Project PCOS Professional of the Month Dr. Dennis Gage
Ashley: When did you first become interested in working with PCOS patients?
Dr. Gage: I first became interested in working with patients with PCOS when the mysteries of Insulin Resistance were unraveling. It was approximately thirteen years ago when Metformin was being used in certain patients who were extremely sensitive to the product and were able to lose weight easily. With the dramatic publicity of Metformin in the media, many patients presented to the office who were interested in trying to lose weight. They did not realize that they had PCOS but after intense hormonal analysis in my office, they were made aware of the diagnosis of PCOS. Indeed we have seen a dramatic increase in the diagnosis of PCOS as awareness has increased about this disease.
Ashley: Why is it harder for a woman with PCOS to loose weight?
Dr. Gage: Women with PCOS tend to have significant Insulin Resistance as part of their syndrome. Most of these women will have upper body obesity which is metabolically active fat, the so called "visceral fat". These women struggle because carbohydrates must be reduced to very low amounts to see significant success and to reduce the Insulin Resistance.
Ashley: What is the difference between dieting and lifestyle change?
Dr. Gage: As Director of The Thinderella Lifestyle Change Program in my NY office, I have made a point of telling my patients "Don't do a diet, live a diet". Dieting itself connotates the concept of a restrictive pattern that is to last for a certain amount of time and then is to be completed. It is as if the patient has a finite amount of time to spend on the diet and then it's over. However it is really the lifestyle change or the everyday patterns that a person goes through that dictates what they are going to weigh. Over time these lifestyle changes are what ultimately dictates success in our program. Patients with PCOS are particularly sensitive to carbohydrates so it is very easy to tell these patients to just get rid of all your simple carbohydrates forever. But if you don't practice a lifestyle pattern, it is easy for other carbohydrate foods to sneak into the home or for the patient to be sabotaged by everyday lifestyle events such as your co-worker who brings bagels in to work every morning. Though changing one's lifestyle pattern may be more difficult than just crash dieting in the short run, it remains the only proven method for long term weight loss.
Ashley: How can defensive eating techniques work for a woman with PCOS?
Dr. Gage: Patients with PCOS improve their Insulin Resistance and indeed some patients have actually reversed much of their syndrome simply by significantly losing weight. Many patients who are successful at keeping weight off are able to have a return of normal menses even without medications. It is one of those strange situations where if you push hard enough, you seem to be able to reverse the syndrome. Thus defensive eating, a technique I teach in my TLC Program, means that you are practicing a certain pattern that you always hold on to and it is not as if you permit yourself to go back up in weight. Clearly "yo-yo'ing" for a PCOS patient would connotate a return of Insulin Resistance and the syndrome would bear down just as it had at the beginning before this patient dieted.
Ashley: How can self esteem impact making lifestyle changes?
Dr. Gage: Self esteem impacts very highly in lifestyle change. In my recent review of the literature, almost every article written about weight loss appears to be improvement in self esteem and lifestyle. Even patients with significant depression when losing weight have improvement in overall image and a lifting of their depression. Self esteem itself is also critical in initiating a lifestyle change. If one does not feel worthy of losing weight, then they go down the road of not even trying. While if one has self esteem, this can positively impact on the ability to have a lifestyle change that will be successful for a long period of time.
Ashley: How do we overcome perceptions and stigmas about weight?
Dr. Gage: Stigmas against the obese individual has been an extremely common event. From the time a child is in elementary school to acquiring a job, people who are overweight or obese have been discriminated against and this has been a continuing issue even to this day. To avoid stigmata, our PCOS patients require good self esteem and self confidence. They also must understand how to define success. If we define success as a realistic healthy weight, though we may not necessarily be considered lean by everyone who sees us, we would know in our mind that we have been successful in our endeavor. An example of this is a person who has been 300 pounds all their life and has lost weight to 225 pounds. The patient would believe in themselves, have self confidence, and know that they can keep this weight off; this despite the fact that other people who have never met this person would still consider them overweight or obese. So really overcoming stigmata is in the eyes of not the person who sees you but in your own eyes. Clearly self confidence becomes a major issue.
Ashley: Why are lifestyle changes so important to a patient with PCOS?
Dr. Gage: PCOS patients can make the lifestyle change that is necessary for long term healthy weight loss and maintenance. They have to realize that they may be fighting certain metabolic issues but even these are conquerable. Most PCOS patients when given the proper utensils and proper behavioral pattern changes that have to occur as described in my book The Thinderella Syndrome can be guided through these changes and can succeed in maintaining their new goal weight. The key right now is to make sure that you are diagnosed early and that you are successful in getting the correct help.
For more information about Dr. Gage:
Dennis Gage, MD, FACP
Endocrinology, Metabolism, and Clinical Nutrition
103 East 75th Street
New York, New York 10021