As someone with PCOS, you might’ve heard the following words from your doc: “Just eat less and move more.”
This “medical advice” is oversimplified, reductionist, and reflective of the over-emphasis (and stigma) on weight prevalent in the medical system.
Mild weight loss can play a role in managing PCOS: it can help with insulin resistance, improve ovulation rates, and support metabolic health (markers). We know that carrying excess fat around the organs impairs how those organs function and contributes to long-term heart disease risks.
Focusing solely on shedding pounds, especially in a vague and generalized manner, really misses the mark, though. This is especially true considering the low success rate for long-term weight loss. Data shows that fewer than 25% of patients, even with doctor supervision and regular check-ins, manage to keep the weight off long-term. This figure drops to less than 10% when we broaden our scope to include the general population.
Success in weight loss usually requires substantial resources, including time, money, and ongoing support from healthcare and fitness professionals. In reality, long-term weight loss is often unattainable for many.
Weight is a product of so many different factors (just like PCOS!). Genetics, upbringing, epigenetics, in utero exposures (i.e., what you were exposed to while you were in the womb), trauma, stress, intergenerational aspects of health, socioeconomic status, education, food and housing accessibility, geography, medical history, the environment, medication use, lifestyle factors, hormonal miscommunications, altered hunger and satiety signals, and so many other things influence what our bodies looks like.
Unfortunately, many PCOS patients experience significant sizeism within the medical system. They’re called lazy and not screened for food restriction or disordered eating.
PCOS treatment should be personalized. It should consider all of these factors and these elements should be part of the discussion so that you also understand that improving your health and moving the needle forward isn’t solely about the size of your body.
In a group already prone to disordered eating, body dysmorphia, anxiety, and depression, this advice can amplify feelings of failure and hopelessness, leading patients to believe that their PCOS is their fault. (Remember: it is not!)
Well-intentioned but overly simplistic advice from doctors can do more harm than good, reinforcing harmful beliefs about food restriction, excessive exercise, and self-blame.
There are plenty of other metrics and lifestyle factors we can focus on. There will always be elements of our health and life that are beyond our control, but we can start to work on:
- using metrics like period frequency, lab tests, and/or energy levels as measures of progress
- adding in more plant foods that contain fibre and antioxidants
- decreasing saturated fat/red meat per week
- adding in more movement, especially the kind you enjoy
- adding in formal exercise without hyperfocusing on weight
- breaking up sedentary time with standing, stretching, or an activity you like
- trying to get outside more frequently
- working on mental health and self-care
- using medication and/or supplements to improve metabolic health and support your journey
- and SO MUCH MORE!
If your doctor is fixated on weight loss, consider seeking another opinion or discussing alternative strategies/treatment options for your PCOS.
Disturbingly, even in the 2020s, many family doctors and specialists in North America report feeling ill-equipped to support PCOS patients due to a lack of time and up-to-date educational resources.
As someone with PCOS/a practitioner working primarily with PCOS patients, we need to move away from telling people to shrink their nutrition, bodies, and lives.
Society bombards us with toxic beauty standards and unrealistic body ideals, and we don’t need our healthcare advice to add to this burden.
Instead, we should focus on sustainable, holistic practices that support long-term health, joy, connection, and flexibility.
If you’re struggling with your relationship with food, consider seeking support through individual or group therapy, engaging with books and podcasts on the topic, and regularly checking in with empathetic healthcare providers. It’s time we shift the narrative from weight loss to overall wellness and quality of life.
The journey with PCOS is complex and personal, and treatment should reflect that. Let’s prioritize approaches that empower and uplift, rather than diminish, our health and lives.
You’ll find detailed narratives and practical tools like this in “The Period Literacy Handbook”. Go grab your copy! There’s a full chapter on PCOS (Chapter 19). I’m also accepting new patients on a rolling basis if you’re looking for individualized support with your polycystic ovarian syndrome.
