Objective To determine the difference in efficacy between drug and bariatric surgery therapy for women with obesity and polycystic ovary syndrome (PCOS). Design Prospective non-randomized trial. Methods A total of 90 women aged 18–40 years with body mass index (BMI) ≥ 27.5 kg/m 2 and waist circumference ≥85 cm fulfilling the 2011 Chinese diagnostic criteria for PCOS were enrolled and 81 subjects completed this study. In the drug group, patients were administered metformin and an oral contraceptive containing ethinyl-estradiol and cyproterone acetate for the first 6 months, and metformin alone for the second 6 months. In the surgical group, patients underwent laparoscopic sleeve gastrectomies. The follow-up time was 12 months. The main outcome was set as the complete remission of PCOS requiring six consecutive regular menstruation or spontaneous pregnancy. Results Median BMI at endpoint was 30.1 kg/m 2 in the drug group and 23.7 kg/m 2 in the surgical group, complete remission rate was 15% and 78%, respectively. Except endpoint BMI, no difference was observed in free androgen index, ovarian morphology, homeostasis model assessment for insulin resistance, and total weight loss between remission and non-remission patients. Logistic regression analyses also revealed that the final BMI was the major factor influencing the remission of PCOS. The cut-off points of the final BMI were 27.5 kg/m 2 for the drug group and 26 kg/m 2 for the surgical group. Overall, nearly 95% of patients with an endpoint BMI below the cut-off values achieved complete remission. Conclusion Complete remission of PCOS in patients with obesity depends on the final BMI after weight loss. Thus, bariatric surgery should be prioritized for these patients.

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Objective This study aimed to investigate the expression of follistatin‐like 3 (FSTL3) in adipose tissue in individuals with overweight or obesity and to explore the role of FSTL3 in human adipocytes, as well as the relationship between serum FSTL3 levels and fat distribution and inflammation. Methods This study enrolled 236 individuals (171 with overweight or obesity; aged 18–67 years). Bulk transcriptome sequencing was performed on subcutaneous and visceral adipose tissue. The function of FSTL3 was studied in human adipocytes. Serum FSTL3 levels were measured using enzyme‐linked immunosorbent assay. Results Adipose FTSL3 expression was higher in individuals with overweight or obesity than in individuals with normal weight. FSTL3 was mainly expressed in mature adipocytes and stimulated by tumor necrosis factor alpha (TNFα). FSTL3 suppressed inflammatory responses in human adipocytes, whereas FSTL3 knockdown promoted inflammatory responses. Serum FSTL3 levels were correlated with adipose FTSL3 expression and obesity‐related indicators (all p < 0.05). Multiple linear regression analysis showed that serum FSTL3 levels were independently associated with the visceral fat area and serum TNFα levels (both p < 0.05). Conclusions FSTL3 was highly expressed in adipose tissue in individuals with overweight or obesity and could suppress adipocyte inflammation. Serum FSTL3 levels might be considered as a biomarker of visceral obesity and inflammation.