Weight Will Not Budge Despite Dieting: Why?

You count calories, skip your lunchtime rice, walk every evening, and yet the scale stubbornly sits at the same number. For many women with PCOS in Malaysia, this is not about “lacking discipline.” Weight and fertility are in fact the two heaviest PCOS burdens for women here, more so than facial hair or acne. There are real physiological reasons behind weight that will not shift, and understanding them helps far more than blaming yourself.

Insulin resistance: the hidden engine behind stubborn weight

The biggest driver is usually insulin resistance. In PCOS, the body’s cells respond poorly to insulin, so the pancreas pumps out more of it to keep blood sugar in check. This high insulin behaves like a “fat-storage” hormone: it encourages the body to store energy as fat, especially around the abdomen, and makes it harder to break down existing fat. So even when you eat less, your body still tends to cling to its fat stores.

The 2023 international PCOS guideline (Monash, ESHRE, ASRM) recognises insulin resistance as a core feature of PCOS. That same guideline notes that routine insulin tests are not accurate enough for everyday clinical use, so doctors often assess the whole picture, namely waist circumference, fasting glucose, HbA1c, and signs like acanthosis nigricans (darkened skin on the neck or armpits), rather than relying on a single insulin number.

Even if you are slim: “lean” PCOS still carries insulin resistance

Many people assume PCOS weight struggles only affect women who are overweight. In reality, some women with PCOS have what is considered a normal body weight yet still have insulin resistance, a pattern often called “lean PCOS”. Studies estimate that roughly a quarter to half of slim women with PCOS still show insulin resistance, and this tendency is more marked in Asian women, including in Malaysia. This means that even when the scale looks fine, abdominal fat stores and disrupted insulin signalling can still affect periods, androgens, and energy.

That is why the real target is not the weight number alone, but metabolic health. A slim woman with PCOS still benefits from screening blood sugar and lipids, because the long-term risk of type 2 diabetes and heart disease does not disappear simply because body weight is low. If you are slim but have irregular periods and feel tired, do not assume PCOS is having no metabolic effect on you.

Leptin, ghrelin, and why you feel hungry again so soon

Weight is not purely calories in versus calories out. It is also governed by appetite hormones. In PCOS, leptin signalling (the hormone that should tell your brain “I am full”) is often disrupted, a state called leptin resistance. When the brain does not “hear” leptin properly, you feel hungry even after eating, and carbohydrate cravings climb.

At the same time, some women with PCOS have a less balanced ghrelin (hunger hormone) pattern. Together this means your body is working hard against your dieting effort. This is not weak willpower; it is biology. Understanding this matters so you do not fall into overly strict diets that eventually trigger overeating.

Why extreme dieting often backfires

When weight is stuck, the first instinct is usually to cut calories as hard as possible. The problem is that the body reads an extreme energy shortage as a “danger” signal. In response, the metabolic rate drops (the body burns less to conserve energy), the hunger hormone ghrelin rises, leptin and thyroid hormones fall, while cortisol (the stress hormone) tends to climb. This phenomenon is known as metabolic adaptation, and it explains why weight loss often “stalls” after a few weeks of very low calorie dieting.

For a woman with PCOS who already has insulin resistance and disrupted leptin signalling, extreme dieting can worsen this and trigger a cycle of overeating. A moderate, sustainable calorie deficit, combined with enough protein to protect muscle, usually delivers more lasting results than an extreme diet that is hard to keep up for long.

A realistic target: 5 to 10 percent, not an “ideal” body

You do not need dramatic weight loss to see benefits. Evidence shows that losing just 5 to 10 percent of body weight can improve insulin sensitivity, lower androgens, and in many cases restore ovulation and more regular periods. For someone weighing 80 kg, that is 4 to 8 kg, a far gentler and more achievable goal.

Shift your focus from the scale to other markers: a looser waistband, steadier energy, more frequent periods, fewer sugar cravings. These markers often improve before the weight number moves much. For a solid grounding on targets and tracking, start with the newly diagnosed quick guide and the big picture at what PCOS is.

Approaches that genuinely help in PCOS

What works for PCOS is usually a little different from generic diet advice. A few steps backed by moderate to strong evidence:

• Put protein and fibre first at every meal. Eggs, chicken, fish, tempeh, vegetables and legumes slow the rise in blood sugar, so insulin does not spike. In Malaysia, this can be as simple as choosing less rice with more protein-rich sides, or swapping half your white rice for vegetables.
• Choose lower glycaemic index carbohydrates. Brown rice, oats, and wholegrain bread are gentler on blood sugar than white rice or white bread. You do not need to quit rice entirely; control the portion and pair it with protein.
• Move in a way that includes resistance training. Strength work (weights, bodyweight exercises) builds muscle that “soaks up” sugar more efficiently, improving insulin sensitivity more than cardio alone. Muscle is also metabolically active tissue, so keeping it helps your burn rate while you lose weight.
• Sleep and stress. Poor sleep and chronic stress raise cortisol and worsen both insulin resistance and food cravings. This is the part most often overlooked, yet its effect is real.

For other related symptoms such as irregular periods or acanthosis nigricans, see the full list at PCOS symptoms.

Eating out and local situations: practical examples

The reality in Malaysia is that we often eat at stalls, mamak shops, and gatherings. You do not have to avoid them entirely; just adjust your choices. At a mixed-rice (nasi campur) stall, take one scoop of rice (not two), add two kinds of vegetables, and choose a protein that is not heavily battered, such as grilled chicken, steamed fish, or egg. For drinks, asking for “less sweet” or switching to plain water or unsweetened tea makes a big difference, because sweet drinks raise blood sugar quickly without making you feel full.

For breakfast, noodles or roti canai on their own raise blood sugar fast; adding an egg or a handful of nuts slows that effect. For coffee or teh tarik drinkers, switching to a less sweet version or one without sweetened condensed milk is a small step worth taking. The aim is not perfection, but consistently reducing insulin spikes across the day so the body is not always in fat-storage mode.

Metformin and supplements: what the evidence actually says

Many people hope metformin will “melt” the weight away. In reality, metformin improves insulin sensitivity and menstrual regularity, but its direct effect on weight loss is modest (studies show an average of only a few percent), and it matters most when paired with dietary changes and exercise. Metformin is a prescription medicine; it should be discussed and monitored by a doctor.

For supplements, keep expectations grounded, always check halal status and NPRA registration, and tell your doctor, especially if you are pregnant, breastfeeding, or taking other medicines:

• Inositol (myo and d-chiro): among the supplements with the most consistent support for the PCOS metabolic profile. The dose used in studies, including the review by Unfer and colleagues (2017), is a 40:1 ratio, roughly 4 g of myo-inositol with 100 mg of d-chiro-inositol per day. It is not a slimming drug, but it can support insulin sensitivity.
• Berberine: in the study by Wei and colleagues (2012), the dose used was 1,500 mg per day (split into three 500 mg doses with meals), with effects on insulin and waist circumference comparable to metformin over the short term. Evidence is still limited compared with metformin, and berberine can interact with many medicines (including metformin itself and drugs processed by the liver), so check with your doctor first and avoid it in pregnancy or breastfeeding.
• Omega-3 (EPA and DHA): studies such as Thomson and colleagues (2011) found moderate benefits for metabolic and androgen profiles. The dose used in studies is typically around 1 to 2 g of combined EPA and DHA per day. Treat it as support for inflammation and lipids, not as a slimming aid.

It is important to understand that none of these supplements is a “slimming drug”. At best, they support the insulin sensitivity that makes your diet and exercise efforts more worthwhile, not a replacement for them.

What to ask your doctor

When you see a doctor, a few questions help you get a fuller assessment than just being weighed:

• Can I have blood sugar screening (fasting glucose or HbA1c) and a lipid profile to assess my metabolic risk?
• Is metformin suitable for my situation, and what side effects should I expect?
• If I try inositol or other supplements, are they safe with the medicines I am already taking?
• Should I be referred to a dietitian, an O&G clinic, or endocrinology?

Listing these questions before the visit makes sure your short consultation time is used well.

When to see a doctor

If your weight does not move at all after several months of consistent effort, or you notice signs such as extreme thirst, frequent urination, unusual fatigue, or darkened thickened skin on the neck, that is the time to talk to a doctor. Many Malaysian women do not realise that PCOS raises the long-term risk of type 2 diabetes and heart disease, so screening blood sugar and lipids is worthwhile. At a KKM Klinik Kesihatan, a visit for citizens costs around RM1 and already includes basic investigations, with follow-up usually around RM5 and referral to a hospital O&G or endocrine clinic if needed. Costs at private clinics or hospitals vary. Stubborn weight in PCOS is not a sign that you have failed; it is a sign that your body needs an approach that targets the hormonal root, not just eating a little less.