Your Comprehensive guide to training with PCOS (Part 2)

PCOS and Weight Loss

Weight loss is an incredibly sensitive topic. The impact of body dysmorphia in our culture cannot be overstated and I have seen firsthand the impact that this can have on the women in my life. At Woven we are weight neutral. We do not believe that someone’s weight alone predicts their health; there are many more factors that we should consider. But as we understand insulin resistance to be the primary factor in PCOS, too much body fat should be one of the first thing to consider when designing and exercise program.

First of all, note that I said body fat and not body weight. As we will discuss more later, a higher number on the scale may actually be a healthier weight, as muscle is integral to managing insulin resistance. Additionally, let’s make the distinction again between subcutaneous and visceral fat. If you have large amounts of subcutaneous fat, I would not worry about it from a health perspective. Subcutaneous fat is relatively innocuous when it comes to your health. But, if you have too much visceral fat? Then I would be worried. How do you know if you have too much visceral fat? Unfortunately the only way to be sure is to do something called a DEXA scan, which is essentially a low level X-ray. However, if you live in New York City, the regulations around these machines have made getting a DEXA scan incredibly expensive. So, if we can’t know exactly the distribution of subcutaneous versus visceral fat, how are we supposed to proceed?

I think this gray area is really important to highlight, because I think it explains a lot of the pushback and misunderstanding about bodyweight. As a fitness professional I would recommend you get a DEXA scan so that you can know if weight loss should be a priority in your fitness plan. If your visceral fat numbers are low, then as a fitness professional I would not recommend weight loss as a goal in this context. But if they are high, I could not in good conscience ignore that information. What if we cannot get a DEXA scan? Then we ultimately cannot answer this question definitively, and I think we need to evaluate weight loss as a goal in the context of the rest of your life. Does losing weight feel like an appropriate goal in your life right now, or does it feel impossible? Regardless of what a DEXA scan says, if you feel like weight loss is not possible in your life right now then there is no point in pursuing it. We can achieve so many health benefits with exercise, regardless of any impact it might have on the number on the scale. The worst case scenario is that we pick an unrealistic goal only for it to torpedo everything else we are hoping to accomplish.

But, if weight loss is a priority for you, let's talk about how to do that as effectively as possible. First and foremost, PCOS is a disease with a wide variety of symptoms and any coaching plan requires a holistic approach. Women with PCOS tend to exhibit higher levels of anxiety and depression, and are more likely to experience sleep disorders, and these factors must be taken into account when formulating a plan. Anything you and your coach decide to try has to be sustainable for it to be effective. If any of the following recommendations feel like you would have to make massive changes to your life to achieve then they are not right for you at this time. Whenever we are trying to implement new habits into our lives, we have to start small and build over time if we want them to stick. 

The specific changes we choose to implement should be different for everyone. There is no one size fits all plan that works for everyone and whatever you choose should be based around what you think you can sustain. You can lose weight eating low or high carb diets, vegan or carnivore, keto or mediterranean. For women with PCOS no one diet is inherently any better than any other. The only broad recommendation I would offer is around eating enough protein, as it is important for us to build and maintain muscle and contributes to feeling full. While it sounds very simple, if we eat three or four meals a day that have a balance of fruits and veggies, protein, carbs, and fats consisting of mostly whole foods we are set up very nicely.

How should you go about making changes to your nutrition? Many see success in the short term tracking their macros via a health app. If you think you can track your calories for the rest of your life, by all means go for it. Tracking your macros can give you valuable information to help you make informed decisions about how much and what types of foods you should eat for your goals. But this is not necessary. Our body releases hormones to tell us how much we should eat, and at Woven our nutrition coaching is based around helping our clients better understand what their body is telling them. We coach nutrition in a thoughtful strategic way, slowly implementing habits over time that see success where so many short term focused strategies fail. And while there is no one path you must follow, having a coach can help you understand the best path that works for you.

One final note on nutrition; consider more diligently the type of carbs you eat. Because women with PCOS will most likely be dealing with some kind of insulin resistance, I recommend eating less of the types of carbohydrates that lead to large spikes in your blood sugar, known as high glycemic index carbs. These carbs can still fit into a healthy diet, but they should not be eaten in large quantities independently of foods with fiber, fats, or protein. This can be as simple as making sure that if we are eating white rice, a high GI food, we eat it with foods higher in fiber, fats, or protein to help the meal digest more slowly. Again, this sounds a lot like eating three or four balanced meals throughout the day. Interestingly, in people with a healthy insulin response, our body can adequately manage this short term spike, as there is mixed evidence on whether eating a diet consisting of a high proportion of high GI foods is bad for us at all. 

Beyond working on your nutrition, we should look at implementing sustainable habits into our lives that improve our metabolism. One path is implementing more cardiovascular training, but it is important not to overdo it. Another path is simply finding small ways to be more active throughout the day, like taking the stairs instead of the elevator, or going for small walks throughout the day. These sound silly, and cliche, but really can make massive impacts in the long run. Strength training is also incredibly important. When pursuing any weight loss we absolutely must work to maintain our muscle. As we lose body fat our metabolism will slow and we want to avoid losing muscle to avoid slowing our metabolism further. In a lot of cases, it’s a good idea to start any long term weight loss strategy after spending three to six months working to gain muscle first so that we raise our metabolism before trying to lose weight. 

It is impossible to give examples of a specific exercise plan for exercise in this context because every single body is different. With that being said, I would recommend strength training two to three times per week in order to build and maintain muscle and engage in low-moderate intensity cardio two to three times per week for anywhere from 30 minutes to an hour per session. Zone 2 is a great target to shoot for in the majority of our cardio because it is a high enough intensity to stimulate the cardiovascular adaptations that positively affect our health without putting unnecessary stress on our bodies. 

Medication can also be an incredibly useful tool here. Metformin is one of the most prescribed drugs for women with PCOS because it helps regulate your blood sugar. GLP-1’s could also be a valuable tool. However, this is not medical advice. Talk to your doctor about these medications and the ways they could impact your symptoms.