Obesity Management in Women with Polycystic Ovary Syndrome

Abstract

Obesity and insulin resistance play an important role in initiating or maintaining ill health in polycystic ovary syndrome (PCOS). This implies that treatment that reduces body weight and insulin resistance would alleviate the symptoms of PCOS. Lifestyle modification has been found to be effective in restoring reproductive function in up to 80% of individuals who achieve at least 5% weight loss. However, long-term weight maintenance is a challenge. This article provides a review of reduced glycemic load diets, including low glycemic index, very low carbohydrate, high-protein and high monounsaturated fat diets, on metabolic and reproductive health in PCOS and non-PCOS populations. Dietary trials in non-PCOS women suggest that higher-protein, reduced glycemic load diets were probably more beneficial than the conventional low-fat, high-carbohydrate diet but further studies are required to confirm this in PCOS women. Similarly, the optimal exercise regime for PCOS women remains to be investigated.Obesity & polycystic ovary syndrome Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions that affects obese and nonobese women during reproductive age. Its symptoms include irregular menses, infertility, acne and hirsutism (excessive hair growth). During pregnancy, PCOS probably also increases the risk of early miscarriages and complications such as pre-eclampsia and gestational diabetes [1]. As a result of these physical manifestations, women with PCOS tend to have poorer psychological health and lower quality of life [2]. Increasing evidence also suggests that women with PCOS may be at greater risk of developing metabolic diseases such as type 2 diabetes and cardiovascular disease in the long term [3,4].Owing to its heterogeneity, the diagnostic criteria for PCOS have been a contentious issue among experts. The 1990 National Institutes of Health (NIH) meeting defined PCOS as the coexistence of chronic anovulation and hyperandrogenism, with the exclusion of other diseases such as thyroid disorder, hyperprolactinemia, congenital adrenal hyperplasia, androgensecreting tumors and Cushing syndrome [5]. In 2003, this definition was broadened to include women with either hyperandrogenism or anovulation in addition to having polycystic ovaries. Using the previous NIH definition, the prevalence of PCOS was estimated to be 5-8% of women of reproductive age [6][7][8][9]. This number is estimated to increase by 65% using the latest revised diagnostic criteria [10]. Obesity & fat distribution in PCOS womenIt is estimated that 30-60% of women with PCOS are overweight or obese in the Western world [7,[11][12][13][14]. Some suggest that the prevalence of obesity is higher in PCOS women compared with healthy controls [7,15,16]. In a study involving 3094 women, Glueck and colleagues found that approximately 73-78% of women with PCOS aged between 20 and 41 years were obese (body mass index [BMI]>30 kg/m 2 ) compared with 7-14% in the general population [16]. In addition to being potentially predisposed to obesity,...

Effectiveness of Lifestyle Modification on Weightloss and Quality of Life in Obese Women With Polycystic Ovarian Syndrome

“…Women with PCOS are more likely to be overweight [2,3]. Some study suggests that prevalence of obese women is higher in PCOS women as compared with healthy controls [4]. PCOS women have an increased risk of metabolic disorder, Type 2 diabetics, impaired glucose tolerance, and cardiovascular diseases [1,2,5].…”

“…It is estimated that about 40-60% of PCOS women are obese or overweight with greater abdominal or visceral adiposity [1]. The presentation of obese PCOS women shows central obesity [4].…”

“…About 5% of weight loss show reduced insulin level, improve ovulatory functions, and also reduce serum testosterone [2]. Considering up to 80% of individuals who reduce at least 5-7% of weight loss show improvement in ovulation and menstrual cyclicity with metabolic improvements where lifestyle treatment should be the first-line treatment for PCOS and remains supplementary when additional treatment is introduced [4,9,10]. Obesity and insulin resistance play an important role in the pathogenesis of PCOS [4].…”

“…Considering up to 80% of individuals who reduce at least 5-7% of weight loss show improvement in ovulation and menstrual cyclicity with metabolic improvements where lifestyle treatment should be the first-line treatment for PCOS and remains supplementary when additional treatment is introduced [4,9,10]. Obesity and insulin resistance play an important role in the pathogenesis of PCOS [4]. This indirectly suggests that treatment that reduces body weight and increases insulin insensitivity can be beneficial for obese.…”

Mood disorders and quality of life in polycystic ovary syndrome

“…Multiple factors contribute to the high prevalence of depression and anxiety in women with PCOS. The most likely reason of psychological complications is physical symptoms experienced by patients with PCOS [11][12][13].…”