Hello everyone,
Thank you so much to those that made it to our webinar. It was a pleasure seeing you in person. For anyone interested in watching the recording, it’s available here.
This week is part 2 of our weight topic. In part 1, we broke down how weight impacts PCOS. If you haven’t read it yet, head over here.
This week’s question
How do I lose weight with PCOS?
In this newsletter, we will cover:
What causes weight gain.
Five weight loss principles.
Whether it is more challenging for us to lose weight.
Is weight loss necessary?
Do we need to go low carb to lose weight?
Support resources for weight loss.
Before we dig into this topic, I want to start by saying that all bodies are beautiful. I am not advocating weight loss as a blank approach for everyone. I think we come in different sizes and shapes, and our uniqueness should be celebrated. We shouldn’t try to fit within “an ideal body” that was somehow created, and millions of women are pushed into.
I don’t believe in diets, and I genuinely think that dieting has put a lot of women close to eating disorders. The weight loss industry is predatory and does more harm than good. However, I understand the desire to lose weight. Unfortunately, dieting is one of the main pieces of advice that healthcare professionals give when it comes to PCOS. So, the question is, how do we lose weight without going on a diet?
What causes weight gain?
The most important thing to understand when considering losing weight is that excess weight is a symptom of an underlying cause. The moment we can see weight gain as a symptom, the same you’d see a headache, we can start unpacking what drives it and find the solution. Excess weight and obesity are probably one of the most complex health issues. To this date, we have NOT been able to solve it at a global scale. The reason for that is because of its complexity. The map below shows how many factors play within weight gain:
To a more generic map:
This is a map of all the different factors that affect weight gain. We live in an environment where food is readily available, in forms that our brain prefers, designed to perfection to enchant our taste buds, in a world where stress is on the rise and nutrition is NOT taught in schools. We are more disconnected from our loved ones and more glued to our computers. A recipe for disaster. All of these contribute to weight gain, so when we try to solve this issue by controlling food, it doesn’t work. It doesn’t work because food alone is never the only issue.
Diets try to control the food element without understanding the behaviours that leads to consuming that food in the firstplace. We try to overide years of habits with a 30 day challenge and address the symptom, without getting to the route cause. No surprise the weight comes back, as soon as we come back to our initial routine.
As a result, the first principle that we need to aware of when trying to lose weight is:
Principle 1: We all have behaviours that work against us. Identifying these behaviours is the first step to address weight gain
If we really want to lose weight in the long run, we need to understand which behaviours and habits are contributing to weight gain in the first place. As soon as these are identified, working towards changing these habits for the long run will ensure we genuinely implement change. The trick is to identify multiple behaviours but only tackle one at a time. Changing your whole routine overnight will never lead to long-term change. Let me give you an example:
Behaviour: Sarah has identified the days when she comes back from work stressed; she passes by the local shop and purchases comfort foods such as biscuits and crisps. This happens 2-3 times a week.
The trigger for Sarah is clearly stress, and the response to the trigger is passing through the local shop when her body craves nutrients and emotionally requires comfort. A suggested habit change could be:
Change: At the end of the day, Sarah checks on herself and brings awareness to the fact that she is hungry and stressed. Being aware means that she can put in place her plan for change. She agreed to come straight home, put in the oven a simple recipe with loads of vegetables and a piece of fish, and take back on her love for puzzles. She knows that puzzles have always calmed her down and offered her comfort.
In this example, Sarah has found an activity to help her feel comfort and decrease stress, but also has made plans on how she will nourish her body.
“But this will take forever to see change” - I hear you say. This brings me to the second most crucial principle:
Principle 2: We need to be in it for the long haul
Weight gain is rarely something that happens overnight (excluding some medical conditions). With this in mind, why do we expect to see weight loss in 2 weeks and if we don’t, lose interest soon after? If it took years to see the weight being put on, the truth is, it will take a long time to undo some of those behaviours and see weight loss. We can lose weight quickly but research shows that drastic changes to our routine are not sustainable in the long run, and the weight comes back. I am sure if you have ever engaged in diets, you know exactly what I mean. So, how do you keep motivation for that long?
This brings me to principle number 3.
Principle 3: Let’s do it for our health, not our looks
If someone asked you:
Are you ok with staying the same weight for the rest of your life if your PCOS symptoms would disspear and you’d be healthy?
If you reacted strongly when reading that question, I recommend watching this interview on kindness. When we start a lifestyle change from a place of hate towards our bodies, it’s unlikely that change will happen. The battle is not in not knowing what to do to improve ourselves, but it's in not knowing WHY we refuse to do it. Body image is a vast topic, but the more we like ourselves, the more likely we are to engage in healthy behaviours.
When we engage in weight loss, we must frame it as an investment in our health. The truth is that the health behaviours that contribute to health will also inevitably lead to weight loss. Focusing on behaviours, not outcomes, means we don’t need to rely on willpower.
What are those behaviours?
Principle 4: Eat for nutrients, not calories
When it comes to food, my number one recommendation is to choose foods which are high in nutrients. There is no such thing as the best diet for weight loss or the best diet for PCOS.
Do we think that our ancestors looked at a potato and said: “This has too many carbs; I won’t eat it”? They didn’t. They also did not have to because the food environment wasn’t so messed up. Unfortunately, we live in a food environment where food without much nutritional value is readily available and cheap. Our hungry brain loves it because it means that it doesn’t have to worry about starving. However, eating highly processed foods only makes us more hungry because our body is deprived of the necessary nutrients.
I will give you an example. A friend of mine was craving meat (despite being vegetarian). My first thought when she said that was “Iron deficiency”. It turns out that she is indeed low in iron. This shows that our body doesn’t only crave energy but knows what micronutrients we need and actively makes us want it. The trick is in being aware enough to pick up on our body’s needs.
I sometimes feel super hungry and reach out for some biscuits, just to be again very hungry one hour later. If I had been in tune with my body the first time it I felt hungry, I would have realised I ate no protein that day and ensured I have a filling meal which would have kept me fuller for longer.
If anyone has the privilege of having grandparents who were raised living in the countryside or growing their own food, you will notice that they don’t worry about how much carbohydrate there is in an apple. They eat in tune with the seasons, with what is available in the land, and rarely worry about weight gain.
Of course, we can’t all pack up and go live on a farm. This means the challenge is in navigating our current food system to choose well. Minimally processed foods, not packaged, with few ingredients and as colourful as possible, tend to be the ones that are high in nutrients. I am personally a big fan of the food that the Mediterraneans eat. Many studies have also proven that this way of eating is protective against disease.
A good resource on specifics is the guide from Precision Nutrition which shows which foods we should eat a lot of, which we should less of and which we should have in moderation → https://www.precisionnutrition.com/what-should-i-eat-infographic.
Principle 5: Take care of our emotional being
Lastly, I don’t think anyone gets from a healthy weight to obesity because they love junk food and are lazy.
Unfortunately, no one teaches us how to deal with life. With the ups and downs, the anxiety, the stress from work, working through relationships etc., food has become a great way to bring comfort when we are uncomfortable. Food is able to trigger the reward centres in our brain, so it gives us a lot of pleasure. We might eat when we are stressed, preparing for a presentation, or after a stressful day. If you think this is the case for you, being aware and starting to implement other resilience tools to deal with emotions will eventually mean that food is not a coping mechanism, so we don’t overconsume and indulge in foods designed to make us feel good.
Cool, I get the principles, but do I need to be in a caloric deficit to lose weight?
Yes, in order for our cells to use stored energy, we need to be in a place where there isn’t immediate energy available from eating. I would absolutely not recommend calorie counting as a way of being in a caloric deficit. Simplistic numbers like calories seem to do odd things to the human brain. They are able to get us very obsessed. Calories are also a very bad way of measuring food as it doesn’t look at the nutritional value of the food.
My recommendation is to engage in the principles above for 3-6 months, and if there are no changes in your PCOS symptoms and weight, having a look at your portion sizes could be helpful. I don’t start with portion sizes because if we eat enough nutrients and take care of our emotional well-being, I believe we have an innate mechanism to regulate hunger, and our portion sizes will automatically decrease. This will allow us to reach a weight our body is comfortable at.
You will notice I said a weight our body is comfortable at, not the weight we might desire. Unfortunately, being a certain body size has a genetic component to it, so we need to get comfortable with the idea that we might never be thin, the same way that I have accepted that I won’t have very long legs 😊. I am currently heavier than I was five years ago, but my PCOS symptoms are considerably more managed.
Is weight loss necessary to manage PCOS?
Weight loss is not necessary for managing PCOS. The management of PCOS focuses on improving symptoms and restoring hormonal balance. As we saw in the last newsletter issue on weight, visceral fat has the ability to secrete certain hormones that can worsen insulin resistance, androgens and inflammation. So, for some women that might carry more visceral fat, reducing weight can have an impact, but it is not the sole or mandatory approach for managing the condition.
Is it harder for us to lose weight?
Insulin resistance promotes fat storage and increases cravings and hunger. In theory, losing weight whilst insulin resistant may be slightly more challenging because of the effect on appetite. However, there are studies where insulin resistance meant that weight loss was more significant than those without. I wouldn’t get too caught up in this belief as it doesn’t serve us.
Do I need to go low-carb to lose weight?
The theory is that due to insulin resistance we need to cut down carbs in order to lose weight. Cutting out carbs entirely is not a good idea because vegetables such as legumes, beans, and pulses, which are carbohydrates, are alshigh in fibre, which is one of the most protective nutrients against insulin resistance. By focusing on balancing your nutrients, I don’t believe you need to go low-carb to achieve weight loss. Studies done on low-carb diets in PCOS don’t mean no carbs at all, but suggest that up to 40% of your food intake should be carbohydrates. Eating moderate carbohydrates by cutting down on processed foods and simple sugars is a good idea.
Support for weight loss
Trying to lose weight on your own can be challenging as it’s harder to be aware of the emotional nuances of eating. It is possible to do it yourself, but please be wary of fad diets. Working with a nutritionist could be a good idea if your budget allows it. A more affordable solution is an online programme. The best one on the market is Second Nature. I might be slightly biased as I work for them. I develop the product and have seen all the inner workings of it. I can genuinely say that they approach weight loss in the best way possible, looking after your emotional being, behaviours and food. I receive no monetary gain for mentioning it.
Lastly, medication is also an option for weight loss. I believe medication should be an add-on to everything discussed above and a last-resort solution. If the underlying cause of weight gain is not addressed, medication will solve the problem only temporarily.
Conclusion
This is a lengthy and complex topic. Trying to stay away from harmful diets is also pretty hard in this modern age. Trying to regulate food intake and emotional well-being in this current time is also challenging. However, how you choose to manage your weight should bare no judgement. The only thing I would say is that: you are enough.
See you next Sunday,
Francesca
1 Sources
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