Understanding Insulin Resistance: Links to ADHD, PCOS (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome), and Weight

Understanding Insulin Resistance and Weight: Connections to ADHD, PCOS (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome), Pain, and More Weight gain is a multifaceted issue for many Australians, influenced by a combination of physiological and psychological factors that extend beyond mere diet and exercise. A significant contributor to this complexity is insulin resistance, a metabolic dysfunction that not only drives weight gain but also exacerbates a variety of health conditions. At Downscale Health, our focus is on identifying the underlying causes of persistent weight issues and providing comprehensive solutions that consider the whole person. What is Insulin Resistance? Insulin resistance occurs when the body’s cells become less responsive to insulin, a hormone crucial for transporting glucose from the bloodstream into tissues. As insulin sensitivity diminishes, the pancreas compensates by producing more insulin, which can lead to increased fat storage—particularly in the abdominal area—disruption of appetite regulation, and escalation of inflammation and fatigue. This creates a detrimental cycle that significantly interacts with many prevalent chronic conditions. ADHD and Insulin Resistance Research indicates that individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are at a heightened risk of developing insulin resistance and subsequent weight gain. Factors contributing to this include impulsive eating behaviours and potential neurological abnormalities affecting insulin signalling. Notably, even those with a normal body mass index (BMI) may experience metabolic dysfunction associated with ADHD (Nazar et al., 2016). Polycystic Ovary Syndrome (PCOS) (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome) The relationship between PCOS (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome) and insulin resistance is particularly pronounced, with studies showing that up to 70% of women with PCOS (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome) experience this condition (Diamanti-Kandarakis & Dunaif, 2012). Insulin resistance exacerbates hormonal imbalances, making weight loss exceedingly challenging, regardless of one’s weight. First-line treatments often incorporate metformin, dietary modifications, and structured exercise aimed at enhancing insulin sensitivity. Menopause and Perimenopause The transition into menopause and the preceding perimenopausal stage sees a decline in oestrogen levels, which adversely affects insulin sensitivity. This shift results in fat redistribution towards the abdomen and elevates the risk of cardiovascular and metabolic diseases (Davis et al., 2012). Consequently, weight gain during this period is common and often unresponsive to traditional calorie restriction strategies. Rheumatoid Arthritis and Inflammation Chronic inflammatory conditions such as rheumatoid arthritis are linked to an increased risk of insulin resistance, even among individuals of normal weight (Giles et al., 2010). Obesity compounds both inflammation and insulin resistance, leading to heightened pain sensitivity, impaired mobility, and further complicating weight management efforts. Chronic Pain and Stress Long-term pain conditions can elevate stress hormones, particularly cortisol, which promotes fat storage and worsens insulin resistance. The resultant decrease in physical activity due to pain can exacerbate weight gain, further diminishing insulin sensitivity (Maunganidze et al., 2022). Type 2 Diabetes Insulin resistance is a key factor in the development of type 2 diabetes. When left untreated, it can result in hyperglycaemia, fatigue, and systemic inflammation. However, targeted weight loss strategies—especially those focusing on dietary insulin load and increased physical activity—can significantly improve insulin sensitivity and even lead to remission of type 2 diabetes (Taylor & Holman, 2015). The Broader Impact of Insulin Resistance and Weight Gain

• Sleep: Linked to sleep apnoea, poor sleep quality, and chronic fatigue.

• Blood Pressure: A primary contributor to hypertension and cardiovascular risk.

• Mental Health: Associated with mood alterations, depression, and reduced psychological resilience (Milaneschi et al., 2019).

• Relationships & Quality of Life: Impacts self-esteem, intimacy, motivation, and role functioning, particularly in the context of pain or hormonal health. What We Do at Downscale Health At Downscale Health, we adopt a root-cause approach, offering personalised plans that address the metabolic drivers of weight gain—including insulin resistance. Our comprehensive support includes dietary guidance, evidence-based pharmacological interventions, psychological coaching, and sustainable activity programs. We aim to foster lasting behaviour change and improve overall health, transcending the mere numbers on a scale. If you’ve been advised to simply “eat less and move more” without success, rest assured that it’s not a reflection of your efforts. The science indicates that weight management is a complex issue—and effective treatment is available. References:

1. Nazar BP, Pinna C, Pszczolkowski C, et al. Clinical and neurobiological relationships between ADHD and obesity: a systematic review. Rev Bras Psiquiatr. 2016;38(2):167–178.

2. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome) revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981–1030.

3. Davis SR, Castelo-Branco C, Chedraui P, et al. Understanding weight gain at menopause: the role of hormones, metabolic changes, and lifestyle. Climacteric. 2012;15(5):419–429.

4. Giles JT, Allison M, Blumenthal RS, et al. Abdominal adiposity in rheumatoid arthritis: association with cardiometabolic risk and disease characteristics. Arthritis Rheum. 2010;62(11):3173–3182.

5. Maunganidze F, Reventlow S, Maree JE. How patients experience weight-related issues in chronic pain: a qualitative meta-synthesis. J Clin Nurs. 2022;31(9–10):1158–1171.

6. Taylor R, Holman RR. Normal weight individuals with type 2 diabetes: the forgotten minority. BMJ. 2015;351:h4823.

7. Milaneschi Y, Simmons WK, van Rossum EFC, Penninx BWJH. Depression and obesity: evidence of shared biological mechanisms. Mol Psychiatry. 2019;24(1):18–33. This information is suitable for individuals experiencing ADHD, PCOS (now also known as PMOS — Polyendocrine Metabolic Ovarian Syndrome), chronic pain, menopause, type 2 diabetes, and those recovering postpartum. For tailored, evidence-based outcomes, contact us today at www.downscaleclinic.com.au or follow us on Instagram @downscalehealth.