In 2018, a group of experts recommended overweight patients follow a diet of no more than 750 calories per day. Now the same group withdraws that guideline and recommends a balanced diet.
For years, people who had polycystic ovary syndrome (PCOS) and were also overweight were told that their symptoms would improve if they lost pounds through a restrictive diet. In 2018, a leading group of PCOS experts recommended that women with the hormonal disorder who are overweight or obese consider reducing their caloric intake by up to 750 calories per day.
That orientation triggered the appearance of questionable diets on social media, and reinforced an impression among people with PCOS that if only they might successfully alter their eating habits, they would feel better.
But the recommendations were not supported by strong studies on PCOS, and researchers now say there is no concrete evidence to suggest that a long-term restrictive diet has a significant impact on PCOS symptoms. Dieting rarely leads to long-term weight loss, and for people with PCOS, losing weight is particularly difficult.
Additionally, the link between long-term weight loss and symptom improvement is not very clear or well established, said Julie Duffy Dillon, a registered dietitian specializing in PCOS care.
In 2023, the same group, called the International PCOS Network, updated its guidelines based on a new analysis of research and removed all references to calorie restriction. The group now recommends that people with PCOS maintain a “healthy, balanced dietary regimen” similar to the Mediterranean diet, which is associated with a lower risk of PCOS-related health problems such as cardiovascular disease and diabetes. It is unknown if this type of diet might improve PCOS symptoms.
The guideline changes consider “the literature on PCOS and the lived experience of people living with it,” said Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It’s regarding blaming people or stigmatizing them, or suggesting that because of a flaw in their personal behavior they have a higher weight.”
What is the syndrome of ovary polycystic?
Polycystic ovary syndrome is a hormonal disorder that affects five million women in the United States. It is characterized by irregular periods, infertility, excessive facial hair growth, acne and hair loss, symptoms that are also common with other health disorders, making diagnosis difficult. People with PCOS usually ovulate less than once a month and also tend to have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on the ovaries (and not, as the name suggests, cysts), or both. things.
Typically, when a woman has symptoms, the doctor scans the ovaries for these follicles or draws blood to test hormone levels. There is no cure for PCOS; The first line of treatment is usually some type of contraceptive to help regulate the menstrual cycle.
Although PCOS is often considered a reproductive problem, it can also affect metabolic health, including blood sugar, blood pressure, and cholesterol levels. People with PCOS often suffer from chronic inflammation, which occurs when the immune system is overstimulated for long periods of time. And they are at higher risk of developing cardiovascular disease, endometrial cancer and diabetes, according to Heather Huddleston, director of the PCOS Clinic and research program at the University of California, San Francisco.
The disease has also been associated with an increased risk of mental health problems, such as depression, anxiety, suicide attempts and eating disorders.
The relationship with weight
The relationship between PCOS and weight is complex; The disease is closely related to obesity. People with PCOS are predisposed to gaining weight, and by doing so, their symptoms can worsen, explained Anuja Dokras, director of the Pennsylvania Polycystic Ovary Syndrome Center and co-author of the 2023 guidelines. “It’s a two-way relationship,” she said, but “ “We don’t understand why they tend to gain weight.”
The 2023 guidelines also noted that obesity rates among people with PCOS vary in different parts of the world. And, Dokras said, not all people with obesity have PCOS.
Some studies have shown that weight loss through lifestyle changes might improve some hormonal and metabolic symptoms of PCOS, Teede said, but “the evidence around fertility is challenging.”
Very few studies have measured changes in ovulation and pregnancy rates. “One of our biggest research questions is how much weight loss, for how long, and how much stability of that weight do we need to get the body’s reproductive system working once more,” he added.
The most compelling sign that weight loss might be associated with improved ovulation and pregnancy rates comes from recent studies that have looked at the outcomes of bariatric surgery in obese women with and without PCOS, according to Dokras. These data show that, following surgical intervention and drastic weight reduction, those affected by PCOS “begin to have very regular periods and male hormone levels also decrease.” Research to study whether weight loss drugs like Ozempic can improve symptoms in PCOS patients is ongoing.
But many women with PCOS have insulin resistance, meaning the body does not effectively use the insulin it produces, causing high blood sugar levels. This can exacerbate some symptoms, including weight gain, and also make weight loss particularly difficult, Huddleston said.
And Dillon said the old advice to restrict calories in order to lose weight has been especially concerning given the higher rates of eating disorders among people with PCOS. Anecdotally, she said he has seen the lasting harm of the advice in many of his patients.
When people try diets “and they inevitably fail because they don’t work for most people, then they take ownership of that, and they’re like, ‘Well, that’s my fault,’” Dillon said. “Then they no longer seek health care. It is not uncommon for people with PCOS to tell me when they meet me that I am the first person they have seen in 10 years.”
At that time, she added, “they have a lot of health problems, like diabetes and high cholesterol, but they are also ashamed, depressed and anxious.”
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