Polycystic Ovary Syndrome and Weight Management

Lisa J Moran; Catherine B Lombard; Siew Lim; Manny Noakes; Helena J Teede

Women's Health. 2010;6(2):271-283.

Polycystic Ovary Syndrome & Lifestyle Modification

Given the strong association between obesity, abdominal obesity, insulin resistance and the features of PCOS, weight loss or prevention of excess weight gain is a logical initial treatment aim. The Androgen Excess PCOS Society (AEPCOS) statement on lifestyle modification in women with PCOS proposes lifestyle modification as the primary therapy in overweight and obese women with PCOS.^[32] Lifestyle intervention has been advocated as part of a targeted approach to the treatment of the clinical, reproductive and metabolic features of PCOS, to be used prior to or in combination with medical therapies (Figure 2). A number of short- to medium-term studies demonstrate that modest weight loss (5–10% of initial body weight) improves metabolic, reproductive and psychological features of PCOS, including hyperandrogenism, insulin resistance, dyslipidemia, glucose tolerance, menstrual function, ovulation, pregnancy, conception and quality of life.^[32,38–40] A multidisciplinary approach is being increasingly advocated and the benefits of exercise and behavioral interventions in PCOS have been demonstrated, both in combination with^[38–40] and independent of structured energy restriction.^[41,42] Despite these documented benefits, achieving and maintaining weight loss is an issue of increasing concern both for the general population and for women with PCOS.^[43] The AEPCOS position statement notes the issue of maximizing program compliance, retention and weight maintenance as crucial clinical and research questions.^[32] With regard to the comparative efficacy of dietary, exercise or combined integrated interventions, nonsignificant lower drop-out rates were reported for a combined diet and exercise intervention (40.6%) versus diet alone (53%) in women with PCOS.^[38] Similarly, nonsignificant higher drop-out rates were reported for a diet alone intervention (35%) compared with a structured exercise training program (15%) in women with PCOS,^[41] with similar levels of adherence to the diet or exercise programs. However, there are limited data examining these concepts. To date, the optimal intervention in order to maximize compliance and reduce attrition in young women with PCOS is unknown and requires further research.

(Enlarge Image)

Figure 2.

Summary of a targeted approach to lifestyle and medical therapy in polycystic ovary syndrome.
Anti-A: Antiandrogen; MF: Metformin; OCP: Oral contraceptive pill.
Adapted with permission from ^[111].

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Cite this: Polycystic Ovary Syndrome and Weight Management - Medscape - Mar 01, 2010.

Abstract and Introduction
Polycystic Ovary Syndrome
Obesity & Polycystic Ovary Syndrome
Polycystic Ovary Syndrome & Lifestyle Modification
Polycystic Ovary Syndrome & Potential Mechanisms of Barriers to Weight Management
Polycystic Ovary Syndrome & Dietary Treatment
Barriers to Obesity Management in Younger Women
Weight Management Strategies in Younger Women
Practical Implications for Weight Management in Younger Women
Conclusion
Future Perspective
References
Sidebar

Table 1. Trials of modification of dietary macronutrient composition in lifestyle programs and its impact on key features in overweight/obese women with polycystic ovary syndrome.
Author (year)	Subjects	Duration	Intervention	Weight change	Hormones, metabolism and reproduction	Ref.
Moran et al. (2003)	n = 28 BMI: 37.4	4 months (3 months ER, 1 month WM)	RCT; 12 weeks: 6000 kJ/day; 4 weeks: WMD; HP: 30% P, 40% C, 30% F; HC: 15% P, 55% C, 30% F	HP: −8.5 ± 1.1 kg vs LP: −6.9 ± 0.8 kg (NS)	All subjects: IR, TC, LDL-C, TG, total T ↓ SHBG ↑ and menstrual cyclicity improved; Diet comparison, postprandial glucose ↓ for HP, HDL-C ↓ ER for LP, TC/HDL-C ↓ ER for HP and FAI ↑ during WM for LP	^[44]
Stamets et al. (2004)	n = 26 BMI: 37–38	4 weeks	RCT; Energy deficit: 4200 kJ/day; HP: 30% P, 40% C, 30% F; HC: 15% P, 55% C, 30% F	HP: 3.7 ± 1.9 kg vs LP: 4.4 ± 1.5 kg (NS)	All subjects: IR, total T and free T ↓, SHBG ↑ and menstrual cyclicity improved	^[45]
Hays et al. (2003)	n = 15 BMI: 36.1	24 weeks	Uncontrolled intervention study; High saturated fat, low starch (very low C), 7200 kJ/day; No control group comparison	-14.3% BMI: −3.7	Insulin ↓	^[68]
Mavropoulos et al. (2006)	n = 5 BMI: 38.5	6 months	Uncontrolled intervention study; Ketogenic (<20 g C/day); No control group comparison	-5 kg, 12%	Insulin and free T ↓	^[69]
Moran et al. (2006)	n = 23 BMI: 35.4	2 months ER, 6 months WM	RCT; 2 months: meal replacements: all subjects; 6 months: high GL or low GL education	High GL: 5.9 ± 2.1 kg vs low GL: 4.4 ± 0.7 kg (NS)	All subjects: insulin, total T and FAI ↓, menstrual cyclicity improved	^[72]
Kasim-Karakas et al. (2009)	n = 33 BMI: 25–40	2 months	RCT; Energy reduction of 700 kcal/day and supplement with 240 kcal whey protein or simple sugar	Protein: 3.3 ± 0.8 kg vs simple sugar: 1.1 ± 0.6 kg	All subjects: no change in glucose, insulin, IR, HBA1c, triglyceride, hsCRP, T and SHBG; Diet comparison: greater ↓ fat mass, TC, HDL-C and ApoB for protein	^[71]

C: Carbohydrate; ER: Energy restriction; F: Fat; FAI: Free adrogen index; GL: Glycemic load; HBA1c: Glycosylated hemoglobin; HC: High carbohydrate; HDL-C: High-density lipoprotein cholesterol; HOM: Homeostasis assessment of insulin resistance; HP: High protein; hsCRP: Highly sensitive C reactive protein; IR: Insulin resistance; LDL-C: Low-density lipoprotein cholesterol; NS: Nonsignificant; P: Protein; RCT: Randomized controlled trial; SHBG: Sex hormone-binding globulin; T: Testosterone; TC: Total cholesterol; TG: Triglyceride; WM: Weight maintenance; WMD: Weight maintenance diet.
Adapted with permission from ^[32].

Box 1. Lifestyle modification principles suggested for obesity management in polycystic ovary syndrome.
Guidelines for dietary and lifestyle intervention in polycystic ovary syndrome Weight management through lifestyle modification combining behavioral, dietary and exercise management can be effective in improving reproductive function, as well as metabolic and psychological parameters. Reduced-energy diets (500–1000 kcal/day reduction) are effective options for weight loss and can reduce body weight by 7–10% over a period of 6–12 months. Dietary pattern should be nutritionally complete and appropriate for each life stage. A variety of approaches, including high carbohydrate diets, high dietary protein diets, low glycemic index or load diets, as well as meal replacements, may be successful for achieving and sustaining a reduced weight. The structure and support within a weight management program is crucial and may be more important than the dietary composition. Goal setting, weight monitoring and individualization of the program, intensive follow-up and monitoring by a physician and support from a physician, family, spouse or support from peers, may assist in improving successful outcomes. Lifestyle programs need to address issues such as self-esteem, managing stress, emotional eating and time constraints. Structured exercise is an important component of a weight loss regime.

Adapted with permission from ^[112].

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