PCOS, or polycystic ovary syndrome, is a hormonal condition that affects around 8-13% of women of reproductive age, with approximately 21% of Indigenous women affected.
Women with PCOS may experience cysts on the ovaries, disruptions to the menstrual cycle, as well as skin and hair changes. It is a leading cause of infertility, however, many women who have it don't know and remain undiagnosed.
PCOS symptoms can vary significantly between different people, however, PCOS belly is one of the most commonly experienced symptoms among sufferers, and it looks different from other types of weight gain.
Unfortunately, PCOS can also make weight loss difficult or even sometimes feel impossible. So, let's take a look at why PCOS belly fat affects people differently than regular weight gain.
What is PCOS?
Women with PCOS usually have high levels of insulin that don't work effectively or have high levels of male hormones, known as androgens, or both.
It's unknown what the cause of PCOS is, however, genetics, hormones and lifestyle are believed to play a role. Insulin resistance is common and can affect 4 out of 5 PCOS sufferers.
PCOS is a common condition, with many women going undiagnosed. While up to a third of women can have polycystic ovaries, to be diagnosed with PCOS, you will need to have 2 of the following:
- Absent or irregular periods
- Acne, excess facial or body hair growth, scalp hair loss or high levels of androgens, such as increased testosterone, in the blood
- Polycystic ovaries visible on an ultrasound
Women with PCOS may also experience:
- Reduced fertility
- Mood changes
- Obesity
- Sleep apnoea
What is PCOS belly?
A common symptom of those with PCOS is abdominal weight gain, also known as PCOS belly. It's the result of PCOS-related weight gain and may be caused by different factors.
PCOS belly involves more abdominal visceral fat gain in comparison with the rest of the body, and this kind of weight gain is associated with inflammation.
Studies have found that fat in the abdomen of women with PCOS contains inflammatory molecules, which can increase oxidative stress in the body.
This may lead to glucose dysfunction and insulin resistance, where insulin and sugar build up in the bloodstream. High insulin levels stimulate the production of androgens, and too many of these hormones cause fat gain.
What does PCOS belly look like?
PCOS belly looks different to other types of weight gain, with PCOS sufferers reporting they have an enlarged belly, while the rest of their body remains the same size as it has always been.
This may be due to bloating, excessive weight gain, or both. Women with PCOS will often find it difficult to lose belly fat.
One study looked at the levels of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) between those with PCOS and controls. The results found that those with PCOS had higher visceral fat, despite having a normal BMI (body mass index), and had more visceral fat surrounding their organs.
Visceral fat is harder to lose than subcutaneous fat, and it is the type of fat that causes the abdominal wall to push outwards, giving a beer-belly look to the PCOS belly.
Why can it be difficult to lose weight with PCOS?
If you have PCOS, losing weight can help ease symptoms and potentially regulate your menstrual cycle.
However, it can be very difficult for women with PCOS to do so because their bodies produce too much of the hormone insulin, which can cause fat gain. More than half of PCOS sufferers will be overweight due to this reason and find it difficult to shed weight.
Insulin is the hormone that transports glucose, your body's main fuel source, from your blood and into your cells, where your body uses it for energy. If you have PCOS, your cells resist insulin signals, causing your body to produce more insulin.
These hormonal imbalances promote fat gain in your midsection. Insulin is also an appetite-stimulating hormone, so having higher insulin levels can make PCOS sufferers feel hungrier, leading to higher calorie consumption and, thus, weight gain.
PCOS sufferers may also have abnormal hormonal regulation of appetite and the feeling of fullness. Appetite-regulating hormones such as ghrelin, cholecystokinin, and leptin have been proven to be impaired in women with PCOS.
If these hormones aren't operating at the correct levels, they can stimulate hunger, making it difficult to lose weight.
What is the connection between PCOS and belly fat?
Research has found increased belly fat to be linked with insulin resistance, which many people with PCOS suffer from.
One study followed a group of 110 PCOS sufferers and 112 weight-matched control subjects, with the researchers finding that while all patients had similar trunk fat, those with PCOS had higher levels of abdominal fat.
These patients also had significantly higher insulin levels and significantly reduced insulin sensitivity than the controls.
What are the other symptoms of PCOS?
PCOS belly and weight gain are not the only symptoms of PCOS. Other symptoms include:
- Irregular menstrual cycles; periods may be less or more frequent
- Abnormal bleeding
- Amenorrhoea (no period); some women with PCOS will not have a menstrual cycle
- Excessive body or facial hair growth
- Acne
- Thinning hair
- Reduced fertility/difficulty falling pregnant; ovulation may be less frequent or totally absent
- Mood changes
- Sleep apnoea
- High blood pressure
Women who have PCOS are also at a higher risk of developing other health issues, including high cholesterol and sexual health issues.
Your doctor may ask you to have a blood test or an ultrasound to determine whether or not you have PCOS.
Healthy ways for women with PCOS to reduce belly fat
While it might feel like an uphill battle, having your body working against you, if you have PCOS and want to reduce belly fat, there are several ways you can do so.
Speak with a doctor
Before embarking on a weight loss journey, it's important to have a conversation with your doctor. They will be able to help create a treatment plan for you.
Consume a high-fibre diet
Studies have found that a high-fibre diet can lead to lower insulin resistance and lower total body fat and belly fat in women with PCOS. You should aim for around 14 grams of fibre per 1000 calories, with women usually recommended to aim for 25 grams daily.
Eat anti-inflammatory foods
Sugary and highly processed or packaged foods are linked to inflammation, with chronic inflammation linked to obesity.
Women with PCOS should eat a healthy diet similar to the Mediterranean diet, including whole foods, fruits, green leafy vegetables, olive oil, omega-3-rich foods such as fatty fish, and whole grains to reduce inflammation.
Use complex carbohydrates to regulate your blood sugar
Around 70% of women with PCOS will have insulin resistance, which occurs when your cells stop recognising the effects of insulin, which is necessary for blood sugar management and energy storage in your body.
Higher insulin levels are linked with increased body fat and weight gain. If you lower your carbohydrate intake, you can reduce your insulin levels.
One study had PCOS sufferers follow a low-carb diet of 40% carbs, 45% fat and 15% protein over 3 weeks and then a diet of 60% carbs, 25% fat and 15% protein for a further 3 weeks, with insulin levels dropping by 30% in the lower-carb, higher-fat weeks.
A low-glycemic diet will also benefit PCOS sufferers, with studies also showing the benefits of going low-GI on insulin sensitivity.
Prioritise protein
Eating foods high in protein can help keep you fuller for longer and help stabilise blood sugar after a meal. It can also reduce cravings, help manage your hunger hormones and promote weight loss.
Protein also helps you build muscle (if you are strength training), which helps burn more calories at rest. A study of women with PCOS found that those who ate high-protein lost an average of 4.4kg after 6 months, much more than those in the control group.
The general rule is 1.2-2 grams of protein per kilogram of body weight — so if you weigh 70kg you will be aiming for between 84g-140g of protein per day. The upper end is more advisable.
Add more protein by eating eggs, chicken, and seafood or choose high-protein snacks like the Juniper Nourish Shakes.
These shakes are great meal replacements that will satisfy hunger while providing you with 20 minerals and nutrients you need for overall health and immunity. The shakes are just 205 calories, making it easy to stick to your calorie goal for the day, and they are also high in protein, with almost 30g per shake.
Your gut health is also accounted for with pre- and probiotics to assist with inflammation, digestion and immunity. Use Juniper's Nourish Shakes once or twice daily to help you reach your goal.
Add healthy fats
Healthy fats can also help keep you fuller and more satisfied after meals, which can also help with weight loss.
Studies have found that diets rich in healthy fats (avocado, olive oil, nut butter, salmon etc.) can reduce hunger and body fat loss in women with PCOS.
Manage stress and get enough sleep
Chronic stress increases your cortisol levels, with high cortisol levels being linked to insulin resistance and weight gain. It also increases your risk of developing belly fat, which increases inflammation and triggers the body to create more cortisol — a vicious cycle.
Meditation, yoga and gentle daily exercise such as walking can help with stress management and lower cortisol levels. Lack of sleep is also associated with an increase in hunger hormones, which make you want to eat more throughout the day.
Studies have also found that those who sleep less than 5 hours a day are more likely to be obese, while better quality sleep can lead to fat loss. Aim for 6-8 hours of sleep a night to enjoy the health benefits.
Exercise
Any form of exercise will be good for your health, but strength training is particularly effective for helping women manage PCOS.
One study of 45 women with PCOS found those who did weight training 3 times a week lost belly fat, gained muscle and reduced testosterone and blood sugar levels.
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