PCOS and Weight Loss: Why the Traditional Approach Doesn't Work

If you have PCOS, chances are you’ve been told to “just lose weight” to improve your symptoms - without any clear explanation of why, how, or what to expect. This advice is often frustrating, leading you to cycle through different diets, lose weight temporarily, and ultimately regain even more. Each time, symptoms worsen, leaving you feeling discouraged and lost.

You deserve better answers. That’s why we’re breaking it all down today. In this post, we’ll cover why people with PCOS often experience weight gain over time, how weight stigma affects health, and what to do if you want to lose weight.

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PCOS and Weight Gain

Let's talk about weight and PCOS. Data suggests that people with PCOS tend to experience higher longitudinal weight gain over their lifetime. But why does this happen?

The International Evidence-Based Guidelines for the Assessment and Management of PCOS 2023 (I'll refer to this as the guidelines from now on) explored this question through an extensive literature review. They examined both modifiable extrinsic factors (what’s happening externally) and intrinsic factors (what’s happening inside the body).

Starting with extrinsic factors, researchers asked whether modifiable factors like diet and exercise contribute to weight gain in people with PCOS. In other words, do people with PCOS eat or move differently than those without?

The studies were conflicting. Some suggested that people with PCOS had more health-promoting habits while others suggested they had less health promoting habits, and some found no significant difference at all (and here). So, current research on lifestyle habits of this population is quite limited, and the existing ones don’t strongly suggest that people with PCOS have different eating or exercise habits. This debunks the stereotype of people with PCOS being “lazy” or “overeating,” which is simply not true. You can’t eat or not move your way into PCOS! I truly can’t stress this enough.

I also believe there’s a gap in the research, one that hopefully we’ll fill in the upcoming years. There’s minimal data on non-modifiable extrinsic factors like access to healthcare, food availability, social support, and the physical environment. We know the social determinants of health play a much larger role on health statuses than individual choices. These factors affect well-being on a structural level and could play a crucial role in how PCOS develops and progresses, as they do with other chronic diseases. I’m eager to see future research in this area!

Next, intrinsic factors. Researchers are investigating various areas, such as appetite-stimulating and suppressing gut hormones, subjective hunger and fullness, mealtime-induced thermogenesis (how much energy our body uses to digest and break down food) and resting energy expenditure (how much energy is required to maintain the body functions at rest).

Research, again, is limited, but growing evidence suggests that these intrinsic factors may function differently in people with PCOS, which could lead to feeling hungry more often or never feeling full (hence the cravings), and slower metabolic rate (hence the higher weight over lifespan).

The key takeaway is that we don’t yet know exactly why people with PCOS tend to gain weight over their lifetime, though the data points to intrinsic factors as being more influential.

Unfortunately, people with PCOS often face weight stigma and are unfairly labeled as “non-compliant” or “lacking discipline”, which is not backed by strong data. Weight gain is likely driven by underlying factors within the body, not by what or how much you're eating. From my experience, people with PCOS are highly motivated to make changes because their symptoms can be uncomfortable, and they want to feel better!

PCOS and Weight Stigma

Let’s talk about weight stigma. What exactly is it? Simply put, it’s negative attitudes, beliefs, and discrimination directed at people based on their body weight. Weight stigma can affect people across the weight spectrum, though it’s mostly assumed that thinner is always healthier and better. This belief is especially pervasive in healthcare, particularly for patients with PCOS.

A systematic review found that 19-41% of people with higher body weights reported experiencing blatant weight discrimination. In the U.S., nearly 40% of adults face weight-related mistreatment, with women experiencing it more often.Here are a few examples of how weight stigma plays out:

A patient with PCOS experiences severe menstrual irregularities, acne, and hair loss due to PCOS, only to be repeatedly told by healthcare providers that losing weight is the solution, that doesn’t address the underlying hormone imbalances. The focus on weight loss diverts attention from managing the hormonal issues with proper treatments like medication, supplements and lifestyle interventions that specifically target the hormonal imbalances with PCOS. This not only is unhelpful, but harms the patient’s mental health, reinforcing the harmful idea that their symptoms are solely due to weight.
A client has chronic fatigue. She was repeatedly told to lose weight before switching providers, and finally got diagnosed with hypothyroidism. After receiving the proper treatment, her energy levels dramatically improved.

Research suggests that weight stigma contributes to about 27% of the prospective link between body weight and health complications. Those who experience weight stigma are at higher risk for inflammation, oxidative stress, and high blood pressure. It also leads to social isolation, body dissatisfaction, anxiety, depression and feelings of worthlessness.

The critical truth is that weight is not a reliable indicator of individual health. This doesn’t mean unexplained, significant changes in weight shouldn’t be investigated - but basing someone's health status solely on a number on the scale is irresponsible and inaccurate care.

When people with PCOS are told to just lose weight, without proper support for diet and lifestyle changes, they often fall into the cycle of crash dieting, restricting, binging, and weight cycling, which worsens both physical and mental health.

What If You Want to Lose Weight?

If you’re wondering, “What if I do want to lose weight with PCOS?” - this blog post isn’t here to shame you for that desire. We live in a world that often prioritizes a certain body ideal and places a lot of value on appearance.

If you find yourself caught between the desire to lose weight and not wanting to control your body, here’s where we can start: What if we accepted that multiple truths can coexist? Yes, you might want to lose weight for personal reasons, while recognizing that long-term wellbeing often requires releasing rigid control over your body.

Online, there’s a lot of pressure around body positivity, but for some, it can feel inauthentic and forced. If that’s you, I suggest focusing on body acceptance/neutrality. It’s not about body positivity or negativity - it’s about detaching your self-worth from your size. Whether you’re at a higher weight or a lower weight, either is okay. This approach gives you more space to focus on behaviours that support your health, creating a more empowering and sustainable approach to long-term changes.

On a nutrition level, when many patients with PCOS start with us, they’re actually malnourished at baseline (from years of dieting and weight cycling). When we start working together, we focus on nutrition support to stabilize blood sugar levels, manage meal timing, restore nutrient deficiencies, increase insulin sensitivity and reduce inflammation.

These changes support your overall well-being and may lead to weight changes (increase, decrease, or stay the same) as a natural outcome. Remember, weight is influenced by many complex factors, both modifiable and non-modifiable. Diet and lifestyle are some of the modifiable factors, but they’re just one piece of the puzzle.

When clients ask about losing weight, I completely understand that want, and like to also explore why weight loss matters to them. We make dietary changes to improve their PCOS markers, and I remind them that weight may fluctuate, and that it's important to let go of rigid expectations.

We open up room to attach joy to the process, and over time, they may even notice and celebrate non-scale victories. These are often things like having more energy, waking up without feeling exhausted, experiencing regular digestion, or enjoying a meal out without stress. Maybe blood work improves, and they’re no longer in the pre-diabetes range. These wins - whether physical or mental - are worth celebrating.

Ultimately, it’s about informed nutrition changes, balance, kindness to self, and keeping an open mind. Once you embrace this approach, you can make lasting, meaningful changes that truly benefit your health.

The Takeaway

It's important to acknowledge that people with PCOS may experience weight gain due to intrinsic factors, and the weight stigma that often surrounds this condition can be harmful. If losing weight is a goal for you, there’s no shame in that - what matters is learning to find joy in the behaviors that support your health and well-being. Over time, as you focus on nourishing your body and adopting more health-promoting habits, you may notice improvements not just in your physical health, but in your mental and emotional well-being as well. The journey is about progress, not perfection, and embracing that can lead to lasting, meaningful change.

Hi! I’m Trista

A Registered Dietitian and reproductive health expert. I’m here to help you gain confidence to overcome your Polycystic Ovary Syndrome and digestive health woes, while bettering your relationship with food.