Hello everyone,
Today I bring you a lovely conversation with Registered Dietitian Tara | PCOS Journal about a well-known myth:
“Losing weight is the only way to manage PCOS.”
If you’ve ever sat in a doctor’s office with PCOS, you’ve likely heard some version of this. At least I did.
In this episode, we go through:
Is weight loss necessary for PCOS management?
The type of fat that is problematic for PCOS
The psychological impact of wanting to lose weight
This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.
I share snippets from our conversation and short-form content on Instagram. Follow us there:
It’s ok to want lose weight
For many women, this is the very first thing they hear after diagnosis. Before sleep is discussed, before insulin resistance is explained, before lifestyle, stress, or muscle mass are explored, the focus immediately shifts to the scale. The message is often delivered as if it is straightforward and universally applicable.
However, as we unpacked in the conversation, this issue is far more nuanced than it is often presented.
Before even touching the science, Tara made an important point about the emotional weight of the topic itself.
Body weight is not a neutral subject for women. It carries years of cultural messaging, moral judgment, family expectations, and medical dismissal.
When weight becomes the centrepiece of PCOS management, it is not simply interpreted as a metabolic suggestion. It often feels personal, loaded, and at times shaming.
At the same time, it’s important to acknowledge that it is not inherently wrong to want to lose weight. There is a growing narrative online suggesting that weight loss should never be a goal, which can also feel invalidating to women who genuinely feel uncomfortable in their bodies. Two things can be true at once. A woman can want to feel different in her body, and the culture around weight loss can still be deeply unhealthy.
Is weight loss necessary for PCOS management?
From a physiological perspective, there is evidence showing that even modest weight loss can improve insulin resistance and androgen levels in some women with PCOS. Insulin resistance is a central driver of the condition for many people, and improving metabolic health can lead to more regular cycles and symptom improvement. That part of the conversation should not be ignored.
However, what is often missed is that weight itself is not the root cause of PCOS. Insulin resistance and metabolic dysfunction are key players, and those do not map perfectly onto body weight alone. Body composition matters. Visceral fat, which surrounds internal organs and is metabolically active, contributes more significantly to inflammation and hormonal disruption than subcutaneous fat. Two women can weigh the same and have very different metabolic profiles. Equally, a woman with a higher BMI can have stable markers, while someone in a lower BMI range may struggle with insulin resistance.
This is where the blanket advice to “just lose weight” becomes problematic. It collapses a complex metabolic condition into a single external outcome and ignores the underlying mechanisms driving symptoms.
The psychological impact of wanting to lose weight
We also discussed the psychological impact of focusing exclusively on the scale. Tara shared that she often advises clients to put the scale away, not because progress does not matter, but because the number can eclipse every other sign of improvement. A woman can be sleeping better, lifting heavier weights, feeling more energised, experiencing fewer cravings, and cycling more regularly. If the scale does not move, or even increases slightly due to muscle gain, all of that progress can feel erased in an instant.
When weight becomes the sole marker of success, it can drive women toward increasingly aggressive strategies. Severe calorie restriction, excessive cardio, and chronic dieting often follow. In the context of PCOS, where stress and metabolic regulation are already sensitive, those strategies can backfire. Undereating and overexercising can elevate stress hormones, disrupt hunger cues, and make long-term adherence nearly impossible.
One of the most powerful themes that emerged from this part of the conversation was that you cannot hate yourself into health. If weight loss is pursued from a place of shame or self-loathing, it rarely leads to sustainable change. In fact, that internal stress can compound the physiological stress already present in PCOS.
The goal, then, cannot simply be to make the body smaller. The focus needs to shift toward improving insulin sensitivity, supporting muscle mass, reducing inflammation, improving sleep, and managing stress. When those foundations are addressed, weight may change as a byproduct. Sometimes it does, sometimes it does not, and sometimes the changes are slower than expected. But the primary aim becomes metabolic health rather than aesthetic transformation.
Our conclusion
In the end, we concluded that the statement “losing weight is the only way to manage PCOS” is neither fully true nor fully false. For some women, modest weight loss may improve certain markers. For others, focusing on weight can distract from more meaningful interventions. The key lies in understanding individual biochemistry, lifestyle, and stress load, rather than applying a universal prescription.
PCOS is not a condition that can be reduced to a single instruction. It is metabolic, hormonal, psychological, and environmental. When weight becomes the only lens through which it is viewed, important pieces of the puzzle are missed.
Health is not defined solely by a number on the scale, and PCOS management requires far more nuance than that.
See you Sunday,
Francesca
