Polycystic ovary syndrome in women with severe obesity - effects of a 12-month weight loss intervention

Abstract

Background: Polycystic ovary syndrome (PCOS) affects one out of eight women and is associated with reproductive, metabolic, and psychiatric features. There is a strong association with obesity but studies on PCOS in women with severe and morbid obesity are lacking. Aim: To estimate the prevalence of PCOS in women with severe obesity (body mass index [BMI] ³ 35 kg/m2), and to compare hormonal and metabolic features, anxiety and depression, health-related quality of life (HRQoL), energy intake, physical activity, and eating behavior by PCOS diagnosis and evaluate the effects of a 12-month weight loss intervention. Methods: Participants with severe obesity were recruited from the obesity unit at Sahlgrenska University Hospital where they had been referred for weight loss treatment. Participants were divided into groups by PCOS-status, diagnosed with the National Institutes of Health-criteria, and assessed with clinical examination and questionnaires at baseline and after a 12-month weight-loss intervention. Results: PCOS was present in 25.6% (n=63/246). Participants with PCOS had higher androgen levels, lower low-density lipo-protein cholesterol (LDL-C) and lower total cholesterol compared to women without PCOS. Groups did not differ in the prevalence of metabolic syndrome, symptoms of anxiety and depression, HRQoL, energy intake, or physical activity at baseline. Those with PCOS had higher cognitive restraint eating behavior at baseline. Anti-müllerian hormone (AMH) was higher in those with PCOS, but due to low sensitivity and specificity it was not possible to use AMH as a discriminator between women with and without PCOS. Over the course of the 12-month weight loss intervention, 70% (n=174) of participants dropped out leaving 72 women for follow up (PCOS n=16, non-PCOS n=56). Both groups lost weight (PCOS -12.5 ± 9.3 kg p <0.001; non-PCOS -14.0 ± 12.5 kg p <0.001), with no difference between groups. In women without PCOS, weight loss was associated with lower androgens, insulin and blood lipids, less symptoms of anxiety and depression and higher mental HRQoL. Further, those without PCOS reported reduced energy intake, and changed eating behavior. From baseline to follow-up, in comparison between the two groups, women without PCOS reported larger increase in cognitive restraint than those with PCOS and larger reduction in carbohydrates and sugars compared to women with PCOS, whereas women with PCOS reported larger reduction in fat intake. Conclusion: In this unique cohort of women with severe obesity, PCOS was present in one out of four. AMH could not be used as a single surrogate marker of the syndrome. Before obesity treatment, women with PCOS had more conscious control regarding eating. Importantly, using a structured weight loss intervention, those with PCOS lost weight to the same extent as women without PCOS. Comparing groups regarding change from baseline, there were no major discernible differences except that women without PCOS changed more in eating behavior with more cognitive restraint towards a behavior more favorable for further weight loss.