Weight Management in Adolescents with Polycystic Ovary Syndrome

Abstract

Purpose of Review Polycystic ovary syndrome (PCOS) is a common condition that clinically presents during adolescence. PCOS is associated with increased rates of overweight and obesity, as well as higher rates of metabolic disease, especially type 2 diabetes. Weight loss decreases PCOS symptoms and risk for metabolic disease. The goal of this review is to evaluate recent studies describing the hormonal, metabolic, and weight effects of different weight loss strategies: dietary, physical activity, pharmacotherapy, bariatric surgery, mood modification, and sleep. Recent Findings Calorie restriction continues to be supported as the primary nutrition intervention to achieve weight loss in individuals with PCOS, and a dietary macronutrient composition with lower compared to higher glycemic carbohydrates may be more effective. There is limited data that vitamins, nutraceuticals, and probiotics may improve hormonal and metabolic outcomes. Most types of physical activity are effective in improving outcomes in PCOS and lowering weight. Whereas there are promising data on anti-obesity medications such as glucagon-like peptide-1 receptor agonists in adults with PCOS and adolescents with obesity, further work is needed to know if these therapies are effective in youth with PCOS. Research is lacking on the effectiveness of other anti-obesity medications in PCOS. Bariatric surgery is especially promising for decreasing weight in adults and youth, and reversing type 2 diabetes in youth, though PCOS data are lacking. Treatment of depression in adolescents with insulin resistance and women with PCOS is associated with improved weight loss. Adolescents with PCOS and obesity may have greater sleep-related risks including circadian misalignment and obstructive sleep apnea, interventions for which have not yet been conducted. Summary Clinical trials on weight loss strategies in adolescents with PCOS remain limited, with most information inferred from studies in women with PCOS or adolescents with obesity. However, there are multiple options to optimize weight loss in dietary, activity, pharmacotherapy, bariatric surgery, mood modification, and sleep domains.

Clinical review: Guide to pharmacological management in pediatric obesity medicine

“…AOMs approved by the FDA to treat the indication of obesity are used as an adjunct to ILT when ILT alone is insufficient. Few studies are available assessing newer AOMs on PCOS [ 66 ]. Metformin is used in patients with PCOS of any weight to improve ovarian insulin sensitivity and restore menstrual function.…”

Effects of GLP-1 on ovarian dysfunction in polycystic ovary syndrome: A protocol for systematic review and meta-analysis

“…[6] The recommended treatments for PCOS women, especially for PCOS patients with obesity, are lifestyle and nutrition interventions and weight loss. [7][8][9] The treatment approach to PCOS generally focuses on goals for fertility or ovulation, bothersome hirsutism, and the screening and modification of common metabolic derangements. [10] Reduction in body weight has been demonstrated to improve hyperandrogenism, reproductive function, and metabolic parameters such as hypertension, hyperlipidemia, and glycemic control in women with PCOS.…”