PCOS and obesity – PCOS 5

October 6 2018 by , medical review by in PCOS / Fertility, The obesity epidemic

From a disease perspective, obesity is associated with 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:

PCOS causes obesity
Obesity causes PCOS
Both obesity and PCOS are caused by a third problem

Is PCOS the cause of obesity?

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. This is 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 increase 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 and PCOS

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 in my opinion, 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. 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.

—
Dr. Jason Fung

Dr. Fung’s top posts

Longer fasting regimens – 24 hours or more
How to renew your body: Fasting and autophagy
My single best weight loss tip

Type 2 diabetes

My low-carb story with Marc Gossange
03:01
After living somewhat of a high-carb life and then living in France for a few years enjoying croissants and freshly baked baguettes, Marc was diagnosed with type 2 diabetes.
Living low carb with Chris Hannaway
08:19
What does living low carb look like? Chris Hannaway shares his success story, takes us for a spin in the gym and orders food at the local pub.
MEMBERS ONLY
How to help patients reverse type 2 diabetes
27:43
How exactly do you as a doctor help patients reverse their type 2 diabetes?
Living low carb with Yvonne Lane
05:51
Yvonne used to see all those pictures of people who'd lost so much weight, but sometimes didn't really believe they were real.
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
What's it like being a low-carb doctor on TV?
17:40
What’s it like working with patients and giving controversial low-carb advice in front of a TV audience?
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY

Weight loss

My success story with Kenneth Russell
02:52
When Kenneth turned 50, he realized that he wouldn't make it to 60 the way he was going.
My success story with Chuck Hicks
02:39
At nearly 500 lbs (230 kg) Chuck could barely move at all anymore. It wasn’t until he found a keto diet that thing started to change.
MEMBERS ONLY
My success story with Jim Caldwell
02:23
Jim Caldwell has transformed his health and gone from an all-time high at 352 lbs (160 kg) to 170 lbs (77 kg.
MEMBERS ONLY
Living low carb with Yvonne Lane
05:51
Yvonne used to see all those pictures of people who'd lost so much weight, but sometimes didn't really believe they were real.
Are all calories the same?
20:04
Are all calories created equally – regardless of whether they come from a low-carb, low-fat or a vegan diet?
MEMBERS ONLY
Diet Doctor Podcast #35 with Ben Bikman, PhD
00:00
Why is insulin so important for us to control and why does a ketogenic diet help so many people? Professor Ben Bikman has studied these questions in his lab for years and he is one of the foremost authorities on the subject.
Pie-making champion goes low carb
03:23
Learn how this pie-making champion went low carb and how it changed his life.
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
"It was so incredibly easy!"
16:53
In this interview Stephen Bennett shares what he has learned from his low-carb journey.
MEMBERS ONLY
What's it like being a low-carb doctor on TV?
17:40
What’s it like working with patients and giving controversial low-carb advice in front of a TV audience?
Is obesity caused by too much insulin?
25:27
Is obesity mainly caused by the fat storing hormone insulin? Dr. Ted Naiman answers this question.
MEMBERS ONLY

Keto

MEMBERS ONLY
All things keto with Keto Connect
16:44
What is it like running the very popular YouTube channel Keto Connect?
MEMBERS ONLY
My success story with Jim Caldwell
02:23
Jim Caldwell has transformed his health and gone from an all-time high at 352 lbs (160 kg) to 170 lbs (77 kg.
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
Diet Doctor Podcast #35 with Ben Bikman, PhD
00:00
Why is insulin so important for us to control and why does a ketogenic diet help so many people? Professor Ben Bikman has studied these questions in his lab for years and he is one of the foremost authorities on the subject.
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
Diet Doctor Podcast #31 – Dr. Ken Berry
51:26
Dr. Ken Berry wants us all to be aware that much of what our doctors say may be a lie. Maybe not an outright malicious lie, but much of what “we” believe in medicine can be traced back to word-of-mouth teachings without a scientific basis.
MEMBERS ONLY
My success story with Gillian Szollos
02:55
Gillian had a normal life when she all of a sudden started to get seizures. She suffered terrible side effects from the meds so she started a keto diet.
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY

Intermittent fasting

MEMBERS ONLY
MEMBERS ONLY
MEMBERS ONLY
The 7 benefits of fasting
07:33
Dr. Fung's fasting course part 4: About the 7 big benefits of fasting intermittently.
What to do instead of counting calories
16:02
Why is counting calories useless? And what should you do instead to lose weight?
The top 5 tips to make fasting easier
05:19
Dr. Fung's fasting course part 8: Dr. Fung's top tips for fasting
Breakfast! Is it really that important?
07:08
Dr. Fung's fasting course part 6: Is it really that important to eat breakfast?
MEMBERS ONLY
The perfect treatment for diabetes and weight loss
45:20
Do doctors treat type 2 diabetes completely wrong today – in a way that actually makes the disease worse?
How to fast - the different options
06:47
Dr. Fung's fasting course part 3: Dr. Fung explains the different popular fasting options and makes it easy for you to choose the one that fits you best.
Therapeutic fasting
46:09
What if there was a more effective treatment alternative for obesity and type 2 diabetes, that is both simple and free?
MEMBERS ONLY
The power of a 7-day fast
03:34
How do you fast for 7 days? And in what ways could it be beneficial?
How to get started with fasting
02:30
Dr. Fung about what you need to do to start fasting.
MEMBERS ONLY
MEMBERS ONLY
Diet Doctor Podcast #23 – Dr. Jason Fung
59:15
If fasting has been around since the beginning of time, why is it so controversial? Dr. Jason Fung has a different perspective.
What is fasting?
05:21
Dr. Fung's fasting course part 1: A brief introduction to intermittent fasting.
Understanding and treating type 2 diabetes – Dr. Jason Fung
59:44
In this video, Dr. Jason Fung gives a presentation on diabetes to a room full of medical professionals.
How to maximize fat burning
03:52
Dr. Fung's fasting course part 2: How do you maximize fat burning? What should you eat – or not eat?
Diet Doctor Podcast #4 with Joseph Antoun
48:22
In this episode, Dr. Joseph Antoun talks about fasting for health and longevity.
01:03
If you’re wondering if intermittent fasting is right for you, Dr. Bret Scher will help you sort through the hype and learn how to use fasting to reach your health goals. This course is designed for health coaches who want to add intermittent fasting to their toolbox of options for helping clients improve their health.

More with Dr. Fung

All posts by Dr. Fung

Dr. Fung has his own blog at idmprogram.com. He is also active on Twitter.

Dr. Fung’s books The Obesity Code, The Complete Guide to Fasting and The Diabetes Code are available on Amazon.

Name	Provider / Domain	Expiration	Description
ckdc-premium	.dietdoctor.com	1 month
app-banner	.dietdoctor.dev.dietdoctor.com	1 day	This cookie shows whether user closed the App Banner prompt
_gaexp	Google LLC dietdoctor.com	1 year	Used to determine a user's inclusion in an experiment and the expiry of experiments a user has been included in.
_gaexp	Google LLC .dietdoctor.com	1 year	Used to determine a user's inclusion in an experiment and the expiry of experiments a user has been included in.
_opt_awcid	.dietdoctor.com	3 days
_opt_awmid	.dietdoctor.com	3 days
_opt_awgid	.dietdoctor.com	3 days
_opt_awkid	.dietdoctor.com	3 days
_opt_utmc	.dietdoctor.com	3 days
_opt_expid	.dietdoctor.com	25 seconds
gtm_auth	.dietdoctor.com	3 days
gtm_debug	.dietdoctor.com	3 days
gtm_experiment	.dietdoctor.com	3 days
gtm_preview	.dietdoctor.com	3 days
_hjAbsoluteSessionInProgress	Hotjar Ltd .dietdoctor.com	30 minutes	The cookie is set so Hotjar can track the beginning of the user's journey for a total session count. It does not contain any identifiable information.
_ga	Google LLC .dietdoctor.com	2 years	This cookie name is associated with Google Universal Analytics - which is a significant update to Google's more commonly used analytics service. This cookie is used to distinguish unique users by assigning a randomly generated number as a client identifier. It is included in each page request in a site and used to calculate visitor, session and campaign data for the sites analytics reports.
_dc_gtm_UA-3268327-1	.dietdoctor.com	1 minute	This cookie is associated with sites using Google Tag Manager to load other scripts and code into a page. Where it is used it may be regarded as Strictly Necessary as without it, other scripts may not function correctly. The end of the name is a unique number which is also an identifier for an associated Google Analytics account.
_hjFirstSeen	Hotjar Ltd .dietdoctor.com	30 minutes	The cookie is set so Hotjar can track the beginning of the user's journey for a total session count. It does not contain any identifiable information.
_dc_gtm_UA-22012422-2	.dietdoctor.com	1 minute	This cookie is associated with sites using Google Tag Manager to load other scripts and code into a page. Where it is used it may be regarded as Strictly Necessary as without it, other scripts may not function correctly. The end of the name is a unique number which is also an identifier for an associated Google Analytics account.
AWSELBCORS	Amazon.com Inc. www.podbean.com	5 minutes	The cookies AWSELB and AWSELBCORS are functionally the same cookies. The latter has an explicit SameSite attribute set because of changes made from Chrome 80 and upwards.
_ga_YMCP8KW9S4	.dietdoctor.com	2 years
_hjIncludedInSessionSample	Hotjar Ltd www.dietdoctor.com	2 minutes	This cookie is set to let Hotjar know whether that visitor is included in the data sampling defined by your site's daily session limit
__cf_bm	Cloudflare Inc. .vimeo.com	30 minutes	This cookie is used to distinguish between humans and bots. This is beneficial for the website, in order to make valid reports on the use of their website.
_gid	Google LLC .dietdoctor.com	1 day	This cookie is set by Google Analytics. It stores and update a unique value for each page visited and is used to count and track pageviews.
CookieScriptConsent	CookieScript www.dietdoctor.com	1 year	This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
__cf_bm	Cloudflare Inc. .podbean.com	30 minutes	This cookie is used to distinguish between humans and bots. This is beneficial for the website, in order to make valid reports on the use of their website.
_hjIncludedInPageviewSample	Hotjar Ltd www.dietdoctor.com	2 minutes	This cookie is set to let Hotjar know whether that visitor is included in the data sampling defined by your site's pageview limit.
_dc_gtm_UA-22012422-1	.dietdoctor.com	1 minute	This cookie is associated with sites using Google Tag Manager to load other scripts and code into a page. Where it is used it may be regarded as Strictly Necessary as without it, other scripts may not function correctly. The end of the name is a unique number which is also an identifier for an associated Google Analytics account.
_gaexp_rc	.dietdoctor.com	25 seconds

Name	Provider / Domain	Expiration	Description
IDE	Google LLC .doubleclick.net	1 year	This cookie is set by Doubleclick and carries out information about how the end user uses the website and any advertising that the end user may have seen before visiting the said website.
_uetvid	Microsoft Corporation .dietdoctor.com	1 year	This is a cookie utilised by Microsoft Bing Ads and is a tracking cookie. It allows us to engage with a user that has previously visited our website.
loc	Oracle Corporation .addthis.com	1 year 1 month	Stores the visitors geolocation to record location of sharer
test_cookie	Google LLC .doubleclick.net	15 minutes	This cookie is set by DoubleClick (which is owned by Google) to determine if the website visitor's browser supports cookies.
_gcl_au	Google LLC .dietdoctor.com	3 months	Used by Google AdSense for experimenting with advertisement efficiency across websites using their services
_uetsid	Microsoft Corporation .dietdoctor.com	1 day	This cookie is used by Bing to determine what ads should be shown that may be relevant to the end user perusing the site.
uvc	Oracle Corporation .addthis.com	1 year 1 month	Tracks how often a user interacts with AddThis
YSC	Google LLC .youtube.com	Session	This cookie is set by YouTube to track views of embedded videos.
MUID	Microsoft Corporation .bing.com	1 year	This cookie is widely used my Microsoft as a unique user identifier. It can be set by embedded microsoft scripts. Widely believed to sync across many different Microsoft domains, allowing user tracking.
_fbp	Meta Platform Inc. .dietdoctor.com	3 months	Used by Facebook to deliver a series of advertisement products such as real time bidding from third party advertisers
VISITOR_INFO1_LIVE	Google LLC .youtube.com	6 months	This cookie is set by Youtube to keep track of user preferences for Youtube videos embedded in sites;it can also determine whether the website visitor is using the new or old version of the Youtube interface.

Name	Provider / Domain	Expiration
_hjSession_1945121	.dietdoctor.com	30 minutes
_hjSessionUser_1945121	.dietdoctor.com	1 year
_ga_Y4DLH4EPXM	.dietdoctor.com	2 years