lifestyle. Weight loss medications are used in conjunction with lifestyle changes.

The cost, side effects and availability all need to be considered carefully before using weight-loss medications. In addition, pregnancy needs to be avoided while they are being taken.

Taking action

Talk to your doctor about managing your weight. Discuss what sorts of influences in your life affect your weight. These will be different for everyone, so it is important to understand your own situation in order to work out the plan that will suit you best.

You might also like to speak with a psychologist, dietitian or exercise physiologist to help you change the way you think and feel about eating and physical activity. Good support will help you make changes that you can maintain over time, and that will benefit your health in many ways. Further information on managing a healthy weight is also available here.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at September 2019.