Are you frustrated and embarrassed by fat that collects around your waist more and more every year? Some folks just tend to gain weight around the waist rather than the hips, and it’s even more true for people with Polycystic Ovary Syndrome or PCOS. That’s because the insulin resistance, inflammation and high testosterone that come with PCOS all contribute to belly fat accumulation (1).

So, how do you get rid of that stubborn PCOS belly fat? It isn’t as straight forward as just losing weight or cutting calories. I like to say that losing PCOS belly fat is an advanced skill. First you have to learn to address all the root causes of PCOS belly fat, then you can focus on specific diet and exercise changes that will help you build muscle and lose fat. In this post, I’ll walk you through how to first tackle the underlying causes of belly fat, then start losing fat and gaining muscle to help you lose that belly fat for good.

What is Belly Fat or Visceral Fat?

Belly fat is visceral fat or fat that surrounds your organs. It’s a lot more risky than fat on your butt and thighs. It’s more likely to lead to heart disease, diabetes and even certain cancers, so it’s a good idea to start working on it now (1).

Start by addressing the Root Causes of PCOS Belly Fat

Lower Blood Sugar for Less Fat Accumulation

PCOS often comes with insulin resistance, meaning sugar has trouble getting into your cells. And a recent analyses showed that it’s highly associated with visceral or belly fat (2). The more insulin resistance over time, the more belly fat will accumulate, so what can you do?

There are several steps you can take to balance blood sugar and lower insulin resistance. They include balancing carbs with protein, fat and fiber, limiting added sugar, exercising after eating and using tools like cinnamon, vinegar and supplements if needed. Read more about how to balance blood sugar in my recent post on stopping PCOS Sugar Cravings.

Lower Testosterone for Better Fat Distribution

Have you ever noticed that men tend to gain weight around their bellys, whereas women tend to gain more around their butt and thighs? That’s due to male and female hormones. With PCOS, you have high testosterone and low estrogen, causing this same pattern (3).

This makes it essential to find ways to lower testosterone to help combat belly fat. Luckily, there are studies that show 2 cups of mint tea per day and eating phytoestrogens like soy and flax may help (4, 5). Plus, ensuring you have adequate vitamin D and Omega-3s helps naturally lower testosterone (6, 7). Lastly, strength training exercise may also help lower testosterone with PCOS (8).

Lower Inflammation & Cortisol For Less Belly Fat

Inflammation and belly fat are strongly associated, but there’s a bit of a chicken and egg problem with them. Visceral fat actually lets out inflammatory molecules, but inflammation from cortisol and other sources likely contributes to the accumulation of visceral fat too (9).

This means that you need to lower inflammation and stress in order to get rid of belly fat. An anti-inflammatory diet consisting of lots of fruits and vegetables, whole grains, nuts, seeds, beans and fatty fish can help fight inflammation (10). Antioxidant rich spices like turmeric, ginger, cinnamon and garlic also help lower inflammation.

Plus, you’ll want to make sure you get plenty of sleep and manage stress. Cortisol naturally wakes us up in the morning, but skipping a night’s sleep can increase cortisol and other inflammatory markers (11).

So can stress. Stress causes our body to tap into the fight or flight or sympathetic nervous system, which is fine if you’re being chased by a bear. But, if you’re constantly in that fight or flight or have chronic stress, it can increase chronic inflammation.

Boost Gut Health To Lower Inflammation & Visceral Fat

We’re finding more and more that gut health is tied to weight management. In fact, not only do women with PCOS have lower diversity in their gut microbiome than women without PCOS, but women with PCOS and higher levels of visceral fat have different micriobiomes (12).

While more research is needed to know exactly which probiotics would help lower visceral fat, it can be helpful to increase microbiome diversity by eating fermented foods, plenty of fiber and possibly taking probiotics. You can learn more about improving gut health here.

Address Metabolic Deficits

Build Muscle To Burn More Calories

Once you’ve balanced hormones and lowered inflammation, you can start building muscle, which will also help combat belly fat. Women haven’t historically been encouraged to build muscle, but it’s actually so good for us!

Building muscle not only helps redistribute visceral fat, it helps increase the amount of calories you burn throughout the day. As I mentioned before strength training also seems to lower testosterone in folks with PCOS (9).

Get at least 120-150 minutes of cardio weekly

For some reason, people seem to think that you shouldn’t do HIIT or other vigorous physical activity when you have PCOS. But, at least 2 studies show these types of exercise are beneficial and help lower visceral fat in women with PCOS (10, 11).

More studies are needed, but I find this compelling enough to recommend it, especially since it’s based on the national recommendations.

Get Plenty of Protein

You need a little extra protein in order to build muscle. It also helps you keep your blood sugar balanced throughout the day. In fact studies have shown that higher protein diets tend to help women with PCOS have better blood sugar control (12)

The general recommendation for protein is .8 grams of protein per kilogram of body weight, but I find my clients do better on 1.3 – 1.5 grams per kilogram of body weight. Studies have shown that there’s no benefit after 1.6 grams per kilogram, so that would be the maximum, even when you’re doing pretty heavy strength training (13).

Eat A LOT of Fiber

When it comes to fat loss, there is probably no more powerful tool than fiber. Fiber is pretty magical in that it isn’t digested by our body, so it goes straight through us. Soluble fiber forms a gel that even pulls excess fats from our body and helps us eliminate them. Insoluble fiber is the roughage that adds bulk to your poop.

The general recommendation for fiber is 25 grams per day, but most Americans don’t get that. PCOS studies find that higher fiber intake is associated with lower testosterone and insulin resistance (14, 15). And in weight loss studies, fiber is a strong predictor of long-term success (16.)

That’s why I recommend 25 or more grams of fiber per day. Foods rich in fiber include fruits, vegetables, beans, nuts, seeds and whole grains. You can also supplement with psyllium husk or acacia fiber if needed.

Follow a Mediterranean Style Diet

What does this all look like as a diet? In my opinion, the Mediterranean Diet is a great way to incorporate all of these changes into one dietary philosophy. The big difference between the Mediterranean Diet and a regular “healthy” diet is that it’s higher in healthy fats from olive oil, nuts, seeds, avocado and oily fish. You also get some of your protein from plants sources like beans and legumes as well as fish, rather than relying solely on meat.

The Med diet even seems to be better than even a low fat diet at lowering waist circumference and testosterone in women with PCOS (17, 18). Another study showed that a “pulse-based” diet or diet high in beans helped improve metabolic health better than a generic healthy diet (19).

Consider Time Restricting Your Eating or Intermittent Fasting

I don’t usually recommend intermittent fasting (IF) for PCOS, because most people interpret this to mean they don’t have to eat in the morning. However, studies show that IF works best if you stop eating earlier in the evening.

One study in particular found that restricting eating to 8 am to 4 pm with PCOS helped lower belly fat and several other metabolic outcomes (20). Now, 4 pm is pretty early, but I think there are benefits to stopping eating even 1,2 or 3 hours before you go to bed, so you may want to start there.

Why Not Follow a Keto Diet to Lose Fat with PCOS?

Yes, keto diets have been shown to help folks with PCOS lose weight, so why not just go keto (21)? Well, for one, the keto diet is really hard to follow! It involves giving up almost all carbohydrate, even from healthy foods like whole grains, fruits and vegetables. Plus, it can be tough to get enough fiber and healthy fats on a Keto Diet.

But mostly, I find that my clients don’t want to live this way, especially in the long-term. We’re also lacking good research on how keto affects health long-term. Whereas, we have lots of great longevity data on the Mediterranean Diet.

Find the Right Supplements to Support Your PCOS Weight Loss Journey

Certain supplements like berberine, NAC and green tea extract may help boost fat loss (22), but they have to be used strategically and in conjunction with diet and lifestyle changes in order to be effective. It’s important to work with a dietitian or doctor to find the right supplements for your body.

A Note on Weight Loss with PCOS

You could do all of this perfectly and still not see the scale budge at all, and that’s OK! It’s really not about weight – it’s about making yourself metabolically healthy and strong. A lot of times your clothes will fit better, you’ll feel more energetic and you’ll notice you’re stronger. Those are the results that really matter.

Losing fat with PCOS is not easy. In fact, it can be more difficult for you than for folks without PCOS, but that shouldn’t discourage you. You now have an outline for how to lose fat with PCOS. You first have to address the root cause of belly fat – insulin resistance, high testosterone, inflammation and gut issues. Then, you can work on metabolic health by following the right combination of exercise and increasing fiber and protein.

Need a little support to heal your PCOS symptoms naturally? Book a free nutrition chat to work with me one-on-one, in a supportive group setting or through insurance: