A scoping review exploring the biological barriers to successful weight management in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine condition in women of reproductive age, that has considerable reproductive, metabolic and psychological implications. Weight gain and obesity worsen the features of PCOS, and hence weight loss is a first line management strategy. Weight management strategies in women with PCOS should encompass multidisciplinary lifestyle interventions, comprising dietary, exercise and behavioural therapy. However, while effective lifestyle modification is a key component of PCOS management, evidence of higher longitudinal weight gain in community populations [1] and high attrition rates in clinical dietary interventions [2], suggests that women with PCOS experience challenges with weight management. There are a number of potential physiological reasons unique to women with PCOS that may explain these difficulties with weight management. Appetite regulation has been reported to be impaired in women with PCOS, with studies showing increased postprandial hunger and abnormal regulation of appetite hormones, including ghrelin and cholecystokinin [3,4]. Women with PCOS also appear to have higher metabolic inflexibility (reduced metabolic capability to switch from lipid oxidation in fasting conditions to lipid availability in glucose rich conditions) [5], which leads to increased lipid accumulation in visceral tissues [6]. While there is accumulating evidence suggesting that abnormalities in appetite regulation and energy metabolism may contribute to difficulties with weight management in PCOS, to our knowledge no single review has attempted to identify all of the possible biological predispositions to weight gain in this population. The primary aim of this scoping review is to examine the extent and range of research undertaken to evaluate biological barriers to weight management in women with PCOS. 1. Teede HJ, Joham AE, Paul E, Moran LJ, Loxton D, Jolley D, Lombard C. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity. 2013 Aug;21(8):1526-32. 2. Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2019(3). 3. Moran LJ, Noakes M, Clifton PM, Wittert GA, Tomlinson L, Galletly C, Luscombe ND, Norman RJ. Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. The Journal of Clinical Endocrinology & Metabolism. 2004 Jul 1;89(7):3337-44. 4. Linden Hirschberg A, Naessen S, Stridsberg M, Byström B, Holte J. Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome. Gynecological endocrinology. 2004 Aug 1;19(2):79-87. 5. Rimmer M, Tan BK, Teede H, Thangaratinam S, H. Al Wattar B. Metabolic inflexibility in women with polycystic ovary syndrome: a systematic review. Gynecological Endocrinology. 2020 Jun 2;36(6):501-7. 6. Galgani JE, Moro C, Ravussin E. Metabolic flexibility and insulin resistance. American journal of physiology-endocrinology and metabolism. 2008 Nov;295(5):E1009-17.