PCOS and Obesity – PCOS 5

From a disease perspective, obesity leads to many medical complications, including heart disease, breathing problems, cancer and arthritis. PCOS is just one more of these medical complications.

Not all obese women have PCOS and not all PCOS women are obese. Nevertheless,obesity is one of the most common and perhaps most important features of PCOS, despite the fact that it is not part of the diagnostic criteria. Obesity occurs in 30-75% of women with PCOS and is associated with worsening of all three primary diagnostic features of PCOS – increased masculinizing features, worsening menstrual difficulties and more ovarian cysts.In women with PCOS, the risk of type 2 diabetes and prediabetes increases as body weight increases.

There is an obvious connection but the exact link is under debate. There are three possibilities to consider:

  1. PCOS causes obesity
  2. Obesity causes PCOS
  3. Both obesity and PCOS are caused by a third problem

Can PCOS cause obesity? Hyperandrogenemia only affects the distribution of fat, not the increase in overall body fat. During puberty, increased testosterone in young men cause less fat accumulation than the increased estrogens in females. While pre-pubertal girls and boys have roughly the same percentage of body fat, this changes dramatically during puberty. Under the influence of estrogens, girls will gain approximately 50% more body fat than boys. The fat is also distributed to the hips and breasts in females, as opposed to the more central distribution in males.

High testosterone promotes central, or visceral, obesity where the fat is distributed primarily in and around the abdominal organs. Thisis of particular concern because visceral obesity is a far greater risk factor for metabolic syndrome and cardiovascular disease.  The different distribution of fat between males and females appears shortly after puberty and disappears after menopause. Women without PCOS have more subcutaneous (under the skin) fat on their arms and legs rather than concentrated in the abdominal area. An estimated 50-60% of women with PCOS have central obesity, regardless of their BMI. This is often noticeable as an increased waist circumference and also referred to as “masculinized body fat distribution” This masculinized fat distribution is associated with lower conception rates and ovulatory frequency. The heavier a woman gets, the less likely she is to ovulate.

Does obesity cause PCOS? That is a more interesting possibility.The severity and risk of developing PCOS increases with obesity but the correlation is very loose. In obesity clinics, a new diagnosis of PCOS was made in a substantial 28.3%. This is a whopping 5-fold increase over the 5.5% prevalence in lean women in the general population

Weight loss improves all signs and symptoms of PCOS. During bariatric surgery, weight loss was accompanied by decreases in hirsutism, androgen levels, resolution of insulin resistance, restoration of regular menstrual cycles. The diagnosis of PCOS could not be sustained in any of the patients after surgery, showing the potential reversibility of this condition. In the United States, rates of childhood and adolescent obesity have almost quadrupled in the last 40 years and is a well-known risk factor for PCOS. Obese adolescents with PCOS have higher insulin levels and increased insulin resistance emphasizing insulin’s huge role in obesity.  In adolescents with PCOS, obesity and hyperandrogenism is clearly related since 65% of obese pre-pubertal girls had elevated testosterone levels.

The foods that we eat have changed significantly in quality, quantity and frequency over the last 50 years. People eat more processed food, in greater amounts, more times a day. My grandmother ate 2 to 3 meals per day entirely based on whole, unprocessed, mostly home-grown foods. Snacks? Forget about it.

Today, nutritional authorities recommend 6 to 7 small meals per day focusing on “whole-grains”, low-fat foods and lots of fruit and vegetables. Processed, processed and partially modified.  Schools have a “healthy snack program” but there is no such thing as a healthy snack! It is bizarre to consider that snacking was considered a superfluous luxury only a generation ago, and now is considered a necessity. Not feeding your child some highly processed, sugary cookies every few hours seems to be grounds for charges of child abuse, even as we wonder why our children are so obese. Humans have survived for thousands of years without snacking. There is simply no medical requirement to put muffins in our mouths every few hours to be healthy. 

But obesity is clearly not the sole cause of PCOS, even from my own experience. Indeed, I was normal or even mildly underweight, according to BMI, at the time of my diagnosis, but had clear evidence of PCOS. Obesity, but not PCOS varies widely throughout the world. For example, the prevalence of PCOS is fairly similar between the United States, Spain and the UK, but obesity differs significantly between those countries. Studies show only a very loose correlation between severity of obesity and the prevalence of PCOS. While increasingly severe, obesity, as measured by BMI, is associated with higher rates of PCOS, the correlation is not tight enough to suggest a direct causal relationship.

Obesity, while clearly related in some way to PCOS, is not the sole cause. This leaves only the third possibility, that some underlying factor causes both obesity and PCOS. But what is the other factor? Hyperinsulinemia.

2018-10-02T14:13:00+00:007 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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Steve
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Steve

“Indeed, I was normal or even mildly underweight, according to BMI, at the time of my diagnosis, but had clear evidence of PCOS.”

Jason… is there something you’d like to tell us?

Pete Kaye
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Pete Kaye

Dr. Fung works with one of the IDM educators, Nadia, and if you read earlier, she is the one with PCOS!
But good catch!

Jan
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Jan

I don’t think the statistics about diagnosis for thin and fat young women are accurate. PCOS is almost never suspected in thin women even when the symptoms are obvious. Because of my history (severe PCOS despite the fact that I was thin until my early 30’s) I recognized the symptoms early in my 85 lb daughter and had to argue with her doctor to get her tested. Doctor called me to apologize when she saw how high the testosterone levels were! Other doctors, reading my daughter’s chart, said “she can’t have PCOS, she’s too thin.” She never would have been… Read more »

Julie
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Julie

” Not all obese women have PCOS and not all PCOS women are obese.” The very top of this article.

gpisabela
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gpisabela

I am really tired of reading that obesity causes this or that. If obesity caused PCOS, all PCOS sufferers would be fat. If obesity caused T2D, all T2D sufferers would be fat and so on. But they aren’t. Obesity is just a symptom of insulin resistance, like many other symptoms related to PCOS, diabetes and so on. Insulin resistant people can get obese, can get diabetes, can get PCOS but not necessarily all of these. Losing weight doesn’t fix your diabetes or your PCOS – but lowering carbs/IF lowers insulin resistance which in turn helps with losing weight, PCOS, diabetes,… Read more »

Heather Corbett
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Heather Corbett

Gpisabela I would read the article again. It states that it is not the only reason and often thin women has PCOS

gpisabela
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gpisabela

Heather, I read ALL the articles, some multiple times, but you didn’t read my comment. I didn’t say that the article didn’t mention that thin women can have PCOS – I said that this article (and many of the articles) jump to the conclusion that obesity is the CAUSE- or one of the causes.