People with PCOS are consistently told to first + foremost focus on weight loss to manage the condition + its symptoms, to qualify for access to reproductive medicine, + shamed when weight loss doesn’t happen long term. It’s time to review the #PCOS weight science. A thread.

First PCOS weight loss studies have 3 categories--short term (<6 weeks), "long term" (<12 weeks + note researchers don't use quotes yet I do bc 3 m is NOT long term), and REALLY long term (>2 yrs). Distinction important yet often neglected to be mentioned when recommending diets

Short term studies overwhelmingly (<6 weeks) report weight loss diets (any of them) lower insulin, blood sugar, improve egg quality + ovulation, + lower blood pressure. Inflammation markers decrease. This is when we get the majority of PCOS weight loss outcome data. 6 WK STUDIES

“Long term” PCOS weight science data aka 12 wk studies report weight loss, lower inflammation markers, improved ovulation. Increased self esteem. Less cravings. But—drop out rates are higher than 6 wk studies (data often taken just from those who didn’t drop out + assumed for all

Why did more drop out? Can we assume the numbers and outcomes were the same for those who remained compared to those who dropped out? We can't.

Consider data from REALLY long term PCOS studies--oh, what there aren't any. We only have studies on the general population. Is this good enough? Nope. It is not. But we can glean some info from these long term studies appreciating that PCOS affects insulin, inflammation, etc

Long term (>2 years) weight science research report
most regain the weight lost whether they continue the diet or not; 1/3 to 2/3 of those studied regain more than ever lost. Sound familiar?

Long term (>2 years) weight science research report Insulin levels increase, A1c goes up, inflammation markers worsen, blood pressure increases. This is NOT good for those with PCOS.

Even more, researchers have found a history long term dieting predicts binge eating + cravings for those with PCOS. Depression rates increase + self esteem worsens. Lots of shame + feelings of failure.

People w PCOS are told they are to blame from the diets not working. But the tools scientifically sucks. The data is consistent with your lived experience. Here's more.

Higher weight is related to disease yet weight cycling (the experience of going on and off a diet aka yo-yo dieting) and weight stigma is causally related to disease--namely they causeincreased inflammation and higher insulin levels. For what we know about PCOS, this is not good.

We must demand better tools for PCOS. Stop recommending weight loss as a way to manage PCOS. Stop demanding weight loss for access to reproductive medicine. Stop blaming patients when they are living at higher weights. YOU ARE CAUSING THE VERY DISEASES YOU ARE TRYNG TO PREVENT.

People w PCOS have been dismissed for too long. Help people w PCOS feel safer + treat them with dignity when accessing health care. Check your weight stigma. Help people discern the behaviors that help + avoid the ones that don't. Most of all: LISTEN + BELIEVE patients w PCOS