Other strengths were the usage of validated questionnaires and the structured weight loss intervention with regular check‐up visits, as well as the long follow‐up time of 12 months. This seems contradictory but could be explained by the fact that more unfavorable behaviors for weight loss at baseline give room for larger behavioral changes during the intervention. These results indicate that cognitive restraint eating can favor weight loss, whereas uncontrolled eating can be a barrier to weight loss. Uncontrolled eating correlated positively with energy intake in women without PCOS, whereas this correlation was not evident in women with PCOS. In women with PCOS, self‐reported energy intake did not decrease significantly; however, a reduction in E% fat was found. Moreover, the number of ovarian follicles was reported in six studies, among which five studies reported a significant reduction in the number of ovarian follicles after lifestyle intervention compared to the status prior to the intervention. This study analyzed the reproductive, anthropometric, androgenic, and metabolic indices to confirm the effects of the lifestyle modification program in PCOS patients with obesity. Hence, this study aimed to present an updated paper to confirm the effectiveness of lifestyle modification programs in the management of PCOS patients with obesity and confirm the effect of lifestyle modification programs on improving reproductive function for the first time. Obesity is one of the most common concerns among patients with PCOS. The application of the Rotterdam criteria for the diagnosis of adult women with PCOS was approved by international evidence-based guidelines. The diagnosis and management of PCOS is a challenging endeavor because it is a mysterious condition with major symptoms that vary with age, and the treatment should be tailored to meet the specific requirements of each patient . Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility and endocrine disorders and affects approximately 8–13% of reproductive age women 1,2. This scenario warrants further studies with larger sample sizes to develop ideal treatment protocols. Meta-analysis revealed no significant differences between exenatide and metformin in terms of anthropometric, biochemical hyperandrogenism, or metabolic outcomes, except that metformin resulted in a greater reduction in fasting blood glucose compared to exenatide . A recent systematic review, encompassing studies published up to July 2022, identified eight trials evaluating the efficacy of GLP-1RAs in women with PCOS. Lastly, STEP 5 demonstrated the durability of weight loss with semaglutide, maintaining a 12.6% point reduction over placebo at two years . Researchers at the University of Oxford comprehensively searched several scientific research databases for RCTs from database inception until June 2024 comparing interventions aiming to reduce weight against usual care or low-intensity weight-loss interventions in people with PCOS. Collaborating with healthcare professionals ensures a comprehensive plan that addresses hormonal imbalances and insulin resistance. Personalized strategies, such as low-glycemic diets and strength training, have shown promising results in Singaporean case studies. Additionally, existing studies often lack long-term follow-up data, raising concerns about the sustainability of weight loss and metabolic benefits over time. Current interventions recommended for women with PCOS are not effective in reducing metabolic morbidity in this group. As women with PCOS demonstrate a significantly higher prevalence of overweight, obesity and central obesity, the risk of metabolic morbidity is exacerbated . The health benefits of weight loss programmes are reported to last for up to 5 years after the end of the programme . More recent studies demonstrate the efficacy of semaglutide in obese women with PCOS, providing insights into both immediate and sustained weight management. Adherence to the diet was defined by the percentage of energy supplied from carbohydrates, protein, and fat.These appointments included weight assessments and support for both dietary modifications and increased physical activity.In addition, resistance exercise improves insulin sensitivity by increasing muscle mass, and aerobic exercise improves glucose disposal by increasing glycogen synthase activity 34,35.Studies of both IWMPs and GLP-1 RAs report an average weight loss of 5% for up to 5 years following cessation of treatment.The aforementioned result is concurrent with the updated international evidence-based guidelines that recommend a healthy lifestyle involving a healthy diet and regular physical activity for the management of patients with PCOS .This review evaluates the effects of various weight loss interventions on reproductive, hormonal, and metabolic outcomes in overweight or obese women with PCOS.Additionally, existing studies often lack long-term follow-up data, raising concerns about the sustainability of weight loss and metabolic benefits over time. However, it may be necessary to achieve at least a 16% weight loss or more for improvements in conditions such as non-alcoholic fatty liver and symptoms of obstructive sleep apnoea . Studies of both IWMPs and GLP-1 RAs report an average weight loss of 5% for up to 5 years following cessation of treatment. However, despite an inherently higher risk of metabolic morbidity, there is a notable absence of research focused on the application of IWMPs specifically for women with PCOS. While cardiometabolic improvements reverted toward baseline, reductions in free testosterone levels persisted, indicating some lasting benefits of the intervention . What dietary strategies help with PCOS weight loss? A variety of balanced dietary approaches to reduce dietary caloric intake and a gradual increase in physical activity are recommended to accomplish weight loss . Non-surgical weight loss tools, a comprehensive support system, and lifestyle coaching work together to help patients improve their health and achieve their weight loss goals. Knowing that even modest weight loss following dietary intervention can lead to improving quality of life may cause to maintain motivation in obese women to follow weight loss programs. The results of other interventional studies documented such associations and reported that weight reduction had a greater impact on the physical than mental dimensions of HRQOL 41, 42. Regarding the inclusion criteria used by the studies, 21 included overweight or obese subjects who were included on the basis of the value of BMI, among which, ten, five, and three studies used BMI values of 25, 27, and 30, respectively. This study used the Cochrane Risk of Bias tool (RoB) and the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) to evaluate randomized control trials (RCTs) and other studies. Furthermore, the type of intervention; specific components of the intervention program; and duration, frequency, and time of day with reference to the implementation of intervention were recorded as the characteristics pertaining to the intervention program, that is, lifestyle modification. It is relevant to note that both of these studies included women with a mean BMI ranging from overweight to obesity but not severe obesity.10, 25 Thus, the result of the present study is supported by the study of Basar et al.,25 which shows that cognitive restraint eating behavior is more prevalent in women with severe obesity and PCOS compared to women with severe obesity without PCOS. Correlations between physical activity, dietary intake, and eating behavior at baseline with a 12‐months weight change in women with severe obesity with and without PCOS. This study aimed to assess eating behavior and lifestyle factors in women with severe obesity (BMI ≥35 kg/m2), with and without PCOS, and the effect of weight loss on these behaviors. In most previous studies, weight loss was the outcome of dietary intervention, and sample size estimation was based on weight reduction whereas the outcome of the present intervention was HRQOL and the sample size calculation was based on the change in HRQOL scores. Among the mental aspects of HRQOL, the significant improvement due to weight loss occurred in the domain of vitality in both groups, findings are consistent with studies that reported the vitality aspect of HRQOL is sensitive to weight reduction .Our study has several strengths. Despite this review, we found that weight loss after dietary intervention had a positive effect on the physical aspects of HRQOL and vitality. A population-based study revealed at least 5–10% weight loss was related to improved HRQOL .We demonstrated that the greatest improvement occurred in the physical function of HRQOL.This result may be related to the negative effect of obesity on mobility and musculoskeletal disorders . Anthropometric assessments, dietary intake, physical activity levels, and HRQOL scores were compared at baseline and 24 weeks with intervention. Among non-randomized studies, seven out of 17 studies had a high risk of attrition bias related to incomplete outcome data. Considering the geographic distribution, nine studies were published in Europe, seven in North America, five in Oceania, two in Asia, and one each in Africa and the Middle East. Among the 25 articles included in the current systematic review, eight were RCTs and 17 were non-randomized clinical trials or observational studies. A summary of the characteristics of these studies is presented in Table 1. We demonstrated that the greatest improvement occurred in the physical function of HRQOL. Furthermore, at baseline, women participating in that trial had high scores of HRQOL so there was little room for enhancement . We matched our participants for BMI and age, factors influencing the HRQOL. We used the SF-36 questionnaire that was previously validated for Iranian women. This guide explores 12 evidence-based methods to address weight management challenges linked to PCOS. This condition often leads to irregular menstrual cycles, insulin resistance, and challenges in managing body weight. Comparative analysis in accordance with the type of intervention requires the establishment of a standardized study design. Hence, the current study performed a subgroup analysis according to the improvement in fasting insulin level or lack of the same. This study found higher levels of cognitive restraint eating behavior in women with severe obesity and PCOS. At baseline, there was no difference in self‐reported energy intake, macronutrients or micronutrients, or physical activity levels between women with and without PCOS (Table 1). Conversely, women without PCOS reported reductions in uncontrolled eating and emotional eating and increased cognitive restraint eating compared to baseline (Table 2). Metabolic morbidity in this subgroup of women however continues to be significant, bringing into question the effectiveness of the interventions in routine clinical care. The interventions are delivered at various tiers of the health service and the choice of intervention depends on body mass index (BMI) and the presence of co-morbidities. Insulin sensitivity and body weight are two key modifiable risk factors for metabolic morbidity in women with PCOS 1, 5, 6. In dietary interventions, the beneficial effect of weight loss on subscales of generic HRQL varied across the studies. This study aimed to compare the impact of weight loss following a 24-week dietary intervention on HRQOL in obese women with and without PCOS. In this prospective study of women with severe obesity, those with PCOS reported higher conscious control regarding eating than women without PCOS, a behavior correlated with lower self‐reported energy intake irrespective of PCOS status. Those dropping out of weight loss studies tend to be those who lose less weight during the intervention or those who are younger than 50 years,40 as women were in this study. Previous studies showed no difference in weight loss after a low‐fat diet compared to a low‐carbohydrate diet,34 and indeed, the two groups in the present study did not differ in weight loss. Data Availability Statement Thus, understanding and verifying the metabolic effects of lifestyle modification among PCOS patients with obesity is important from the perspective of management. Among the studies that divided the subjects into groups according to the degree of weight loss and compared the results, two studies 25,32 observed a significant reduction in insulin levels in the group that lost more than 5% of body weight. Moreover, 9 of the 12 studies reported a significant reduction in body weight after lifestyle intervention. In addition, in reference to the variation in parameters before and after lifestyle modification, 7 of 11 studies reported a significant decrease in BMI after lifestyle intervention compared to the situation before intervention, while four studies did not report any statistically significant difference. Furthermore, in reference to the variation in parameters before and after lifestyle modification, four of six studies reported a significant reduction in the fasting glucose level after lifestyle intervention compared to the level prior to the intervention. First, the sample size of the studies included in the review was not adequate. Because a meta-analysis was not possible due to the lack of a sufficient number of studies, further studies are required to improve the level of evidence on the subject. No significant change was observed in the group that lost less than 5% of body weight. 34% of participants who initially achieved remission of T2D continuing to remain in remission, underlining the program’s long-term effectiveness in metabolic health improvement 18,19,20.Counseling regarding physical activity was given during the whole treatment period and was individualized in relation to the preferences of the participants.Studies show that low-glycemic diets can reduce insulin levels by 22% in individuals with PCOS.This study found higher levels of cognitive restraint eating behavior in women with severe obesity and PCOS.Previous studies have employed lifestyle interventions to manage anovulatory infertility and endocrine disorders.Amongst other factors discussed earlier, adequate uptake of interventions remains a significant barrier to treatment effectiveness.A review article including 20 studies revealed significant improvement in physical aspects rather than mental health components after weight reduction, however, they mainly included research on HRQOL due to surgical interventions rather than dietary interventions .Personalized treatment approaches that consider metabolic, reproductive, and psychological factors may also improve outcomes for individuals with PCOS. The Nutritionist IV software was used to calculate the energy and nutrient intake of each food item. Adherence to the diet was defined by the percentage of energy supplied from carbohydrates, protein, and fat. Each participant received a personalized food menu based on eating habits and energy requirements. With their proven expertise in weight loss, they can provide the guidance and support you need to reach your goals effectively. The rate and extent of improvement depend on various factors, including the amount of weight lost, individual metabolic factors, and the specific symptoms experienced. Both Suture Sculpt endoscopic sleeve gastroplasty (ESG) and the Orbera gastric balloon are minimally invasive weight loss procedures that have been proven to offer significant weight loss results. One study went on to report that many women seeking to become pregnant naturally conceived after the restoration of their menstrual cycle. For individuals with PCOS, incorporating movement into daily life is essential for hormonal balance and overall health. Regular physical activity is a cornerstone of managing PCOS symptoms effectively. This is particularly beneficial for individuals with PCOS, who often have slower metabolic rates. It also has a higher thermic effect compared to carbs and fats, meaning the body burns more calories digesting it. Dietary intake was assessed with a validated semi‐quantitative Food Frequency Questionnaire (FFQ) and covered habitual dietary intake over the last 3 months when completing the FFQ.20 Energy and nutrient calculations were done with the food database from the Swedish Food Agency.21 To address these disparities, future clinical trials should focus on tailored approaches that incorporate behavioral therapy, patient-centered service models, and culturally sensitive interventions. Furthermore, efforts should be made to enhance study diversity by including participants from various ethnic and socioeconomic backgrounds, ensuring findings are broadly applicable. The variability in intervention protocols across studies complicates direct comparisons, reducing the ability to establish standardized clinical guidelines. Despite the promising potential of IWMPs and GLP-1 RAs in managing metabolic morbidity in women with PCOS, several limitations must be acknowledged. Four health centers were randomly selected from the centers affiliated with SBUMS. World Health Organization declared the prevalence of obesity has doubled since 1980 . The incidence of PCOS in Iranian women based on criteria of the National Institute of Health (NIH), Rotterdam, and the Androgen Excess Society (AES) were 7.1%, 14.6%, and 11.7%, respectively . The characteristic features of PCOS encompassing hirsutism, oligomenorrhoea, and obesity impair quality of life . Polycystic ovary syndrome (PCOS) is a complicated endocrine disorder with widespread symptoms that reduce women’s quality of life. Moreover, this is the first study to report the effects of lifestyle modifications on reproductive function. Forest plot for the meta-analysis of improvements in reproductive function according to the degree of weight loss. Forest plot for the meta-analysis of lifestyle modification, compared to controls. Summary estimates of individual studies were synthesized by meta-analysis when the results of two or more studies were reported using the same subindex. Regarding the criteria used to diagnose PCOS, eight studies employed the Rotterdam diagnostic criteria, one study used the National Institutes of Health diagnostic criteria, and one study employed both. Avoiding specific items can help reduce inflammation, balance hormones, and improve overall health. Professional guidance can provide personalized strategies to manage stress and improve mental health effectively. "Group mindfulness sessions increase adherence by 65%, making it easier to incorporate stress management into daily life." Most studies found that most patients were successful in achieving a significantly lower BMI about 12 months after their bariatric surgery. As part of your weight loss plan, you will receive support from a team of professionals that will help monitor your progress, make adjustments if necessary, and keep you on track. The Batash Endoscopic Weight Loss Center in NYC can create a customized weight loss plan that considers your PCOS diagnosis. In severe obesity, women with PCOS have more conscious control over their eating than those without PCOS. In women with severe obesity (BMI ≥35 kg/m2), those with PCOS have more conscious control of eating (higher cognitive restraint eating behavior). The knowledge regarding eating behavior and disorders in women with polycystic ovary syndrome (PCOS) and severe obesity is limited. This study is published in Annals of Internal Medicine. We would like to thank all the people who contribute to the completion of the study. No datasets were generated or analysed during the current study. Future studies should focus on optimizing combination strategies to enhance treatment efficacy. Lifestyle modification is the first-line intervention for polycystic ovary syndrome (PCOS). Exercise and Physical Activity for PCOS Comparisons between groups were made with independent samples t‐test for weight loss and energy intake, and Mann–Whitney U‐test physical activity and eating behavior. Energy intake, eating behavior, and physical activity for all women at 12 months in relation to two weight change categories. The diagnostic procedure for PCOS has been described in detail earlier.15 Subsequently, before the start of treatment and at 12 months, patients underwent anthropometric assessments and laboratory sampling and responded to self‐administered questionnaires regarding eating behavior, dietary intake, and physical activity. While these interventions have demonstrated benefits for weight loss and metabolic improvement, challenges remain, including variability in patient uptake, adherence, and long-term sustainability. However, unlike IWMPs, GLP1-RAs have been trialled specifically in women with PCOS and reported to induce weight loss and improve markers of metabolic morbidity . Energy intake, eating behavior, and physical activity for all women at 12 months in relation to two weight change categories.To evaluate long‐term effects of weight loss intervention on eating behavior, longer follow‐up studies regarding eating behavior after weight loss intervention is warranted in women with severe obesity and PCOS.Another study reported that four of the six (66.7%) patients in the intervention group displayed ovulation, whereas the same was observed in only one of the six (16.7%) patients in the control group.Thus, an optimal weight management strategy to reduce metabolic morbidity in the specific subgroup of women with PCOS is lacking.The diagnostic procedure for PCOS has been described in detail earlier.15 Subsequently, before the start of treatment and at 12 months, patients underwent anthropometric assessments and laboratory sampling and responded to self‐administered questionnaires regarding eating behavior, dietary intake, and physical activity.Previous studies have shown that a high BMI causes metabolic abnormalities in patients with PCOS, such as increased insulin resistance and exacerbation of hyperandrogenemia .Current interventions recommended for women with PCOS are not effective in reducing metabolic morbidity in this group.Collaborating with healthcare professionals ensures a comprehensive plan that addresses hormonal imbalances and insulin resistance.Study exclusion criteria included pregnancy, breastfeeding, using lipid-lowering agents, insulin-sensitizing drugs, contraceptive drugs, special diets or exercise for weight loss, and antipsychotic or hormonal medications during the previous 6 months. Weight Loss: A Powerful Option For Treating PCOS It is evident that BMI wouldn’t be the isolated definitive factor to deteriorate the HQOL in PCOS women, regarding those studies comparing HRQOL between women with PCOS and controls, showed various aspects of HRQOL were worsened in PCOS women 32, 33. The mean percentage change in HRQOL regarding weight loss classification is illustrated in Table 5. With trivial exceptions, mean percentage changes in HRQOL were lower in women with PCOS compared to non-PCOS women, however, the percentage change comparison between groups was not statistically significant. A total of 25 studies were included in the present systematic review after the selection process based on the aforementioned inclusion and exclusion criteria (Figure 1). Of the 3093 studies, 3012 studies were excluded by screening the titles and abstracts, followed by 56 studies from the full-text review. Publication bias could not be evaluated owing to the inadequate number of studies included in the meta-analysis. Categorical variables are presented as percentages and the Chi-square test was used to compare among study groups. The IPAQ guideline was used to assess physical activity which scores Met level of 8 for vigorous, 4 for moderate intensity, and 3.3 for walking. This questionnaire consists of 7 items about vigorous, moderate physical activity, and walking time during the previous week . How Insulin Resistance Affects Weight Alterations in eating behavior after intervention, characterized by reductions in uncontrolled eating, emotional eating, and increased cognitive restraint eating, and behaviors in favor of weight loss, were exclusively observed in women without PCOS.Olive oil, a staple of the Mediterranean diet, decreases inflammation markers by 30%.When cells fail to respond to insulin, the pancreas produces more of it, leading to higher insulin levels in the blood.One of the primary reasons weight management is difficult with PCOS is insulin resistance.Combination therapy with diet and exercise resulted in improved fasting insulin levels, compared to monotherapy with diet or exercise.A population-based study revealed at least 5–10% weight loss was related to improved HRQOL .We demonstrated that the greatest improvement occurred in the physical function of HRQOL.This result may be related to the negative effect of obesity on mobility and musculoskeletal disorders .This scenario warrants further studies with larger sample sizes to develop ideal treatment protocols.The incorporation of behavioural therapy into any weight management strategy has shown promise .In contrast, the intervention induced alterations in eating behavior among women without PCOS that may be favorable for further weight loss or the maintenance of achieved weight loss. The participants were requested to complete the short form of the International Physical Activity Questionnaire (IPAQ) every 4 weeks. It has been validated for use in assessing health-related quality of life in Iran . The Short Form Health Survey (SF-36) is a widely known tool to measure health concepts . Body mass index (BMI) was estimated by dividing weight in kilograms by the square of the height in meters. Therapeutic strategies such as time-restricted eating, which has been linked to improvements in mitochondrial function through epigenetic modifications, may hold promise as adjunct treatments for metabolic dysfunction in PCOS patients. Another notable gap is the insufficient engagement of patients in the design and implementation of weight management programs, which may impact adherence and long-term success. Insulin sensitisers such as metformin improve insulin sensitivity but have minimal impact on weight loss 52,53,54. Up to 75% of lean PCOS women and as high as 95% of obese PCOS women are reported to have insulin resistance . Weight regain is seen as a major hurdle to sustainability of most interventions and research highlights the value of concomitant behavioural treatment for successful weight maintenance. The current results regarding the effect of lifestyle modification alone, without any additional treatment, on the reproductive index are expected to offer encouragement for patients regarding their chances of conception due to the fact that PCOS patients often have concerns about fertility . Lifestyle modification plays an important role in the improvement of reproductive outcomes in PCOS patients with obesity. Furthermore, the subgroup analysis revealed that combination therapy with diet and exercise had better effects on metabolic and androgenic parameters than monotherapy. The main finding of the present review is that the group that underwent lifestyle modifications displayed significant improvement in reproductive function compared to the control group. Why is weight loss difficult with PCOS? However, no significant differences were found between the groups in emotional eating or uncontrolled eating (Table 1). Between‐group comparisons of women with and without PCOS were conducted using a Student's t‐test for normally distributed variables or Mann–Whitney U‐test for skewed variables, adjusting for age with an analysis of covariance (ANCOVA). Dietary advice within the framework of an energy‐reduced diet included more foods with low energy density, eg vegetables, fruits, and foods with high satiation effects, eg whole‐grain cereals. IPAQ is a validated questionnaire with nine items, measuring recalled physical activity during the last 7 days with information on the time spent walking, activities of vigorous or moderate intensity, and sedentary activity/sitting. Unlike our findings, a randomized control trial demonstrated that weight reduction had no significant positive effect on subscales of HRQOL, a difference that may be related to participants’ age in the latter study, the mean age of participants was 60 years old. In PCOS women the lowest scores were reported on the mental health, vitality, and role emotional domains of the SF-36 (Table 3). Of these participants, 105 women with PCOS and 111 without PCOS completed a 24-week hypocaloric LGI diet. All participants were trained to record their daily dietary intake by a qualified nutritionist. All the study procedures were performed in accordance with the principles of the Declaration of Helsinki. FS contributed to the study design and execution, data analysis, manuscript drafting, and critical discussion. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. This result may be related to the negative effect of obesity on mobility and musculoskeletal disorders . The sample size was relatively small, and the study’s findings are limited by its single ethnic focus, potentially affecting the generalisability of the results to all South Asian populations. Conducted among South Asians in the UK, the RCT utilized a randomized control design and an expanded observational cohort to assess both the immediate and delayed effects of the intervention. Diabetes remission was achieved by 61% of the intervention group, significantly surpassing the 12% in the control group. This was followed by 8 weeks of structured food reintroduction and 31 weeks of supported weight maintenance. The inclusion criteria were age (between 18 and 40 years), BMI between 26 − 38 kg/m2, ability to read and write, and weight stability for 3 months before the intervention. Participants with a confirmed diagnosis of PCOS (cases) were selected from the Reproductive Endocrinology Research Center of SBUMS and controls were recruited from among women who attended health centers for their routine gynecological exams. Finally, a total of 286 women, including 140 with PCOS and 146 BMI and age-matched controls without PCOS, agreed to participate in the study. Our findings are contrary to those studies reporting no independent association between PCOS and reduced general HRQOL . In both groups, the greatest improvement was in the physical function of HRQOL; however, the percentage change comparison between groups was not statistically significant. In controls, the HRQOL improved significantly in all dimensions of physical HRQOL, PCS, and vitality. In the PCOS group, we noticed a significant enhancement in mean scores of PF, GH, RP, VT, and PCS at six months of intervention. Moreover, moderate weight loss (a minimum of 5%) resulted in an improved metabolic index. Combination therapy with diet and exercise resulted in improved fasting insulin levels, compared to monotherapy with diet or exercise. PCOS affects how your body processes insulin, which can make weight loss more challenging. The pathogenesis of PCOS has not been fully clarified and includes genetics, obesity, and insulin resistance (IR). These methods, combined with a consistent lifestyle, pave the way for sustainable results. Effective management of PCOS requires a holistic approach tailored to individual needs. For more insights on managing PCOS through diet, visit this comprehensive resource. Most participants achieved weight reductions of 5–9.9% (59% for the PCOS group and 49.5% for the non-PCOS group). The mean weight reduction is 5.1 ± 2.7 kg for PCOS women and 5.79 ± 3.36 kg for non-PCOS women. After the intervention, physical activity levels did not differ significantly in either of the two groups (Table 2). It is a self-reported measure of physical activity that is appropriate for evaluating population levels of physical activity . & Vahidi, S. The effects of weight loss on health-related quality of life in obese women with PCOS and controls. Among the mental aspects of HRQOL, the significant improvement due to weight loss occurred in the domain of vitality in both groups, findings are consistent with studies that reported the vitality aspect of HRQOL is sensitive to weight reduction . Furthermore, at baseline, women participating in that trial had high scores of HRQOL so there was little room for enhancement .In both groups, a remarkable improvement in HRQOL was reported with regard to aspects of PF, RP, GH, VT, and PCS in participants who had lost ≥ 5% of their initial weight. Similar to our findings, a recent study demonstrated weight loss had similar positive changes in the HRQOL of women with and without PCOS . This study aimed to investigate self‐reported eating behavior, energy intake, and physical activity before and after a 12‐month weight loss intervention in a cohort of women with severe obesity, with and without PCOS, and to compare the results within and between the two groups. Eating behavior, dietary intake, and physical activity in women with severe obesity with and without PCOS at baseline and after a 12‐month weight loss intervention. It is necessary to recommend healthy lifestyle modifications, including dietary interventions to reduce caloric intake and regular exercise, for obese women with PCOS. These findings indicate that weight loss interventions may be an effective tool for PCOS management in applied clinical settings, and clinicians could use these results to counsel patients with PCOS on the improvements in PCOS markers after weight loss and direct them towards appropriate interventions. Interventions included behavioral interventions (diet or physical activity), current or previously licensed weight loss pharmacotherapy (or those which share a class-effect), bariatric surgery, or combinations of such interventions. This review evaluates the effects of various weight loss interventions on reproductive, hormonal, and metabolic outcomes in overweight or obese women with PCOS. Moreover, the current study performed subgroup analyses based on the type of intervention and degree of weight loss in order to identify the ideal intervention in such patients. Getting help from an expert like Dr. Steven Batash can provide women with PCOS relief from their symptoms through sustainable weight loss.This broader approach enabled us to explore the implementation and effectiveness of these interventions across diverse populations with a primary focus on assessing metabolic morbidity outcomes.Forest plot for the meta-analysis of improvements in reproductive function according to the degree of weight loss.Currently, evidence on the impact of these interventions on pregnancy rates and long-term reproductive outcomes in overweight or obese women with PCOS is limited.This review highlights the potential role of interventions such as IWMPs and GLP-1 RAs in managing these risks but acknowledges the limited robust evidence specific to women with PCOS.IWMPs incorporate total diet replacement with structured food reintroduction and GLP-1 RAs work by appetite suppression, slower gastric emptying, and effects on glucagon and insulin metabolism.Despite this review, we found that weight loss after dietary intervention had a positive effect on the physical aspects of HRQOL and vitality.These changes not only support weight loss but also enhance overall well-being. Protein plays a vital role in managing PCOS symptoms and supporting metabolic health. Studies show that low-glycemic diets reduce insulin levels by up to 22% in individuals with PCOS. These diets focus on foods that release glucose slowly, helping to stabilize blood sugar levels and improve insulin sensitivity. Studies show that low-glycemic diets can reduce insulin levels by 22% in individuals with PCOS. Therefore, compared to those trials, this study had greater power to detect enhancement in HRQOL. In the non-PCOS group, with greater weight loss, an increasing tendency to improve the mental aspects of HRQOL was noted. In both groups, the percentage change in HRQOL scores was related to the amount of weight loss. We noted that after six months of dietary intervention, both groups had a noticeable improvement in HRQOL. To assess physical activity, the short version of the International Physical Activity Questionnaire (IPAQ)22 was used. Raw scores were transformed into scaled scores of 1–100, where higher scores for each subscale indicate greater emotional eating, greater cognitive restraint eating, and greater emotional eating characteristics. Body height, weight, and waist circumference were measured according to standard protocol at baseline and at 12 months. The same questionnaires were completed by the participants at both baseline and follow‐up. Besides impacting individual health and quality of life, the management of metabolic morbidity has a significant economic impact for the health and social care service and a wider economic impact on society. Women with PCOS face unique metabolic challenges, including heightened insulin resistance, compounded by obesity. While there is limited data specifically targeting PCOS, emerging studies suggest GLP-1 RAs can improve weight, insulin sensitivity, and menstrual regularity in this group. A 1‐year weight loss program resulted in clinically significant weight loss in both groups but did not elicit discernible effects on eating behavior in women with PCOS. Additionally, self‐reported dietary intake is another limitation, where participants may tend to both under‐report and mis‐report dietary intake. In women without PCOS, sedentary behavior/sitting time and uncontrolled eating were negatively correlated with weight loss; thus, the higher the baseline sedentary behavior/sitting time and uncontrolled eating, the greater the weight loss at 12 months. The reason why women with PCOS, in the present study, showed no change in cognitive restraint eating while women without PCOS did could be explained by the limited number of participants at follow‐up, resulting in a potential lack of statistical power. Therefore, the aim of this study is to compare the effect of weight loss following the hypocaloric low glycemic index (LGI) diet on HRQOL in women with and without PCOS. Some studies have reported improvements in PCS and MCS following dietary interventions , while others have found improvements in various subscales of HRQOL 21,22,23,24. Current evidence regarding the impact of dietary weight loss interventions to change generic HRQOL among the general population is scarce and inconsistent as some trials show improvements while others do not. Anthropometric assessments, dietary intake, physical activity levels, and HRQOL scores, according to the Iranian version of SF-36, were compared at baseline and 24 weeks with intervention. 3.2. Effectiveness of Lifestyle Modification according to the Degree of Weight Loss It consists of eight domains; physical functioning (PF), role limitation due to physical problem (RP), bodily pain (BP), general health perception (GH), vitality (VT), social functioning (SF), role limitation due to the emotional problem (RE) and mental health (MH). Once every two weeks, counseling visits were provided to participants to teach them how to record daily food intake. A list of high Glycemic Index foods was prepared and the participants were prohibited from eating any high GI items. Lifestyle modification is recommended as the primary treatment for weight management in PCOS patients with obesity . Increased body weight and insulin resistance are the underlying causes of symptoms in PCOS patients with obesity. Previous studies have shown that a high BMI causes metabolic abnormalities in patients with PCOS, such as increased insulin resistance and exacerbation of hyperandrogenemia . Moreover, it has been reported that the risk of obesity is four times higher among patients with PCOS than among healthy controls . His expertise in obesity management can help identify and address the underlying causes of obesity with a combination of innovative solutions and personalized programs. The question then becomes, "Is there such a thing as an effective PCOS weight loss plan?" The answer is yes! Anyone who has tried to lose weight can understand how frustratingly challenging it can be, but for women with PCOS, it is even more of an uphill battle. Because a meta-analysis was not possible due to the lack of a sufficient number of studies, further studies are required to improve the level of evidence on the subject.In addition, this study performed a subgroup analysis according to the type of intervention and degree of weight loss.The tools used for the assessment of the risk of bias were contingent upon the study design.For individuals with PCOS, incorporating movement into daily life is essential for hormonal balance and overall health.Eating behavior domains at baseline in women with severe obesity with and without PCOS.Additionally, patients with PCOS may benefit from weight loss medications such as Semaglutide which help reduce appetite, increase feelings of fullness, and improve insulin sensitivity.Studies show that low-glycemic diets reduce insulin levels by up to 22% in individuals with PCOS.The prevalence of BED in the general population ranges from 1%–2% to 14%–19% in populations with severe obesity,27 which is in line with our results. In addition, resistance exercise improves insulin sensitivity by increasing muscle mass, and aerobic exercise improves glucose disposal by increasing glycogen synthase activity 34,35. This study performed a meta-analysis of data pertaining to improvements in reproductive function (Figure 5). Forest plot for the meta-analysis of combination therapy, compared to monotherapy. This study performed a meta-analysis of the data pertaining to the anthropometric indices of BMI and WC (Figure 4). Among the studies included in the present review, reproductive indices were used to assess the outcomes and report the results of 24 studies (Table 3). Comparisons between groups were made with independent samples t‐test for weight loss and energy intake, and Mann–Whitney U‐test physical activity and eating behavior.Furthermore, the subgroup analysis revealed that combination therapy with diet and exercise had better effects on metabolic and androgenic parameters than monotherapy.Considering the abovementioned results, it is assumed that moderate weight loss (minimum of 5%) might be effective in improving the metabolic index.FS contributed to the study design and execution, data analysis, manuscript drafting, and critical discussion.The pathogenesis of PCOS has not been fully clarified and includes genetics, obesity, and insulin resistance (IR).Lifestyle modification using combination therapy is a promising therapeutic approach that can be employed in the management of PCOS patients with obesity.This is particularly beneficial for individuals with PCOS, who often have slower metabolic rates. Access this article Currently there is insufficient patient involvement in creation of service models that would enable adequate uptake of interventions and matching of service models to patient needs . Amongst other factors discussed earlier, adequate uptake of interventions remains a significant barrier to treatment effectiveness. The incorporation of behavioural therapy into any weight management strategy has shown promise . A calorie-restricted diet has been mainly used to achieve weight loss in PCOS patients with obesity, and several studies have confirmed the effects of symptomatic improvement along with weight loss . The aforementioned result is concurrent with the updated international evidence-based guidelines that recommend a healthy lifestyle involving a healthy diet and regular physical activity for the management of patients with PCOS . Although the results of dietary interventions suggest that the percentage of weight loss achieved by both the PCOS women and non-PCOS women are the same, it is not clear if obese PCOS women experience the same improved HRQOL after weight loss. Moreover, most studies about the influence of weight loss on HRQOL have focused on combined obesity treatments including anti-obesity medications combined with dietary intervention or bariatric surgery, and conducted in Western countries. The study’s retrospective design and the variable duration of follow-up among participants pose limitations, potentially introducing bias and affecting the generalisability of the results 23, 24. Weight regain was inversely related to initial weight loss and participant age, and directly related to the follow-up duration. Out of 78 participants, initial weight dropped significantly from 144 ± 26 kg to 121.2 ± 24 kg, but some weight was regained by the third and fourth years, stabilizing at a moderate net loss of 4.7 kg to 7.0 kg from baseline. This randomized controlled trial (RCT), conducted in the UK, included an 8-week TDR phase, followed by a 4-week food reintroduction and ongoing behavioural support for weight management. In contrast, the intervention induced alterations in eating behavior among women without PCOS that may be favorable for further weight loss or the maintenance of achieved weight loss. High drop‐out rates are common in weight loss interventions, and this study falls within the upper interval, possibly caused by the follow‐up time of the study. Alterations in eating behavior after intervention, characterized by reductions in uncontrolled eating, emotional eating, and increased cognitive restraint eating, and behaviors in favor of weight loss, were exclusively observed in women without PCOS. However, the present study shows that they respond to a weight loss treatment as well as women without PCOS, and this information may be used in discussions with women with PCOS and obesity. In addition, recent reviews have reported that the effect of lifestyle interventions on an oral glucose tolerance test is uncertain 7,36. The results reported by previous studies regarding the effects of lifestyle modifications on the metabolic index have been controversial. Hence, this scenario warrants the development of an optimal intervention for the management of PCOS patients with obesity. Moreover, there was no significant difference between the two interventions with regard to weight loss, and both resulted in adequate weight loss. The Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET) trial provides further evidence for the efficacy of structured interventions using the IWMP Cambridge Weight Plan. Our objective was to evaluate the effects of IWMPs and GLP-1 RAs on weight loss and markers of metabolic morbidity in women with PCOS combining results from published literature. They may be effective for weight loss and reducing metabolic morbidity in women with PCOS at lower thresholds. Thus, an optimal weight management strategy to reduce metabolic morbidity in the specific subgroup of women with PCOS is lacking. Among the five studies that compared the group that underwent lifestyle intervention programs with the control group , one study assessed and reported fasting insulin levels. Conversely, previous studies have reported ambiguous results regarding the variation in metabolic indicators after lifestyle interventions among patients with PCOS . A review article including 20 studies revealed significant improvement in physical aspects rather than mental health components after weight reduction, however, they mainly included research on HRQOL due to surgical interventions rather than dietary interventions . To the best of our knowledge, this is the first study among Iranian women that compared the impact of dietary weight loss intervention on HRQOL between women with and without PCOS. The announcement of the weight loss project, the conditions for its implementation, and the information of the principal investigator were posted on the notice boards of the selected clinics and the Reproductive Endocrinology Research Center. HRQoL is a multidimensional concept that includes an individual’s own evaluation of physical, mental, social, and other aspects of health . Current evidence suggests obesity has a mutual association with PCOS and can deteriorate clinical, reproductive, metabolic, and psychological features of PCOS . Previous studies have employed lifestyle interventions to manage anovulatory infertility and endocrine disorders. Contact us today and set up a consultation to learn more about how we can work together to create a plan for sustainable weight loss to improve your health and your metabolic symptoms related to PCOS. Additionally, patients with PCOS may benefit from weight loss medications such as Semaglutide which help reduce appetite, increase feelings of fullness, and improve insulin sensitivity. It does not involve a fad, crash diet, or surgery but rather ongoing lifestyle changes that help you achieve sustainable weight loss. While not all individuals with PCOS are obese, there is a higher prevalence of overweight and obesity among women with PCOS compared to the general population.