Weight Reduction Through a Cognitive Behavioral Therapy Lifestyle Intervention in PCOS: The Primary Outcome of a Randomized Controlled Trial

Abstract

Objective Long‐term weight loss is important and difficult to achieve for many women with polycystic ovary syndrome (PCOS). Lifestyle interventions (LS) in PCOS have shown moderate short‐term effects. Three‐component LS that combine nutrition advice, exercise, and cognitive behavioral therapy have not been tested in long‐term interventions. Methods Women (N = 183) with PCOS who were trying to conceive and had BMI > 25 kg/m2 were assigned to 20 group sessions of cognitive behavioral therapy combined with nutrition advice and exercise (LS with or without Short Message Service [SMS] via mobile phone) or care as usual (CAU). Results More weight loss was observed in LS than in CAU (P < 0.001). Adding SMS was even more effective (P = 0.017). In CAU, 13 of 60 (21.8%) succeeded in achieving a 5% weight loss, as did 32 of 60 (52.8%) in LS without SMS and 54 of 63 (85.7%) in LS with SMS. The odds of achieving a 5% weight loss were 7.0 (P < 0.001) in LS compared with CAU. More than 18 of 60 (29.0%) of the women in CAU gained weight versus 5 of 60 (8.5%) and 2 of 63 (3.1%) in LS without or with SMS, respectively. The overall dropout rate was 116 of 183 (63.4%). Conclusions A three‐component LS program resulted in reasonable weight loss in women with PCOS. Adding SMS resulted in more weight loss.

Improvements in PCOS characteristics and phenotype severity during a randomized controlled lifestyle intervention

“…All three groups demonstrated favourable within-group changes regarding PCOS characteristics, although these were more profound within the lifestyle intervention groups compared to the CAU group. This is in line with the extent of weight loss per group (Jiskoot et al 2020).…”

“…However, achieving weight loss in women with PCOS is challenging, and previous lifestyle studies show modest reductions in weight (Moran et al 2011). In our study, moderate weight loss after 12 months was achieved in all groups, though more often in the lifestyle intervention groups (Jiskoot et al 2020). Hence, drastic and significant differences in improvements in PCOS characteristics and phenotype distribution between the groups cannot be expected knowing that some of these parameters respond slowly to interventions.…”

“…Given the fact that these are the results of changes in body weight of all three groups combined, indicates that the relation between weight loss and PCOS characteristics may be independent of the way how weight loss is achieved. Thus, weight loss should be the main advice in order to ameliorate the clinical phenotype of PCOS, and a long lasting threecomponent lifestyle intervention ultimately lead to more weight loss compared to other less strenuous interventions (Moran et al 2011, Teede et al 2018, Lim et al 2019, Jiskoot et al 2020). On the other hand, women with PCOS demonstrate an adverse body composition characterized by increased whole body fat relative to lean mass when compared with controls of similar BMI, which is associated with differences in metabolic dysfunction (Ezeh et al 2014).…”

“…Primary outcome measure results, from this three-component randomized controlled trial (RCT) regarding weight loss, showed that weight was statistically significantly more reduced in the LSI groups compared to the care as usual group. Within both lifestyle groups more weight loss was achieved compared to the control group (Jiskoot et al 2020).…”

Metabolic health during a randomized controlled lifestyle intervention in women with PCOS

“…Mean weight loss after 1 year was 7.87 kg in SMS+, 4.65 kg in SMS−, and 2.32 kg in CAU (within all groups, P < 0.001). The proportion of women who achieved >5% and >10% weight reduction was 85.7 and 45.9% within SMS+, 52.8 and 12.2% within SMS−, and 21.8 and 6.8% within CAU, respectively ( 32 ).

Figure 1 CONSORT flowchart.

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