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Obesity and PCOS: Implications and Treatment

obesity and pcos

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women which affects around 6-8% of women in the reproductive age[1]. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity are commonly seen in women with PCOS. According to a 2007 study[2], more than 40% of women with this condition are overweight or obese. This doesn’t mean that thin women do not suffer from PCOS but the cases are slightly less than that of obese women. So in this article, we will be talking about the relation between obesity and PCOS and how to manage the condition.

Obesity And PCOS: How Is It Related?

The exact cause of PCOS is not known. However, it is believed that two key factors can up the risk of PCOS which include genetic and environmental factors. Genetic factors lead to ovarian hyperandrogenism (increase in the production of androgens from the ovarian cells) due to the influence of insulin and luteinizing hormone. The environmental factors include obesity, nutrition, and insulin resistance[3].

PCOS increases the production of male hormones called androgens which in excess can lead to weight gain. Whereas obesity is linked to abnormal functioning of the hypothalamic-pituitary-ovarian (HPO) axis which can further lead to PCOS[4]. Though obesity doesn’t solely cause PCOS, it is most likely due to its interaction with the endocrine system and other systems. Here is how obesity can lead to PCOS due to its action on:

Ovarian function: Obesity is associated with insulin resistance which is known to stimulate androgen production by the ovaries. Obesity also causes an increase in growth factors and inflammatory factors which stimulate excess ovarian androgen production leading to the symptoms[4].

Hypothalamic-pituitary function: Excess body weight can influence hypothalamic-pituitary function which causes abnormal gonadotropin secretion (reproductive hormones). One of the key factors involved in this function is insulin resistance. Moreover, obesity can affect the metabolism of sex steroids[4].

Central adiposity: The distribution and amount of fat can also impact the metabolic and reproductive profile of women with PCOS. Women who have increased visceral fat and central adiposity (fat accumulated in the abdominal region) are generally at higher risk of suffering from inflammation, hyperandrogenism, and metabolic dysfunction[4].

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Obesity also increases the risk of hirsutism, infertility, and pregnancy complications in women with PCOS[5]. Women with PCOS are at a high risk of developing many health problems associated with weight gain and insulin resistance. These include:

-High Cholesterol Level

-Type 2 Diabetes

-Sleep apnea

-Irregular periods

-Heart diseases

-Endometrial Cancer

Obesity And PCOS: How To Get It Treated?

Many women with PCOS face body image issues due to obesity, excessive facial hair, and acne. Moreover, it can negatively impact mood, self-esteem and psychological well-being causing poor quality of life. The management of PCOS is difficult and mostly involves a multidisciplinary approach. The treatment options include lifestyle changes, weight control, medications, and surgery. Lifestyle changes are the first line of treatment in the management of PCOS in women who are overweight. Studies[6] have shown that lifestyle change with as little as 5–10% weight loss has significantly improved the psychological, reproductive and metabolic outcome.

PCOS can only be managed and not cured so it is important to manage the condition with proper weight control, medications and doctor consultation. One legit way to control obesity and PCOS is by watching your weight which also lowers the risk of heart disease, high blood pressure, and other lifestyle diseases[7].

Diet: Your eating habits play a major role in weight loss. Ensure your diet is nutritionally balanced with low-fat, moderate-protein and high-carbohydrate intake. Include foods rich in fiber such as fiber-rich whole grain bread, cereals, fruits, and vegetables. Fad diets are not a good idea to control weight as these provide short-term weight loss which in most cases is rarely sustainable. Starving or skipping meals to lose weight can worsen the condition. You can even consult a certified nutritionist or dietician for a unique diet plan that can help you lower your intake of sugar and starch without compromising on the nutrient profile.

**Consult India’s best doctors and nutritionists here**

Exercise: It is advised that women with obesity and PCOS should perform moderate regular exercise so as to keep a tab on weight and manage the condition. Ideally, exercising for 30 – 40 minutes a week can help you to cut down weight along with helping you to best stress and improve your mood. You can indulge in exercises such as walking, running, cycling or join a gym to lose weight. But remember to follow a strict diet control along with exercising for proper results. Keeping your fitness schedule on track can keep obesity and PCOS in check.

Medical Therapy: The use of medications such as oral contraceptive pills (OCP) and metformin are used to reduce insulin resistance and control the symptoms of PCOS as per your doctor’s advice. Generally, medical therapy is targeted at controlling the symptoms and hence, should not be used as an alternative to lifestyle therapy for PCOS. It is wise to control your doctor before you take pills to lose weight. In extreme cases, your doctor may advise bariatric surgery to help you lose weight. This is mostly recommended if all the other treatment options to lose weight fail.

In the last 20 years, obesity has dramatically increased with a possible increase in PCOS. If you have experienced obesity and PCOS, then do share your story on how you dealt with it to help our readers get an insight. Also, if you have any queries regarding obesity and PCOS, do write to us in the comments section.

(The article is reviewed by Dr. Lalit Kanodia, General Physician)

Recommended Reads:

Know The Symptoms Of Obesity And Its Treatment

A Sample Diet Chart For Weight Loss From A Nutritionist

References:

1. Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab. 2014 May;18(3):317-24.

2. Sam S. Obesity and polycystic ovary syndrome. Obesity management. 2007 Apr 1;3(2):69-73.

3. Sadeeqa S, Mustafa T, Latif S. Polycystic Ovarian Syndrome-Related Depression in Adolescent Girls: A Review. J Pharm Bioallied Sci. 2018 Apr-Jun;10(2):55-59.

4. Legro RS. Obesity and PCOS: implications for diagnosis and treatment. Semin Reprod Med. 2012 Dec;30(6):496-506. doi: 10.1055/s-0032-1328878. Epub 2012 Oct 16.

5. Beatriz Motta A. The role of obesity in the development of polycystic ovary syndrome. Current pharmaceutical design. 2012 Jun 1;18(17):2482-91. 

6. Ganie MA, Kalra S. Polycystic ovary syndrome – A metabolic malady, the mother of all lifestyle disorders in women – Can Indian health budget tackle it in future? Indian J Endocrinol Metab. 2011 Oct;15(4):239-41.

7. Kataoka J, Tassone EC, Misso M, Joham AE, Stener-Victorin E, Teede H, Moran LJ. Weight management interventions in women with and without PCOS: a systematic review. Nutrients. 2017 Sep 8;9(9):996.

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