Hello everyone,
I am so excited to bring you on the pod Georgia Kohlhoff. We are deep diving into the metabolism of women with PCOS. Georgia has recently co-authored a research paper that aimed to answer the burning question of:
Do women with PCOS have a slower metabolism?
Georgia is a Registered Nutritionist and Trainee Counsellor & Psychotherapist and works in fat loss and PCOS. You can find her here on Substack at Flourishing Health or on Instagram. For anyone interested in the paper itself, you can find the abstract here. It’s still going through peer review, but should be fully out soon.
This episode is available on Apple and Spotify. If you prefer reading, I have summarised the conversation down below.
In this conversation we go through:
Why was answering this question important to you?
Do women with PCOS have slower metabolism?
How is metabolism defined in research?
What was the methodology of this research paper?
If metabolism is not to blame, what makes it challenging for women with PCOS to lose weight?
What surprised you in this research?
Why was answering this question important to you?
It actually started with frustration. There’s this very persistent idea that women with PCOS have a “slow metabolism,” and I kept seeing how disempowering that was in practice, women being told to eat less, restrict more, and assume their bodies were somehow broken.
A few years ago, some science-focused people in the fitness space put out a paper questioning that idea. My partner (who’s an academic) and I read it and thought, this is exciting, but it deserves proper research. So we decided to take that question seriously and look at the evidence properly.
At its core, the motivation was simple: is PCOS actually causing a metabolic disadvantage, or are we building advice on outdated and poor-quality research? If the assumption is wrong, the way we support women needs to change.
Do women with PCOS have slower metabolism?
The main finding was actually very clear: women with PCOS do not have a meaningfully slower metabolism.
When we pooled all the best available studies together, the average difference in resting energy expenditure between women with PCOS and those without was about 30 calories per day, which is essentially nothing. It’s a couple of bites of food. Clinically, that’s not enough to explain weight gain or difficulty losing fat.
So the idea that PCOS causes a metabolic disadvantage just doesn’t hold up when you look at the data properly. The body isn’t broken. The challenges people experience with PCOS come from other factors, not a fundamentally slower metabolism.
How is metabolism defined in research?
We look at resting energy expenditure, the energy your body needs just to keep you alive: breathing, pumping blood, thinking, maintaining body temperature. That alone makes up about 60–70% of the energy you use in a day.
Then on top of that, you have the energy used for movement, digestion, and everything else you do.
So when we talk about metabolism in research, we’re usually talking about that baseline: how much energy your body needs at rest. And that’s the part people assume is lower in PCOS — but the evidence shows it really isn’t.
What was the methodology of this research?
We conducted a systematic review and meta-analysis, which is essentially research on all the existing research.
We searched major scientific databases and pulled together every study we could find that had directly measured resting energy expenditure in women with PCOS, going back to the 1990s. Importantly, we only included studies that actually measured energy expenditure properly — a lot of papers use indirect or estimated methods, which aren’t very reliable.
Once we had those studies, we analysed them together to see what the overall picture looked like, rather than relying on one small or isolated study.
What stood out was how much of the existing research was poor quality or inconsistent, which is part of why this myth has stuck around. But when you only look at the stronger data and put it all together, the answer becomes much clearer.
If metabolism is not to blame, what makes it challenging for women with PCOS to lose weight?
Insulin resistance
Insulin resistance changes how the body handles energy. Instead of glucose being easily taken up by muscles and used, more of it gets stored as fat. This doesn’t mean weight loss is impossible, but it does mean the body is more biased toward storage, especially when insulin levels are high. Supporting insulin sensitivity often makes everything else feel less uphill.
Appetite dysregulation
Many women with PCOS experience stronger hunger, feel less satisfied from the same meals, and have more frequent cravings. This isn’t imagined — it’s physiological. That’s why jumping straight into intuitive eating can feel impossible at first. When appetite signals are disrupted, “listening to your body” can just mean feeling hungry all the time until those signals are stabilised.
Fatigue
Fatigue is incredibly common in PCOS. When you’re tired, you naturally move less and gravitate toward quick-energy foods, often higher in carbohydrates. That combination feeds back into insulin resistance. It’s not a motivation problem — it’s a tired nervous system doing what it can to cope.
Low mood, anxiety and depression
Women with PCOS are more likely to experience low mood and anxiety, which affects how food is used emotionally. Food can become comfort, relief, or a way to regulate feelings. That doesn’t mean anything is “wrong” psychologically — it means emotional and metabolic health are deeply connected.
Sleep disruption
Poor sleep worsens insulin resistance, increases hunger hormones, and increases cravings for high-energy foods. After a bad night, almost nobody wakes up wanting a salad and a workout. Sleep quietly but powerfully shapes eating behaviour and energy use.
Body image and visible symptoms
Things like weight changes, acne, or facial hair can affect how someone feels in their body. That relationship with the body matters. When you feel disconnected or frustrated with your body, it’s much harder to care for it consistently.
So when you zoom out, weight loss in PCOS isn’t about calories alone. It’s about managing a cluster of metabolic, hormonal and psychological factors that all interact. That’s why one-size-fits-all diets fail and why working with the body changes everything.
What surprised you in this research?
Two things really stood out.
First, how little evidence there actually is to support the idea of a slower metabolism in PCOS and yet how strong and persistent that myth is. When you read the data carefully, most studies don’t show a meaningful difference at all, but that message has somehow turned into “fact” online.
Second, I was surprised by how inconsistent the research is. Different studies use different diagnostic criteria for PCOS, so sometimes you’re not even comparing like with like. That makes it really hard to draw clean conclusions and it explains why confusion sticks around.
Overall, it was striking to see such a gap between what the evidence actually says and what women are being told every day.
Your closing thought
My main message is that your body isn’t broken. PCOS doesn’t mean doom and gloom, it just means there are a few extra considerations to work with.
Once you take metabolism off the table, it becomes much more empowering. You can stop fighting your body and start understanding what it actually needs. And interestingly, there are even things that can work in your favour with PCOS, like a slightly greater ability to build muscle.
So it’s really about saying: these are the cards I’ve been dealt, how do I play them well? When you work with your body rather than against it, everything becomes more sustainable and far less punishing.
See you next Sunday,
Francesca
