Ep 43. Why is it hard for girls with PCOS to lose weight?

Is it normal for a 15 year old to have PCOS?

In this episode I talk about insulin resistance and the impact of weight loss on menstrual regularity in teenage girls with PCOS. 

Ornstein RM, Copperman NM, Jacobson MS. Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2011 Jun;24(3):161-5. doi: 10.1016/j.jpag.2011.01.002. Epub 2011 Mar 21. PMID: 21419674.

I’m Dr. Jenny Gourgari—pediatric endocrinologist, certified in obesity medicine and a health coach.
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Episode Transcript

Speaker 1 (00:08):
This is the Lifestyle and Weight Loss for Teens
podcast.
If you're a mom and want tohelp your child who is
struggling to lose weight, youare in the right place.
If you are looking for healthylifestyle tips, dr Gorgery is
here to help you understand thescience around safe weight loss
in teens and children, becausewhat works for adult weight loss
is not always the best forchildren.

(00:29):
This podcast is for educationalpurposes only.
Dr Gorgory does not providemedical, psychological or
nutrition therapy advice.
You should not use thisinformation to diagnose or treat
any health problems withoutconsulting your own medical
practitioner and now your host,dr Jenny Gorgery.

Speaker 2 (00:55):
Hello, welcome to another episode of the Lifestyle
and Weight Loss for Teenspodcast.
This is Dr Jenny Gorgery andI'm here today for another
episode that I wanted to focuson the difficulties that teenage
girls that have PCOS orpolycystic ovary syndrome have
with their weight, and one ofthe main reasons that this

(01:19):
happens in girls that have PCOSor polycystic ovarian syndrome
is because they have very highinsulin resistance.
Now we know that insulinresistance in girls with PCOS is
part of the syndrome, and oneof the medications that is given

(01:40):
to these girls to improve theirperiods because often girls
with PCOS don't have regularperiods is metformin.
So metformin is a medicationthat is used to improve the
insulin resistance.
However, as I have mentioned inthis podcast, there are natural
ways that teenagers can do toimprove their insulin resistance

(02:04):
, and this rule also applies togirls that have polycystic
ovarian syndrome.
Now, there was the great studythat was done in teenage girls
that have polycystic ovariansyndrome.
With natural ways, byaddressing their weight really,
and giving them different diets,they try to improve their

(02:27):
insulin resistance by eatingbetter, getting to a healthier
weight, and then look and seewhat happens to their periods,
because that is the main problemin teenage girls that have
polycystic ovary syndromes.
They don't have regular periodsteenage girls that have
polycystic ovary syndromes.
They don't have regular periods.

(02:48):
So I wanted to talk about thisbecause it is another example of
how important is hormonalregulation, how important is
weight management, particularlyin teenagers that can have signs
of insulin resistance, and onegroup of teenagers that have

(03:10):
very high insulin resistance isalso teenage girls that have
polycystic ovary syndrome.
So the title of this manuscriptis Effect of Weight Loss on
Menstrual Function inAdolescents with Polycystic
Ovary Syndrome.
It was done at Penn StateChildren's Hospital in
Pennsylvania.
Leading author is Dr RolandOrnstein.

(03:32):
So what the researchers did inthis study is they asked 24
girls that they were between theages of 12 to 22 years of age,
that they have a history of that, they have a diagnosis of
polycystic ovary syndrome andthey had an unhealthy weight.
Their body mass index was abovethe 85th percentile.

(03:55):
And then, if you don't knowwhat body mass index is, I
encourage you to go back andlisten to episode one of this
podcast, where I explain what isan unhealthy BMI and how you
can figure out how much weight ateenager needs to lose to be in
a healthy weight.
But in this particular study,they asked teenage girls that

(04:16):
had unhealthy weight or the BMIwas above the 85th percentile to
participate in the study, andthey divide them into different
groups according to differentdietary plans.
So the first group of teenagegirls that have PCOS was
instructed to follow alow-carbohydrate diet and the

(04:36):
second group was instructed tofollow a low-fat diet and they
wanted to see what would happenat the end of the study.
This was a three-month study.
What would happen at the end ofthe study in terms of the
effect of their weight, theirBMI, and also what would happen
in terms of their irregularperiods, because that, as I said

(04:58):
, is one of the main functionsthat is a problem in girls with
PCOS they have irregular periods.
That is a problem in girls withPCOS they have irregular
periods.
So for the girls that they wereinstructed to get on the
low-fat diet, the instructionwas to have no more than 40
grams of fat per day, with fiveservings of starch per day, and

(05:21):
they could eat as much fat-freedairy foods, fruits, vegetables
for 12 weeks, and a serving ofstarch was defined as having 15
grams of carbohydrates.
They also gave themmultivitamins and they told them
to have extra fiber if theyhave problems with constipation.

(05:43):
Now the other group, that wasthe low carb group.
They were instructed to haveonly 20 grams of carbohydrates
in the beginning, for the firstcouple of weeks, and they could
have as much fat or protein asthey wanted, and then, from
weeks three through weeks 12,they asked them to have a little

(06:05):
more carbohydrates.
They could eat 40 grams ofcarbohydrate and they added
additional low glycemic indexfoods, which is foods that don't
increase too much insulin, suchas nuts, fruits and whole
grains.
And all of them were instructedagain to have at least 50

(06:27):
ounces per day of water andagain they were given extra
multivitamins and fiber if theyhave issues with constipation.
So the whole study was aboutthree months, 12 weeks.
So the whole study was aboutthree months, 12 weeks, and
during this study they also metwith a dietician every two weeks
that would give themrecommendations and they would

(06:47):
talk about their diets.
During the study they would doalso diet histories.
They would ask them what theyeat, they would write them down
and of course they would alsomeasure clinical findings, like
they would measure their bloodpressure, they would ask them
about their periods, they woulddo their weight and things like
that.
So what did they found At theend of the three-month periods.

(07:12):
There were a total of 24adolescents that participated in
this study, 12 and 12.
So it was a relatively smallstudy.
However, they found thatactually both groups of teenage
girls with PCOS whether theywere following the low
carbohydrate plan or whetherthey were following the low fat

(07:37):
diet both of them hadsignificant improvements in
their weight.
They have significantimprovements in their insulin
resistance and they havesignificant improvements in
their belly fat, and the actualweight that they lost during
this program was, as a group, onaverage, 6.5% weight loss.

(08:01):
So they started on an averageweight of 209 pounds plus minus
41 pounds and then, after themodification in their diet, they
had decreased their weight toan average of 195 pounds plus
minus 39 pounds.
So this was a significantchange, and the average body

(08:26):
mass index used to be 35.7 plusminus six and it dropped to 32.9
plus minus 5.8.
So really and the most striking, also at the end of the study
is that they had improved intheir menstrual function.
These girls improved over the12 weeks.

(08:50):
75% had periods during thecourse of this study and some of
them eight of them had somedegree of irregularity, which
basically gives a very importantmessage that, first of all, if
it is possible, for girls thathave PCOS and have high insulin

(09:14):
resistance, it is possible toget to a healthier weight.
Possible to get to a healthierweight.
Number two even if you don'tget to a healthy weight, even if
you lose some percentage ofthat weight not necessarily all

(09:35):
the weight that you need to lose, even if you lose in this
particular study they lost 6%,but on average we know that if
you lose even 5% of your currentweight, that is significant
improvement.
That is so significant that canmake your periods come back
without any medications and thatis because they improve their

(09:56):
insulin resistance insulinresistance.
Number three that is also animportant point is it doesn't
matter whether you are having alow carbohydrate or a low fat
diet.
As long as you are consistentwith the dietary plan that works
for you and you're getting theresults you're getting into a

(10:18):
healthier weight then that isimportant.
That is great in terms ofimproving your insulin
resistance, because if youroverall weight improves, if your
overall fat distribution inyour body improves, then your
insulin resistance is going toimprove.
Then you are going to getbetter cycles and you're also

(10:41):
going to get less belly fat,regardless of whether it is a
low fat or a low carbohydratediet.
This was a great study and thiswas only with 12 weeks of
dietary plan.
Imagine if you can continuedoing that and you can even get
to a healthier weight.

(11:02):
How most likely there's goingto be more regularity in terms
of the periods, there's going tobe even greater improvement in
the weight.
There's even going to begreater improvement in the
insulin resistance.
If you are a mom who has ateenager girl that has
polycystic ovarian syndrome,don't think that it is not

(11:27):
possible to lose weight becauseof that.
And it is a syndrome.
It is not something that is notreversible.
Like teenage girls can get backto regular menses by improving
their insulin resistance.
Of course, there are otherthings that are associated with
polycystic ovary syndrome.

(11:47):
They can have high testosterone, they can have acne, they can
have extra hair, et cetera, and,as I mentioned, this is not
medical advice.
So, first of all, go and talkto your doctor.
Go and talk to yourendocrinologist, pediatric
endocrinologist, about thespecific problem of your child,
if your child has PCOS.

(12:09):
Again, this podcast episode isnot meant to give any medical
advice.
However, it is education aboutthe importance of getting into
unhealthy weight to improveinsulin resistance.
That is true for all teenagersand even so, it is also true for
girls that have PCOS.

(12:31):
I hope this was helpful andgiving some inspiration for you
to get into the healthy habitsthat can improve your insulin
resistance.
Get into the healthy habitsthat can improve your insulin
resistance and therefore you canregulate your periods with
natural ways.
If you don't want to get intoany medications, or maybe you do
need to get in medication, youcan do it in addition to your

(12:54):
medications, because that canenhance the effect of the
medications that you are getting.
That's all I had for you fortoday.
If you found this helpful, feelfree to share it with your
friends and family and if youwant to stay in touch with me,
you can subscribe to get myweekly newsletter.
You can go tolifestyleforteenscom forward

(13:14):
slash newsletter and we'll be intouch and always feel free to
reach out to me with anyquestions or topics you'd like
me to talk about.
Take care.

Speaker 1 (13:25):
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(13:45):
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Thanks for tuning in and we'llcatch you in the next episode of
Lifestyle and Weight Loss forTeens.