PCOS and Weight
Hello everyone,
The week where we unpack PCOS has finally arrived. This is the last reminder to join us on Wednesday at 6pm, UK time. In this webinar we will discuss:
How ovulation works when we have PCOS
The connection between genetics, lifestyle, insulin, inflammation, weight and PCOS
The most effective changes for PCOS
How to build your own PCOS tool kit
This week’s question:
How does weight affect PCOS?
Today we discuss weight. If you are someone who is always looking for ways to lose weight, this newsletter issue is for you. This is a 2 part newsletter topic. This week we will discuss how weight impacts PCOS, and next week we will break down how to lose weight when you have PCOS.
What is considered excess weight?
For adults, WHO (World Heath Organisation) defines overweight and obesity as follows: overweight is a BMI greater than or equal to 25, and obesity is a BMI greater than or equal to 30. To calculate your BMI, you can head over here.
Excess weight = excess fat cells/adipose tissue. The primary role of fat cells is to store excess energy when we consume in surplus and release that energy when we need it. Fat cells continue to enlarge if we overconsume energy (which is super easy to do in this modern age).
Why is excess weight bad for our health?
Fat tissue can be divided into two types:
subcutaneous adipose tissue (SAT): the fat beneath our skin
visceral adipose tissue (VAT): the fat lining internal organs
The reason why adipose tissue can be problematic is because it can act as an organ of itself and is able to secrete up to 50 different molecules that have an impact on our metabolic and hormonal health. In some cases, these molecules, when secreted by subcutaneous adipose tissue (SAT) are beneficial for us, but those secreted by visceral adipose tissue (VAT) can be problematic. Let’s look at a few important examples:
Leptin - this is the hormone that signals to our brain that we are full. In obesity we can become resistant to it, meaning our brain doesn’t respond to it and we are constantly hungry.
Adiponectin - this is a hormone that increases insulin sensitivity and is protective against insulin resistance. In people with high VAT type of fat, adiponectin is decreased.
Inflammatory molecules: IL-6, CRP and TNF-alpha. These molecules increase the inflammatory state of our body and interfere with insulin signalling, contributing to the development of insulin resistance (to revise the role of inflammation in PCOS, head over here)
How does excess weight affect PCOS?
Although not all women with PCOS carry excess weight, between 50-80% of us are within the overweight and obese category. It is also thought that lean PCOS phenotypes may still carry central obesity. Unfortunately, we also are more likely to store abdominal and VAT distribution of fat.
The primary mechanism by which VAT impacts PCOS is by worsening insulin resistance. Several molecules (seen in the image below) contribute to the worsening of insulin resistance, impacting the testosterone level and increasing PCOS symptoms. To revise how insulin resistance impact PCOS, head over here.
In addition to worsening insulin resistance, fat cells are able to impact testosterone production directly. Whilst androgens (testosterone and its forms) production comes from the ovaries and adrenals, they can be further modified within fat cells. Excess weight increases this mechanism, converting certain androgens into more powerful ones and worsening hyperandrogenism.
How do I know how much VAT I have?
It is pretty hard to measure it accurately without imaging tests (MRI or CT), but a good guiding measure is waist circumference. Research shows that women with a waist circumference > 88cm (34 inches) are at higher risk of metabolic complications.
As a result, rather than obsessing over the weight on the scale, which can fluctuate quickly, a way of measuring risk and also progress is through waist circumference measurement.
How can I reduce weight and VAT?
We will discuss how to tackle this problem next Sunday.
I wish you a lovely week. I hope to see you Wednesday over Zoom for our webinar.
Francesca
1 Sources
Gupta, A. K., Menon, A., Brashear, M., & Johnson, W. D. (2012). Prediabetes. In Nutritional and Therapeutic Interventions for Diabetes and Metabolic Syndrome (pp. 57–75). Elsevier.
Ibrahim, M. M. (2010). Subcutaneous and visceral adipose tissue: structural and functional differences. Obesity and Metabolism, 7(2), 64–65. https://doi.org/10.14341/2071-8713-5212
Mittal, B. (2019). Subcutaneous adipose tissue & visceral adipose tissue. The Indian Journal of Medical Research, 149(5), 571–573. https://doi.org/10.4103/ijmr.IJMR_1910_18
Obesity and overweight. (n.d.). Who.int. Retrieved May 16, 2023, from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Spritzer, P. M., Santos, B. R., Fighera, T. M., Marchesan, L. B., & Lecke, S. B. (2022). Intrinsic abnormalities of adipose tissue and adipose tissue dysfunction in PCOS. In Polycystic Ovary Syndrome (pp. 73–96). Elsevier.