Dr Sarah McLean-Orsborn's Groundbreaking Reflection on PCOS and Body Image

Dr Sarah McLean-Orsborn, a Pacific Studies lecturer at the University of Auckland (UoA), has published a poignant autoethnographic paper titled An apology to my body: Mapping the changing relationship with my fat body, a reflection on childhood & PCOS in the journal Fat Studies. Released in December 2025, this work offers a deeply personal exploration of living with Polycystic Ovary Syndrome (PCOS), a common hormonal disorder affecting reproductive-aged women. As a Sāmoan-New Zealander with Chinese, Croatian, and Scottish heritage, McLean-Orsborn draws from her lived experience to challenge conventional medical narratives around weight, dieting, and health, advocating for body sovereignty particularly among Pacific women.

The paper stems from her 2009 PCOS diagnosis, delivered by an older white male doctor who warned of Type 2 diabetes and blindness risks, prompting years of restrictive dieting like the Special K and Atkins diets. These interventions, amid a lack of tailored data for Pacific women in Aotearoa New Zealand, fostered body discomfort and self-blame. Today, McLean-Orsborn celebrates her body's resilience, using the publication to apologize for past harms and promote self-compassion.

This UoA contribution aligns with the university's commitment to Pacific-led research, highlighted at the upcoming International Women's Day seminar on March 9, 2026, at Fale Pasifika, under the theme 'Give to Gain.' Supported by Fofonga – Pacific Research Excellence, it underscores UoA's role in advancing culturally grounded women's health studies.

Understanding PCOS: Prevalence and Challenges in New Zealand

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder characterized by irregular periods, excess androgens (male hormones), and polycystic ovaries on ultrasound. Globally, it impacts 5-18% of women, with New Zealand estimates around 6-15%. Limited local data persists, but studies show Māori and Pacific women face heightened risks: higher obesity rates, insulin resistance, and lipid abnormalities compared to European women.

In Auckland clinics, Māori and Pacific PCOS patients present with worse metabolic profiles. Insulin resistance, a core PCOS feature, exacerbates Type 2 diabetes risk—prevalent at 10.1% among Pacific peoples versus 4.3% Europeans. Hirsutism (excess hair) affects up to 70%, acne 35%, and infertility 75% of cases, compounding physical and emotional burdens.

For Pacific women, socio-economic inequities amplify these issues. McLean-Orsborn notes data gaps hinder targeted care, perpetuating scaremongering over holistic support. UoA's ABI researches women's pelvic floor and breast health, complementing such insights.

The Intertwined Impact of PCOS on Body Image and Mental Health

PCOS profoundly affects body image, with women reporting lower appearance evaluation, body satisfaction, and higher weight concerns. Meta-analyses confirm greater body image distress (BID) in PCOS versus controls, mediating anxiety and depression. Up to 84% show pathological BID scores.

• Hirsutism leads to avoidance behaviors, reducing quality of life.
• Weight gain (average 5-10kg excess) fuels self-stigma, despite PCOS not solely caused by lifestyle.
• Mental health: 3x depression risk, 2x anxiety; eating disorders in 20-40%.

In NZ, Pacific women's cultural body ideals clash with Western thinness norms, intensifying distress. International guidelines (2023) recommend BID screening, yet implementation lags. McLean-Orsborn's paper critiques this, linking BID to broader psychological distress.

A Personal Journey: From Blame to Body Sovereignty

McLean-Orsborn recounts her teenage diagnosis amid family concern, leading to calorie-counting and fad diets. 'This paper is an apology to the body I once blamed, disciplined and doubted,' she writes. Diets failed; her body grew in size and wisdom.

Autoethnography maps relational shifts: childhood fatphobia, medical trauma, to embracing 'Health at Every Size' (HAES). HAES emphasizes intuitive eating, joyful movement, rejecting weight bias—proven to improve metabolic health without dieting.

Pacific worldview informs this: Tui Atua's harmony via self-reflection yields wisdom over labels. Her narrative counters 'fix' narratives, honoring fat, disabled, grieving bodies.

Photo by Niranjan Lamichhane on Unsplash

Critiquing Restrictive Dieting and Medical Stigma in PCOS Care

Restrictive dieting, standard PCOS advice, worsens outcomes: yo-yo cycling increases insulin resistance. Evidence favors lifestyle balance over weight loss; 5-10% reduction aids fertility, but shame hinders adherence.

McLean-Orsborn highlights practitioner bias: scaremongering ignores Pacific contexts. NZ guidelines stress multidisciplinary care, yet mental health integration is rare.

Solutions: Screen for BID/eating disorders; promote HAES; culturally safe care. UoA's Pacific health focus addresses inequities.

Pacific Women, PCOS, and Cultural Resilience at UoA

Pacific women in NZ bear disproportionate PCOS burden: obesity prevalence 70-80% vs 30% Europeans. Yet resilience shines—fa'aSāmoa values body generosity.

McLean-Orsborn's work centers Pacific experiences, urging self-recognition amid biomedical dominance. UoA's Centre for Pacific Studies fosters this via partnerships like Fofonga.

Related research: Pacific youth mental health, grief; aligns with ABI women's health.

UoA's Leadership in Women's Health and Body Positivity Research

UoA pioneers PCOS-adjacent fields: ABI on pelvic floor disorders (affecting 25% post-partum); gender bias critiques harming women's diagnostics.

Body positivity gains traction; McLean-Orsborn's paper advances fat studies, rare in NZ academia. Complements PCOS Research NZ network.

Impacts: Informs policy, training; IWD seminar amplifies reach.

Actionable Insights: Supporting PCOS Journeys in Aotearoa

• Seek multidisciplinary care: endocrinologist, psychologist, dietitian.
• Embrace HAES: focus joyful movement, intuitive eating.
• Screen mental health; join support like PCOS Challenge.
• Advocate data collection for Pacific/Māori women.
• For academics: integrate lived experience in research.

Explore careers in health research via higher-ed-jobs.

Photo by Gaurav Kumar on Unsplash

Future Outlook: Transforming PCOS Care Through Pacific-Led Scholarship

McLean-Orsborn's paper signals shift: from pathology to sovereignty. With rising PCOS awareness (global doubling), UoA leads culturally attuned solutions.

Upcoming: seminar fosters dialogue; potential guidelines influence. Pacific scholars drive equity, aligning with UoA's strategic goals.

Optimism: Our stories carry knowledge—empowering healthier futures.

In conclusion, this UoA publication illuminates PCOS-body image nexus, urging compassion. Check Rate My Professor for insights, explore career advice, or browse higher ed jobs in health. For NZ opportunities, visit NZ jobs.