Reducing Obesity, Insulin Resistance May Improve PCOS-Related Outcomes

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Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine and metabolic diseases in women of childbearing age, but data that compare outcomes between obese and nonobese patients are scarce—something this study sought to remedy.

A new study from China has concluded that to improve outcomes among women with polycystic ovary syndrome (PCOS), reducing the incidence of obesity and insulin resistance may have positive effects on women with the condition. Findings of a comparison between obese and nonobese patients with PCOS appeared in a recent issue of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.

“More than half of PCOS patients are complicated with obesity, and women with PCOS have an increased risk of developing metabolic syndrome over the course of their lives,” the authors wrote. “There are few studies on the metabolism of non-obese PCOS patients, however.”

Their primary outcome was to uncover in-common factors that have an impact on the pathogenesis and progression of PCOS on which to base treatment plans for these individuals.


The 179 patients in the study, from the outpatient clinic of the Shengjing Hospital of the China Medical University, were selected for inclusion from April 2018 to October 2019 and divided into 4 groups, based on body mass index (BMI) and PCOS status:

  • Obese PCOS patients (OP group; n = 79)
  • Normal BMI PCOS patients (NP group; n = 40)
  • Obese non-PCOS patients (ON group; n = 30)
  • Normal BMI non-PCOS patients (NN group; n = 30)

Overall, in the obese PCOS group, the mean (SD) BMI was almost 40% higher vs the normal BMI PCOS group (30.55 [4.03] vs 21.99 [3.59] kg/m2), the waist-to-hip ratio (WHR) was 12% higher (0.94 [0.06] vs 0.84 [0.04]), and visceral fat area was close to double (149.53 [41.52] vs 75.63 [23.14]). Similar findings were seen between the obese non-PCOS and normal BMI non-PCOS groups, with those classified as obese having higher numbers in the 3 measurements.

These differences were considered statistically significant.

The investigators analysis also found the following:

  • Following a 12-hour fast and subsequent ingestion of 300 mL water containing 75 g glucose within 5 min:
    • Insulin release at 0, 60, 120, and 180 minutes and the free androgen index (FAI) were higher in the obese PCOS group vs the normal BMI PCOS group
    • Postprandial blood glucose measures at 0, 60, 120, and 180 minutes were higher in the normal-weight PCOS group vs the normal-weight non-PCOS group
  • Sex hormone binding globulin, luteinizing hormone, and luteinizing hormone/follicle stimulating hormone (LH/FSH) levels were lower in the normal BMI PCOS group
  • Triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and small dense low-density lipoprotein (sd-LDL) levels were higher in the obese PCOS group vs the normal BMI PCOS group
  • The insulin resistance index, LH, LH/FSH, and testosterone levels were higher in the normal-weight PCOS group than the normal-weight non-PCOS group
  • BMI and waist circumference had positive correlations with TC, TG, sd-LDL, LDL-C, and insulin measures at 0, 60, 120, and 180 minutes after fasting
  • The FAI had a positive correlation with the insulin resistance index in both PCOS groups
  • The insulin resistance index had a positive correlation with BMI, waist circumference, visceral fat area, and the FAI

The authors note their findings show endocrine metabolic disorders were more obvious in the women with PCOS vs those without, despite matching based on BMI; that abnormal glucose and lipid metabolism can have more serious implication among obese PCOS patients vs normal-weight PCOS patients; hyperinsulinemia affected both PCOS patient groups; and that the development and pathogenesis of PCOS may be influenced by insulin resistance.

“Therefore, reducing obesity and insulin resistance are important measures for the treatment of PCOS,” they concluded.


Shi W, Zhao Q, Zhao X, Xing C, He B. Analysis of endocrine and metabolic indexes in non-obese patients with polycystic ovary syndrome and its compare with obese patients. Diabetes Metab Syndr Obes. 2021;14:4275-4281. doi:10.2147/DMSO.S329108