Tripping Over the Relationship Between Obesity and PCOS

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting young women, with effects that can span from adolescence to life after menopause. It is a complex condition and despite being so common, it’s still poorly understood. Quite often, obesity occurs coincidentally with PCOS. This coincidence has led to the kind of mistakes that enter into clinical care when human bias is a factor.

Fortunately, recent evidence-based guidance has emerged from a painstaking international process to clear some of these errors. One of them was the presumption that restrictive diets could ease the symptoms of PCOS.

This was an echo of false presumptions about obesity.

False Promises of a PCOS Diet

The false promises of a “PCOS Diet Plan” are just a click away on Amazon, selling “a natural approach to health for women with polycystic ovary syndrome.” It’s based on a presumption that the “underlying cause” of PCOS is insulin resistance. The truth is that insulin resistance might be a feature of PCOS. But the “root causes” are complex and, even now, poorly understood.

Writing in the New York Times, Alisha Haridasani Gupta describes the mistakes that presumptions like this caused:

“For years, people who had polycystic ovary syndrome and were also overweight were told that their symptoms would improve if they lost weight via a restrictive diet. In 2018, a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder consider reducing their caloric intake by up to 750 calories a day. That guidance helped to spawn questionable diet programs on social media, and reinforced an impression among people with PCOS that if only they could successfully alter their diets, they would feel better.

“But the recommendations were not based on robust PCOS studies, and researchers now say that there is no solid evidence to suggest that a restrictive diet in the long-term has any significant impact on PCOS symptoms.”

Coincidence, Causality, and Care

Coincidence should be a spark for curiosity – not for a leap to conclusions about causality and appropriate measures for clinical care. Obesity is often coincident with PCOS.

We find encouragement in the fact that new guidelines for PCOS acknowledge the mistakes of false presumptions. Many parallels between obesity and PCOS that offer us insights. Among those insights is the importance of listening and factoring in the lived experiences of patients seeking care.

We’ve learned this lesson the hard way in care for both PCOS and obesity.

Click here for further perspective from Gupta’s reporting, here for the new PCOS guideline, and here for a brief summary of it.

Portrait of a Woman, painting by Gustav Klimt / WikiArt

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March 14, 2024