Why Experts Say You Should Never Ignore Stubborn Weight Loss

For most of her life, Mila Habsy had remained slim without making much effort. So she was alarmed when her trousers started feeling tighter every morning.

The Manchester social media manager, then 19, had recently stopped taking the birth control pill after using it since she was 16. She hoped the break would give her body “a bit of a rest”.

Within weeks, however, Mila began experiencing persistent bloating and discomfort.

“Nothing else in my life had changed, so I was confused by what was happening,” says Mila. “I had no idea what to do.”

Determined to reverse the change, she began exercising intensely, running several miles every evening, while also restricting her diet. She skipped breakfast and limited herself to small, carefully measured portions at lunch and dinner. Yet the stubborn fat around her stomach, hips and thighs continued to build. In less than a year, Mila had gained just over three stone, a dramatic change from her previously slim figure.

“I felt incredibly confused and very, very insecure,” says Mila. “I had gone from being quite skinny to looking bloated. I couldn’t fit into my clothes and my face had become round and puffy, almost like a moon. I couldn’t even look in the mirror because I felt so bad about myself. It was awful, and nothing seemed to shift the extra weight.”

Now 23, Mila looks and feels like a different person. She has returned to her usual weight, is full of energy, has a notably toned stomach and works part-time as a model.

Her transformation did not come from an extreme diet-and-exercise plan or GLP-1 medication. In fact, Mila estimates that she now eats more than she did previously.

Instead, she was diagnosed with polyendocrine metabolic ovarian syndrome, or PMOS, a condition that explained her sudden and persistent weight gain.

Previously known as polycystic ovarian syndrome (PCOS), the condition is commonly associated with ovarian cysts, missed or irregular periods and difficulty becoming pregnant.

However, an expanding body of research suggests that PMOS can also affect the body’s metabolic system, interfering with the way it converts food into energy.

Consequently, many women with the condition find weight loss especially difficult and are more likely to develop stubborn abdominal fat. On social media, this has become known as “PMOS belly”.

Experts stress, though, that this symptom is not unavoidable.

“PMOS affects one in eight women in the UK, yet almost half may have no obvious symptoms,” says Professor Dipa Kamdar, senior lecturer in pharmacy practice at Kingston University. “As our understanding grows, it is becoming clear that the condition can influence fat storage as well as the reproductive system.

“As a result, many women with PMOS also store more visceral fat — the deeper and more dangerous type that surrounds the internal organs — around their middle. They may have slim arms and legs and a normal BMI, yet still develop a rounded stomach that remains despite even the most restrictive dieting. It can be difficult to tackle, but it is not impossible.”

The first step is understanding what PMOS is.

Once thought to affect mainly the ovaries, PMOS is now understood to have wider effects throughout the body. That is why the condition has been given a new name, reflecting its potential impact on hormones, metabolism, mental health and the cardiovascular system.

In women with PMOS, the ovaries produce excessive amounts of male sex hormones called androgens. This hormonal imbalance may lead to irregular or absent periods, excess facial or chin hair, acne, fertility problems and ovarian cysts.

Elevated androgen levels can also affect metabolism by increasing inflammation and disrupting the way muscles and other tissues process glucose. Over time, this may contribute to insulin resistance, leaving many women with PMOS facing unexpected weight gain or finding it particularly hard to lose weight.

‘Because their fat cells respond differently to insulin, women with PMOS don’t burn energy as efficiently as those without the condition,’ says Dr Adam Balen, professor of reproductive medicine and surgery at Leeds Teaching Hospitals NHS Trust. ‘They also often have abnormalities in their gut hormones, causing a lack of healthy gut bacteria.

‘These differences combine to cause a build-up of excess fat.’

Fat tends to gather around the midsection, adds Professor Kamdar, because elevated levels of androgens direct it there.

‘The female hormone oestrogen causes women to usually develop a pear shape, with most fat accumulating around the hips and thighs,’ she says. ‘High levels of androgens, like testosterone, can override this pattern, instead redirecting fat storage to the midsection, which is where men tend to develop it.’

RELATED: 1 Billion Barrels Transit Strait of Hormuz as ‘Ironclad Blockade’ Keeps Iran’s Oil Exports at Zero

Over time this can become a damaging feedback loop, research shows, in which more insulin leads to more androgens, while more androgens worsen insulin resistance.

And left untreated, visceral fat can raise the risk of several long-term conditions, including heart disease and type 2 diabetes.

The difficulty, says Professor Balen, is that without addressing the root causes of this fat build-up, it can be extremely difficult to get rid of it.

There is no single cure for PMOS belly, says Professor Kamdar, and many of the supplements said to help on social media have no scientific backing. While medications for the condition often focus on specific symptoms rather than a root cause.

‘Women may be put on birth control to help with irregular periods, while a drug called spironolactone can reduce hair growth on the face and body,’ says Professor Kamdar. ‘Metformin, a type 2 diabetes medicine, can also help reduce insulin resistance – which can help with weight gain and infertility. But these drugs can all cause side effects, and while they manage symptoms they are regarded by some as more of a temporary fix.’

Instead, a combination of dietary changes, regular exercise and better sleep habits are the best way to restore hormonal balance and reduce insulin resistance – paving the way for weight loss.

‘There is no such thing as a PMOS diet, but inherently, the Mediterranean diet will be beneficial for PMOS patients, as it is for everyone,’ says Professor Balen. ‘Avoiding processed foods, eating plenty of fruit and vegetables and cooking with anti-inflammatory agents like olive oil will promote a healthy metabolism.’

Eating at regular intervals is also crucial, says Professor Balen.

‘The first thing people need to do is stop snacking between meals. Eating regularly helps to stabilise blood sugar levels, which lowers insulin resistance,’ he adds.

Studies show exercise can also help the muscles absorb glucose more effectively – lowering insulin and reducing testosterone production. ‘I usually recommend women with PMOS do three hours of moderate activity and two hours of vigorous activity every week,’ says Professor Balen. ‘This can be a combination of cardio and weight-bearing exercise, but there is no one thing that is best.’

Finally, any stress on the body can worsen symptoms, says Professor Kamdar. ‘Improving sleep can have a huge impact on PMOS,’ she says. ‘Poor sleep worsens insulin resistance, increases the “hunger hormone” ghrelin and increases oxidative stress, making it harder to reduce fat stores.’

For Mila, it took trial and error to find a routine that worked. Today, she starts her day with breakfast containing 30g of protein and lots of fibre before going for a walk.

‘I try to hit 10,000 steps a day,’ she says. ‘I also do pilates or barre classes, and weight training between four and five times a week.’

She doesn’t drink caffeine on an empty stomach and has swapped dairy milk for almond or coconut milk. As for sweet treats, she sticks to a few squares of dark chocolate when she has a craving.

‘It worked for me,’ she adds. ‘I feel so much brighter and happier now.’

Doncaster-based GP Dr Dean Eggitt says: ‘If you’re experiencing stomach fat that won’t budge, don’t hesitate to bring it up with your doctor. There may be hidden causes that no amount of diet or exercise will solve.’