Research
Insulin Resistance and Long-Term Weight Control
Learn how insulin resistance impacts PCOS and discover effective diet and exercise strategies for long-term weight control and improved health.
June 8, 2025
·
17
Learn how insulin resistance impacts PCOS and discover effective diet and exercise strategies for long-term weight control and improved health.
Struggling with weight management and PCOS? Insulin resistance could be the key issue. Here's what you need to know and do:
Take control of your health today. Small, consistent changes can break the cycle of insulin resistance and improve your quality of life.
Insulin resistance happens when your body’s tissues don’t respond properly to insulin, a hormone that helps move glucose from your bloodstream into your cells after eating. When this process is disrupted, your pancreas still produces insulin, but glucose doesn’t enter cells efficiently. Instead, it builds up in your blood, causing hyperglycemia. To compensate, your pancreas works harder, pumping out more insulin in an attempt to manage blood sugar levels.
Here’s the surprising part: Insulin resistance affects 70-95% of people with PCOS who are overweight and 30-75% of those with lean PCOS. So, even if you’re not overweight, you could still be facing this challenge if you have PCOS.
The root issue lies in how your metabolic tissues - like muscle and fat - respond to insulin. They don’t process insulin efficiently, which leads to elevated blood sugar levels and puts stress on your metabolism. This dysfunction doesn’t just stop at blood sugar; it also contributes to hormonal imbalances that worsen PCOS symptoms.
Insulin resistance doesn’t just disrupt your metabolism - it also throws your hormones out of balance. Chronically high insulin levels stimulate your ovaries to produce excess testosterone. This hormone imbalance interferes with normal ovulation and leads to symptoms like irregular cycles, acne, and excess hair growth.
Dr. Christina E. Boots, a Reproductive Endocrinologist, explains:
"The more testosterone you have, the more ovulation dysfunction you have in your ovaries, and the more symptoms [of PCOS] you have."
She also highlights the cyclical nature of insulin resistance and weight gain:
"The more insulin resistance you have, the more weight you gain, and the more weight you have, the more insulin resistant you tend to become. It's kind of a vicious cycle."
This cycle is particularly challenging because weight gain from insulin resistance worsens PCOS symptoms. Excess fat tissue causes your body to produce even more insulin, which amplifies hormonal imbalances. While most tissues resist insulin’s effects, the ovaries remain sensitive to it, continuing to produce excess testosterone despite the resistance in other parts of the body.
The long-term risks are alarming: people with PCOS are about four times more likely to develop type 2 diabetes compared to those without the condition. Over half of women with PCOS will develop type 2 diabetes by the age of 40. This underscores how serious insulin resistance can become if it’s not addressed.
What’s essential to understand is that high insulin isn’t just a symptom of PCOS - it’s a key driver of the condition. That’s why tackling insulin resistance is often a critical step in managing PCOS effectively. Up next, we’ll dive into how dietary and exercise strategies can help break this cycle.
Understanding how insulin resistance impacts weight gain is only half the battle - making thoughtful changes to your diet can help restore balance. By targeting insulin resistance with strategic food choices, you can stabilize blood sugar and support your overall health.
Refined carbohydrates are notorious for causing rapid blood sugar spikes, which force your pancreas to pump out more insulin. Over time, this can worsen insulin resistance. For people with PCOS, this is particularly concerning, as more than half develop diabetes or prediabetes before turning 40.
To reduce these risks, avoid foods like white bread, muffins, pastries, sugary desserts, soda, and fruit juices - common culprits behind blood sugar surges. Pay attention to ingredient labels when shopping; pasta made with semolina or durum wheat is high in carbs and low in fiber. Also, look out for hidden sugars such as sucrose, high fructose corn syrup, or dextrose.
Instead of cutting out carbs entirely, focus on low-glycemic options that provide a steady energy source. Amanda Stathos, M.S., R.D., L.D.N., a Clinical Dietitian at Johns Hopkins' Sibley Memorial Hospital, advises:
"Eliminating carbs is not something I recommend. However, choosing more low-glycemic carbohydrates (those that do not cause a surge in blood sugar) such as fiber-rich whole grains and non-starchy vegetables can be helpful. The goal is to keep blood sugar stable and avoid big dips and spikes. Smaller, more frequent meals can really help, combined with balanced snacks so you're eating about every four hours."
Practical swaps include replacing white rice with quinoa or brown rice, choosing steel-cut oats over instant oatmeal, and filling half your plate with non-starchy vegetables like broccoli, spinach, and bell peppers. These choices slow down glucose absorption and help stabilize insulin levels.
Next, let’s look at how the Mediterranean diet offers a sustainable approach to managing insulin resistance.
The Mediterranean Diet has proven to be an effective eating plan for managing PCOS and improving insulin sensitivity. Research shows that women who closely follow this diet experience a 32% lower risk of developing PCOS.
Amanda Stathos highlights its anti-inflammatory benefits:
"Research shows that people with PCOS show evidence of all-over inflammation, which is associated with heart disease and other illness. The Mediterranean diet eliminates saturated fats, processed meats and refined sugar, which makes it a powerful tool to address inflammation."
This diet works well because it emphasizes complex carbohydrates, fiber, and healthy fats. A 12-week clinical trial found that overweight women with PCOS who followed a Mediterranean diet combined with a low-carb approach lost more weight (about 13.4 lbs vs. 10.6 lbs), reduced their BMI more effectively (2.12 kg/m² vs. 1.78 kg/m²), and saw better improvements in insulin resistance markers compared to those on a low-fat diet.
Key elements of the Mediterranean diet include:
What makes the Mediterranean Diet especially appealing is its flexibility and long-term focus. As Stathos explains:
"If you are diagnosed with polycystic ovary syndrome, it doesn't mean that you are destined to have poor health. There is a lot you can do to take charge, minimize symptoms and keep yourself healthy."
This approach emphasizes whole, unprocessed foods to prevent feelings of restriction. Timing your meals also plays a role in maintaining steady blood sugar. Stathos recommends eating smaller, balanced meals every four hours. Additionally, swapping hormone-treated dairy for almond, coconut, or oat milk, and staying hydrated with water, unsweetened coffee, or tea, can further support your body’s natural insulin function. These simple adjustments can set the stage for long-term health improvements.
While diet forms the cornerstone of managing insulin resistance, incorporating regular physical activity takes things a step further by boosting insulin sensitivity and aiding in long-term weight management. Exercising at least every two days helps keep insulin action at its peak. For women with PCOS, this is especially important. Studies reveal that 65–70% of individuals with PCOS experience insulin resistance, and women with PCOS are two to eight times more likely to develop impaired glucose tolerance or type 2 diabetes compared to those without the condition.
The International Evidence-based Guideline for the Assessment and Management of PCOS suggests aiming for 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic exercise weekly. For added health benefits, including modest weight loss, this can be bumped up to at least 250 minutes of moderate-intensity or 150 minutes of vigorous-intensity aerobic activity per week. Additionally, muscle-strengthening exercises on two non-consecutive days are highly recommended.
Experts often suggest combining cardio and strength training for at least 30 minutes daily. Let’s look at the types of exercises that work best for improving insulin sensitivity.
Pairing a variety of exercises with dietary adjustments can significantly enhance insulin response and contribute to overall hormonal balance. A mix of steady-state cardio, HIIT, strength training, and mind-body practices like yoga can be tailored to fit individual preferences. Research shows no single exercise type stands out as the most effective for women with PCOS, which means a varied routine can be beneficial.
Among exercise intensities, vigorous activity seems to offer the greatest metabolic benefits. A meta-analysis of 16 studies found that vigorous-intensity aerobic workouts were the most likely to reduce BMI and insulin resistance in women with PCOS. However, this doesn’t mean you need to dive straight into high-intensity workouts - start where you’re comfortable.
Steady-state cardio is an excellent entry point. Activities like walking, cycling, dancing, or participating in an aerobics class are sustainable ways to improve insulin sensitivity.
High-Intensity Interval Training (HIIT) is another standout option, praised for its effectiveness and appeal. HIIT alternates between short bursts of intense activity and rest periods. A study published in PLOS ONE found that women with obesity often enjoy HIIT more than continuous moderate exercise. Enjoyment is a key factor for sticking with a routine over the long term.
Strength training also plays a pivotal role in managing insulin resistance. Whether you’re using resistance bands, weights, or just your body weight, building muscle helps improve glucose uptake. Combining resistance training with aerobic exercise has been shown to significantly enhance insulin sensitivity in women with PCOS. Since muscle tissue is metabolically active, having more lean muscle helps your body process glucose more efficiently.
Mind-body exercises like yoga, Pilates, and tai chi offer unique benefits by addressing both physical and emotional challenges associated with PCOS. These practices not only reduce stress, which can exacerbate PCOS symptoms, but also provide gentle movement that supports insulin sensitivity.
Monica Moore, MSN, APRN, emphasizes the importance of finding joy in your exercise routine:
"In terms of exercise, I will always say that whatever type of movement you enjoy and have fun doing, that you're going to keep up and sustain, is what you should do. A lot of times we think, 'I have to do this super intense workout program,' and that never lasts."
Even short sessions can make a difference. Exercising for 30 minutes a day, three times a week, or accumulating three total hours weekly has been shown to improve both metabolic and reproductive symptoms tied to PCOS. If longer workouts feel daunting, breaking them into smaller chunks throughout the day can still yield positive results.
The key takeaway? Consistency matters more than the specific type of exercise. Regular movement - whatever form it takes - will gradually improve your insulin sensitivity over time.
Once you've made changes to your diet and started exercising regularly, the next step is creating a plan that works for the long haul. For women with PCOS, this isn't just about shedding pounds - it's about building habits that promote hormonal balance and support metabolic health over time.
Amanda Stathos, M.S., R.D., L.D.N., a clinical dietitian at Johns Hopkins' Sibley Memorial Hospital, emphasizes:
"If you are diagnosed with polycystic ovary syndrome, it doesn't mean that you are destined to have poor health. There is a lot you can do to take charge, minimize symptoms and keep yourself healthy."
Research highlights that lifestyle changes - including diet, exercise, and behavioral adjustments - are the cornerstone of managing PCOS. In fact, programs that combine physical and emotional support often prove more effective than focusing solely on diet composition.
When managing PCOS, small changes make a big impact. Studies show that losing just 5% to 10% of your body weight can significantly improve symptoms like insulin resistance, inflammation, and even fertility. For example, if you weigh 180 pounds, shedding 9 to 18 pounds can lead to noticeable health benefits.
Even modest weight loss can result in:
The 2018 PCOS guidelines stress the importance of preventing weight gain and achieving modest, sustainable weight loss. To make this process manageable, set SMART goals - Specific, Measurable, Achievable, Realistic, and Timely. Instead of vague aspirations like "I want to lose weight", focus on actionable steps, such as "I'll eat three cups of vegetables daily" or "I'll walk 30 minutes after dinner five times this week".
Christiann Collins, RD, CDE, CSOWM, lead dietitian at the Center for Weight Management in Portland, advises:
"Set specific behavioral goals that support getting to a healthy weight and track how well you follow through. Focus on what you can do versus what you should do."
Creating an environment that supports your goals is equally important. Stock your kitchen with whole grains, lean proteins, and fresh or frozen vegetables while removing processed snacks. When healthy options are easy to grab, sticking to your plan feels less like a chore.
Meal planning is a powerful way to manage insulin resistance and keep energy levels steady. By stabilizing blood sugar, you can avoid the spikes that trigger cravings and hormonal imbalances.
Here are some strategies to help:
These strategies don't just help with weight management - they can also boost energy, improve mood, and support your body's natural ability to regulate hormones and insulin.
Next, you'll learn how to track your progress beyond the scale to refine your long-term plan.
For more tailored strategies on managing PCOS and maintaining a healthy weight, visit PCOSHelp.
When it comes to managing PCOS and insulin resistance, the number on the scale doesn’t tell the whole story. Progress often goes beyond weight loss, and focusing on non-scale victories can give you a clearer picture of your health improvements.
Once you’ve settled into a meal plan and exercise routine, it’s important to measure your progress in ways that reflect your overall well-being. Tracking the right signs of improvement not only reinforces your efforts but also helps you stay motivated over the long term.
Here are some meaningful ways to track changes that might not show up on the scale:
Energy levels are often among the first things to improve as insulin resistance starts to decrease. Many women notice they can power through the afternoon without experiencing an energy crash. Try rating your energy on a 1–10 scale throughout the day to spot patterns, like feeling more energized after meals.
Menstrual cycle changes can provide valuable insights. Keep track of your cycle’s regularity, length, flow, and PMS symptoms. Even slight improvements in cycle predictability could signal positive hormonal changes resulting from your lifestyle adjustments.
PCOS symptoms such as acne, oily skin, unwanted hair growth, or thinning hair may gradually improve as insulin sensitivity increases. Taking monthly photos of areas prone to breakouts or excessive hair growth can help you document these subtle but meaningful changes.
Blood sugar stability is a key indicator of how well your body is managing insulin. Work with your healthcare provider to monitor glucose and insulin levels through regular tests. Signs of improvement include fewer sugar cravings, reduced hunger between meals, and feeling fuller for longer after eating.
Physical capabilities often improve significantly with consistent exercise. For example, Michelle Rogers, a Certified Personal Trainer, shares the story of a 61-year-old client who, after six months of strength training, found that lifting a 20-pound bag of kitty litter "felt like tissues". Pay attention to milestones like climbing stairs more easily, carrying groceries without strain, or keeping up with your kids during playtime.
Sleep quality and mood frequently get better as insulin resistance decreases. Keeping a journal to track your sleep patterns, stress levels, and mood can help you notice improvements over time.
Body measurements can reveal changes in your body composition that a scale might miss. Use a tape measure monthly to track areas like your chest, waist, hips, and thighs. For example, one client lost 15 pounds but saw a dramatic reduction of 33 inches overall, showing how weight loss doesn’t always tell the full story.
Health markers such as blood pressure and cholesterol levels offer concrete evidence of internal improvements. Regular checkups with your doctor can help monitor these metrics. One health coaching client, for instance, saw her cholesterol drop 30 points to a normal range after adopting healthier eating habits.
As Michelle Rogers puts it:
"When you feel good, it benefits every area of your life. That's powerful, and exercise and nutrition can help you get there".
It’s worth noting that even a modest 5% weight loss can improve fertility and ovarian structure, showing that the benefits of these changes go far beyond what the scale can measure.
To stay on track, choose three to five metrics to monitor on a weekly or monthly basis. This well-rounded approach gives you a clearer picture of your progress and keeps you motivated, even when changes feel slow.
For more tools and tips on managing PCOS and tracking insulin resistance, visit PCOSHelp.
Addressing insulin resistance plays a key role in improving PCOS symptoms and maintaining weight management. Since 50% to 75% of people with PCOS are affected by insulin resistance, understanding this connection empowers you to take charge of your health. It's the foundation for every strategy we've covered.
Research shows that improving insulin resistance directly impacts PCOS symptoms. Even small changes can make a noticeable difference - just a 5% weight loss can significantly improve PCOS symptoms. This reinforces the idea that steady, manageable steps toward better insulin sensitivity can lead to meaningful improvements in your daily life.
The lifestyle strategies we’ve discussed - like reducing refined carbs, adopting a Mediterranean-style diet, staying active, and celebrating non-scale victories - work together to break the cycle of insulin spikes and PCOS-related challenges. These approaches not only ease symptoms but also reduce risks for conditions like type 2 diabetes, heart disease, and depression.
As Amanda Stathos, M.S., R.D., L.D.N., a Clinical Dietitian at Johns Hopkins' Sibley Memorial Hospital, emphasizes:
"If you are diagnosed with polycystic ovary syndrome, it doesn't mean that you are destined to have poor health. There is a lot you can do to take charge, minimize symptoms and keep yourself healthy".
While over half of women with PCOS may develop type 2 diabetes by age 40, this outcome is not set in stone. The dietary shifts, exercise routines, and lifestyle changes outlined here can help improve insulin resistance and enhance overall health.
Your journey is unique - acknowledge every step forward. Focus on sustainable changes that align with your life, celebrate successes beyond the numbers on the scale, and remember that each positive choice contributes to long-term well-being.
For more guidance and support on managing PCOS and insulin resistance, check out the resources available at PCOSHelp.
Insulin resistance plays a major role in the health challenges faced by women with Polycystic Ovary Syndrome (PCOS), and it’s not limited to those who are overweight. Research indicates that 30% to 75% of women with lean PCOS also deal with insulin resistance, which can interfere with hormonal balance and disrupt ovulation.
Higher insulin levels can stimulate the production of androgens, which may result in symptoms like irregular menstrual cycles, acne, and even infertility. Addressing insulin resistance through lifestyle adjustments, such as adopting a balanced diet and committing to regular physical activity, is crucial for all women with PCOS, no matter their weight.
The Mediterranean diet offers a practical approach to supporting insulin management, especially for those dealing with insulin resistance. Here are a few easy ways to bring its principles into your everyday life:
By making these small but meaningful adjustments, you can tap into the benefits of the Mediterranean diet and work toward better long-term insulin health.
Both exercise and a nutritious diet are crucial for improving insulin resistance in women with PCOS. Engaging in regular physical activity, particularly aerobic or resistance training, can boost insulin sensitivity and aid in weight management - two key factors in managing PCOS symptoms effectively.
On the dietary front, making thoughtful food choices is just as important. Incorporating high-fiber foods, lean proteins, and healthy fats into meals can help stabilize blood sugar levels and lower insulin resistance. When exercise is paired with a well-rounded diet, the combined effect often yields the best outcomes. This integrated approach proves to be highly effective in addressing insulin resistance associated with PCOS.
