Tri-component lifestyle intervention benefits women with PCOS

Audrey Abella
28 Jul 2021

A three-component lifestyle intervention (LSI) programme* was effective in improving the metabolic health and weight of reproductive-aged women with polycystic ovarian syndrome (PCOS), according to data presented at ESHRE 2021.

Given the obesity, weight gain, and metabolic syndrome (MetS) tied to PCOS, long-term weight loss programmes are advised for women with this condition. However, most programmes only offer short-term benefits, with most women regaining weight owing to low treatment adherence and high noncompletion rates.

As such, the team explored the benefits of a three-component LSI in 183 women (mean age 29.1 years, mean weight 92.5 kg) with PCOS who had a BMI of >25 kg/m2 and wished to conceive. Participants were randomized 1:1:1 to receive LSI (20 group sessions) with or without short-message service (SMS) support, or care-as-usual** (CAU) for a year.


Weight loss, MetS

While all interventions led to significant weight reductions at 1 year vs baseline (–2.32 [CAU] and –4.65 kg [LSI]), the biggest change was seen with LSI + SMS (–7.87 kg; p<0.001 for all). [ESHRE 2021, abstract O-162]

On post hoc analysis of pooled data from all arms, the changes in body weight percentage led to significant improvements in most*** metabolic parameters (p≤0.001), especially if more (ie, 10 percent) weight loss was achieved.

“[Our] results indicate that this three-component LSI programme … decreased the prevalence, and improved the severity, of MetS in overweight/obese women with PCOS … Aiming at a 5–10-percent weight loss should be recommended for all women with PCOS to improve metabolic health during their reproductive lifespan,” said Dr Alexandra Dietz de Loos from the Erasmus Medical Center, Rotterdam, the Netherlands.

“This, in turn, might decrease the chance of future cardiovascular disease,” she continued, adding that they will continue to explore the long-term effect of LSI.


Weight loss determinants

The odds of achieving a 5-percent weight loss was higher with LSI participation (odds ratio [OR], 4.9; p=0.001), particularly in women with amenorrhoea (OR, 7.4; p=0.006) and those with a higher tendency for restraint eating# (OR, 5.2; p=0.005) and external eating# (OR, 3.1; p=0.001). [ESHRE 2021, abstract O-159]

Conversely, the likelihood of achieving a 5-percent weight loss was lower among women with higher depression scores (OR, 0.55; p=0.013), higher baseline weight (OR, 0.47; p=0.003), and worse body image (OR, 0.23; p<0.001).

The various determinants underline the importance of screening prior to entering LSIs, said Geranne Jiskoot, also from Erasmus Medical Center. “[This] can help doctors personalize treatment for women with PCOS.”


The drawback: Dropouts

However, dropouts were high with LSI (OR, 4.4; p=0.002), which was “quite normal”, according to Jiskoot. “LSIs are quite intense for people. It takes a lot of time [and] energy. [But] for a certain group of people, this [could be] the right intervention.”

The chances of dropout was particularly high in women with higher androstenedione levels (OR, 1.2; p=0.026). “[A]ndrostenedione is associated with a more severe PCOS phenotype. Therefore, women with a more severe PCOS phenotype are more likely to drop out, [will have] more difficulty losing weight … [and may] be less successful in a lifestyle programme,” said Jiskoot.

Baseline weight also increased the likelihood of dropouts (OR, 1.0; p=0.006), potentially due to demotivation, said Jiskoot. Overweight/obese individuals may be inclined to think that their weight will only dim their chances of succeeding with the programme, hence their withdrawal from the programme.

The additional SMS also appeared to influence dropouts (OR, 4.3; p=0.002). “[Although] SMS … played an important role in weight loss … [the participants may] not really like it because the messages come at certain [times of the] day,” she explained.

Other factors that could have triggered the dropouts are personal issues that participants encounter while undergoing LSIs, or feelings of worry or lack of support.


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