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Cited by 58Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, Diet

Weight management interventions in women with and without PCOS: a systematic review

Open access
Kataoka, Josefin, Tassone, Eliza, Misso, Marie, Joham, Anju, Stener-Victorin, Elisabet, Teede, Helena, Moran, Lisa·2017·Nutrients
DOI 10.3390/nu9090996PMC PMC5622756
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Abstract

Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women associated with reproductive, metabolic and psychological features. While weight management is recommended as first-line treatment, it is unclear if women with PCOS achieve similar benefits as women without PCOS. This systematic review thus aimed to compare the efficacy of weight management interventions in women with and without PCOS. Databases were searched until May 2017. The primary outcome was weight and anthropometric, reproductive, metabolic and psychological measures were secondary outcomes. Of 3264 articles identified, 14 studies involving n = 933 (n = 9 high and n = 5 moderate risk of bias) met the inclusion criteria. No statistically significant differences in weight or weight loss following the intervention were found between women with and without PCOS in five studies, with the remaining studies not comparing the difference in weight or weight loss between these groups. Secondary outcomes did not differ significantly between the two groups. This review identified that there is a paucity of high quality research in this area and that more rigorous research is needed.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review compared weight management interventions in women with and without PCOS and found insufficient evidence of significant differences in weight loss or most secondary outcomes. It included 14 studies in 933 women, but most had moderate-to-high risk of bias and heterogeneity precluded meta-analysis.

Key findings

  • Of 3264 articles identified, 14 studies involving n = 933 met inclusion criteria; 9 had high risk of bias and 5 had moderate risk of bias. Five studies found no statistically significant difference in weight or weight loss between women with and without PCOS, while the remaining studies did not compare or report the between-group difference.
  • Secondary outcomes generally did not differ significantly between groups. Exceptions included one diet study reporting double the number of ovulatory events in women without PCOS compared with women with PCOS; one high-risk bariatric surgery study reporting lower post-surgery BMI in women with PCOS (p = 0.013); and one Orlistat + hypocaloric diet + exercise study reporting significant post-intervention differences in total testosterone, FAI (p = 0.021), and total, LDL and HDL cholesterol, though baseline differences were also present.
  • The review concluded there is insufficient evidence to indicate significant differences in weight loss in women with PCOS compared with women without PCOS using lifestyle or weight management strategies, and the relative efficacy of different weight management interventions could not be determined.

Methods

  • Systematic review conducted according to PRISMA; databases searched via OVID (MEDLINE, EMBASE, PsycINFO, EBM Reviews) and CINAHL Plus up to May 2017, limited to English-language articles with no year limits.
  • Included comparative/parallel studies that compared women with PCOS to women without PCOS following a weight management intervention; primary outcome was weight management, with secondary anthropometric, reproductive, metabolic and psychological outcomes.
  • Data were double-extracted and risk of bias assessed using a priori cohort-study criteria; due to clinical heterogeneity, no meta-analysis was performed and results were presented narratively and in tables.

Limitations

  • Stated by the authors: clinical heterogeneity prevented statistical combination of results; the review was limited to English-language studies; many included studies did not report numeric between-group differences; included studies had moderate-to-high risk of bias, were generally small with significant drop-outs, and many did not strictly exclude PCOS in controls; the review was not prospectively registered on PROSPERO; and authors were not contacted for missing data.
  • Evident from the text: only 14 studies were included, interventions varied widely (diet, behaviour change, Metformin, anti-obesity drugs, bariatric surgery, exercise), and many outcomes lacked reported p-values, limiting comparability and certainty.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/nu9090996

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    All included studies were comparative/parallel design.

    “All studies were comparative/parallel design.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In both studies reporting a significant post-intervention total testosterone difference, women with PCOS had statistically significantly higher levels of testosterone at baseline than women without PCOS.

    “However, as expected in both studies, the women with PCOS had statistically significantly higher levels of testosterone at baseline than women without PCOS.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Only one study reported a p-value for the between-group difference in fasting insulin following the interventions (p = 0.58).

    “Only one of these studies reported a p-value for the between-group difference following the interventions (p = 0.58) [44] (Table 4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Kogure, 2016, Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome, Med. Sci. Sports Exerc. source

      Not checked in the free run.

  • Findingcitation

    Only one study reported a non-statistically significant difference in waist circumference between groups following progressive resistance training.

    “The majority of studies did not compare between-group differences after the interventions, with only one study reporting a non-statistically significant difference in WC between groups following progressive resistance training [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Kogure, 2016, Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome, Med. Sci. Sports Exerc. source

      Not checked in the free run.

  • Findingcitation

    One study with a diet intervention reported double the number of ovulatory events in women without PCOS compared to women with PCOS, which was statistically significant.

    “One study with a diet intervention [34] reported double the number of ovulatory events in women without PCOS compared to women with PCOS, which was statistically significant (Table 3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Moran, 2007, C-reactive protein before and after weight loss in overweight women with and without polycystic ovary syndrome, J. Clin. Endocrinol. Metab. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 19
  • May combine two claims. 28
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Two studies were designed as randomized controlled studies but comprised two intervention groups and were used as comparative studies.

    “Two were designed as randomized controlled studies (RCTs) but comprised two intervention groups, respectively, and were used as comparative studies [38,39].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] Pasquali, 2000, Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome, J. Clin. Endocrinol. Metab. source

      Not checked in the free run.

    • cites [39] Toscani, 2011, Effect of high-protein or normal-protein diet on weight loss, body composition, hormone, and metabolic profile in southern Brazilian women with polycystic ovary syndrome: A randomized study, Gynecol. Endocrinol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The sample size of the included studies varied from 31 to 1016.

    “The sample size of the studies varied from 31 to 1016.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    One study with a hypocaloric diet + an anti-obesity drug intervention (Orlistat), and another study with an anti-obesity drug intervention (Orlistat) + a hypocaloric diet + exercise intervention, reported a statistically significant difference in total testosterone following intervention between the two study groups, with the non-PCOS group having lower values in both studies.

    “One study with a hypocaloric diet + an anti-obesity drug intervention (Orlistat) [30], and another study with an anti-obesity drug intervention (Orlistat) + a hypocaloric diet + exercise intervention [35] reported a statistically significant difference in total testosterone following intervention between the two study groups, with the non-PCOS group having lower values in both studies (Table 3).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] Katsikis, 2007, Effect of long-term orlistat treatment on serum levels of advanced glycation end-products in women with polycystic ovary syndrome, Clin. Endocrinol. source

      Not checked in the free run.

    • cites [35] Panidis, 2014, The role of orlistat combined with lifestyle changes in the management of overweight and obese patients with polycystic ovary syndrome, Clin. Endocrinol. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    One study with a hypocaloric diet + anti-obesity drug (Orlistat) intervention reported a statistically significant difference in SHBG between groups (p < 0.05) following the intervention; however, there was also a statistically significant difference in SHBG at baseline between the groups (p < 0.05).

    “One study with a hypocaloric diet + anti-obesity drug (Orlistat) intervention [30] reported a statistically significant difference between groups (p < 0.05) following the intervention; however, there was also a statistically significant difference in SHBG at baseline between the groups (p < 0.05).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Katsikis, 2007, Effect of long-term orlistat treatment on serum levels of advanced glycation end-products in women with polycystic ovary syndrome, Clin. Endocrinol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All included studies reported baseline and endpoint values, except for two studies that reported the difference from baseline to post-intervention.

    “All studies reported baseline and endpoint values, except for two studies that reported the difference from baseline to post-intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Interventions varied across the included studies (diet, diet + behavior change program, diet + Metformin, diet + anti-obesity drug, anti-obesity drug, diet + anti-obesity drug + exercise, bariatric surgery, and various exercise training programs), as did the duration of interventions.

    “Interventions varied across the included studies (diet, diet + behavior change program, diet + Metformin, diet + anti-obesity drug, anti-obesity drug, diet + anti-obesity drug + exercise, bariatric surgery, and various exercise training programs), as did the duration of interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    One study reported a statistically significant difference in BMI following bariatric surgery (p = 0.013), with women with PCOS having a lower BMI post-surgery than women without PCOS.

    “One study reported a statistically significant difference in BMI following bariatric surgery (p = 0.013), with women with PCOS having a lower BMI post-surgery than women without PCOS [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Bhandari, 2016, Effect of sleeve gastrectomy bariatric surgery-induced weight loss on serum AMH levels in reproductive aged women, Gynecol. Endocrinol. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Five included studies had a moderate risk of bias, whilst nine had a high risk of bias.

    “Five studies had a moderate risk of bias, whilst nine studies had a high risk of bias (Supplementary Table S4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The search returned 3264 articles.

    “The search returned 3264 articles (Figure 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For a limited number of outcomes, there was a statistically significant difference in these measures at study completion, but this difference was also present at baseline.

    “While for a limited number of outcomes, there was a statistically significant difference in these measures at study completion, this difference was also present at baseline indicating that examining the within-group change from baseline to the end of the intervention would be more appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The study reporting a significant BMI difference after bariatric surgery had a high risk of bias, with a number of key elements of the study protocol not reported.

    “This study, however, had a high risk of bias, with a number of key elements of the study protocol not reported and should therefore be interpreted with caution.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Five of the studies reported that the difference in weight post-intervention or the change in weight from baseline between the PCOS and non-PCOS groups was not statistically significantly different, while the remainder of studies did not report a p-value.

    “Five of the studies reported that the difference in weight post-intervention or the change in weight from baseline between the PCOS and non-PCOS groups was not statistically significantly different, whilst the remainder of studies did not report a p-value.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Three studies reported a non-statistically significant difference in BMI between the two groups, while eight studies did not report a p-value.

    “Three studies reported a non-statistically significant difference in BMI between the two groups, whilst eight studies did not report a p-value.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    One study with an anti-obesity drug intervention (Orlistat) + a hypocaloric diet + exercise intervention reported a statistically significant difference in FAI values post intervention between groups (p = 0.021), with women in the non-PCOS group having a lower mean value.

    “Five studies reported FAI [31,33,35,40,44], with one study with an anti-obesity drug intervention (Orlistat) + a hypocaloric diet + exercise intervention [35] reporting a statistically significant difference in values post intervention between groups (p = 0.021), with women in the non-PCOS group having a lower mean value (Table 3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Panidis, 2014, The role of orlistat combined with lifestyle changes in the management of overweight and obese patients with polycystic ovary syndrome, Clin. Endocrinol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Nine studies were designed with the specific aim of weight loss, while the remaining five studies did not state if the aim was weight loss.

    “Nine studies were designed with the specific aim of weight loss [34,37,38,39,41,42,43,45,46], while the remaining five studies did not state if the aim was weight loss [30,31,33,40,44].”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    It was not possible in this review to determine the relative effectiveness of specific dietary or non-dietary weight management interventions, or of different types of weight management interventions, in women with and without PCOS.

    “Here, it was not possible to determine the relative effectiveness of specific dietary or non-dietary interventions.”
    • Also stated in: § 5. Conclusions · plain
      “We cannot determine the relative efficacy of different types of weight management interventions and note considerable limitations with the current studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The included studies are set in a research environment, with structured interventions, isocaloric intake and frequent contact and interaction with trained professionals.

    “The included studies are set in a research environment, with structured interventions, isocaloric intake and frequent contact and interaction with trained professionals.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    This is the first systematic review comparing the effectiveness of weight management strategies in women with and without PCOS.

    “We report on the first systematic review comparing the effectiveness of weight management strategies in women with and without PCOS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Methodological quality (risk of bias) of the included studies was assessed by two reviewers using criteria developed a priori designed for cohort studies.

    “Methodological quality, in terms of risk of bias, of the included studies was assessed by two reviewers (J.K. and E.C.T.) in consultation with experienced reviewers (M.M. and L.J.M.) using criteria developed a priori [29], designed for cohort studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Wells, G.A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2017, September 07). The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Available online: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The detailed PICO framework was established a priori.

    “The detailed PICO (Population, Intervention, Comparison, Outcome) framework in Supplementary Table S1, established a priori, was used to include and exclude articles for this systematic review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Obesity, especially central obesity, worsens the clinical and biochemical presentation of PCOS, contributing to insulin resistance, hyperandrogenism, reproductive disorders, diabetes and cardiovascular disease.

    “Obesity, especially central obesity, worsens the clinical and biochemical presentation of the syndrome, contributing to IR, hyperandrogenism, reproductive disorders, diabetes and cardiovascular disease [18,19,20].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] Balen, 1995, Polycystic ovary syndrome: The spectrum of the disorder in 1741 patients, Hum. Reprod. source

      Not checked in the free run.

    • cites [19] Kiddy, 1990, Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: An analysis of 263 consecutive cases, Clin. Endocrinol. (Oxf.) source

      Not checked in the free run.

    • cites [20] Hart, 2015, The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage, J. Clin. Endocrinol. Metab. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Double data extraction was conducted by two independent reviewers.

    “Double data extraction, according to the selection criteria described in Table S1 was conducted by two independent reviewers for the original search (J.K. and A.J.) and by two independent reviewers for the updated search (A.J. and E.C.T.).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Women with PCOS appear to have a higher rate of weight gain and a higher prevalence of overweight, obesity and central obesity compared to women without PCOS.

    “Women with PCOS appear to have a higher rate of weight gain and a higher prevalence of overweight, obesity and central obesity, compared to women without PCOS [15,16,17].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] Lim, 2012, Overweight, obesity and central obesity in women with polycystic ovary syndrome: A systematic review and meta-analysis, Hum. Reprod. Update source

      Not checked in the free run.

    • cites [16] Yildiz, 2012, Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria, Hum. Reprod. source

      Not checked in the free run.

    • cites [17] Teede, 2013, Longitudinal weight gain in women identified with polycystic ovary syndrome: Results of an observational study in young women, Obesity source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This systematic review was conducted in accordance with the PRISMA Statement checklist.

    “This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement checklist [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Publication bias could not be assessed due to the lack of meta-analysis.

    “Publication bias could not be assessed due to the lack of meta-analysis as this requires a meta-analysis to be performed on 10 or more studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Individual quality items were investigated using a descriptive component approach that assessed selection bias, performance bias, attrition bias, reporting bias, potential confounding, and appropriateness of statistical analysis.

    “Individual quality items were investigated using a descriptive component approach that assessed selection bias, performance bias, attrition bias, reporting bias, potential confounding, and appropriateness of statistical analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Women with PCOS generally have hyperandrogenism and lower SHBG.

    “However, women with PCOS generally have hyperandrogenism and lower SHBG [52] and differences at the end of the intervention are again likely related to baseline differences.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Legro, R.S., Kunselman, A.R., Dodson, W.C., and Dunaif, A. (1999). Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. J. Clin. Endocrinol. Metab., 84. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The identified studies had moderate to high risk of bias and were generally small with significant drop-outs.

    “The identified studies also had moderate to high risk of bias and were generally small with significant drop-outs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Many of the included studies did not report numeric differences between groups, and relevant data could not be extracted.

    “Many of the included studies did not report numeric differences between groups and relevant data could not be extracted.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Including studies where weight loss was not the specific goal broadens the applicability of this review's findings to weight gain prevention, weight maintenance and use in lean women with PCOS.

    “We also included studies where weight loss was not the specific goal, broadening applicability of our findings to weight gain prevention, weight maintenance and use in lean women with PCOS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Additional biases may have occurred through identifying articles only in English and through not contacting authors for missing data.

    “Additional biases may also have occurred through identifying articles only in English and through not contacting authors for missing data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Similar efficacy of structured weight management interventions is likely in women with PCOS and the general population, so general population recommendations can be applied to women with PCOS with some degree of confidence.

    “At the current time, recommendations for weight management for the general population should be applied for women with PCOS with some degree of confidence that similar efficacy of structured interventions is likely.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In women with PCOS, metformin plus lifestyle intervention results in greater reduction in fat and improved menstrual cyclicity compared to lifestyle alone.

    “A recent meta-analysis reported that a metformin plus lifestyle intervention results in more reduction in fat and improved menstrual cyclicity, compared to lifestyle alone in PCOS [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Naderpoor, 2015, Metformin and lifestyle modification in polycystic ovary syndrome: Systematic review and meta-analysis, Hum. Reprod. Update source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This systematic review was limited to studies in English.

    “Additionally, this systematic review was limited to studies in English.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Our past longitudinal community cohort studies show unselected community dwelling women with PCOS report a higher caloric intake, which corresponds closely to higher rates of weight gain.

    “Our past longitudinal community cohort studies also show unselected community dwelling women with PCOS report a higher caloric intake, which corresponds closely to higher rates of weight gain [51].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [51] Moran, 2013, The contribution of diet, physical activity and sedentary behaviour to body mass index in women with and without polycystic ovary syndrome, Hum. Reprod. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Our previous systematic reviews showed an elevated prevalence of overweight (RR 1.95), obesity (RR 2.77), central obesity (RR 1.73) and BMI (2.5 kg/m2) in women with PCOS compared to women without PCOS.

    “Our previous research has shown a greater 10-year weight gain (2.6 kg (95% CI: 1.2–4.0)) in community-based cohort studies [17], and an elevated prevalence of overweight (risk ratio (RR) (95% CI): 1.95 (1.52, 2.50)), obesity (2.77 (1.88, 4.10)), central obesity (1.73 (1.31, 2.30)) and BMI (2.5 kg/m2 (95% CI: 1.9–3.1)) in systematic reviews [15] of women with PCOS compared to women without PCOS.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Lim, 2012, Overweight, obesity and central obesity in women with polycystic ovary syndrome: A systematic review and meta-analysis, Hum. Reprod. Update source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Bariatric surgery is an option for people who have not responded to other weight management interventions with sufficient weight loss or for those with morbid obesity and co-morbidities.

    “Overall, bariatric surgery is an option for those who have not responded to these interventions with sufficient weight loss or for those with morbid obesity and co-morbidities [56,57].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [56] Jensen, 2014, 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society, Circulation source

      Not checked in the free run.

    • cites [57] Yumuk, 2015, European guidelines for obesity management in adults, Obes. Facts source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All between-group comparisons presented in the review are presented as the authors reported that data and are per protocol for all analyses.

    “All between group comparisons presented here are presented as the authors reported that data and is per protocol for all analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    This review was not prospectively registered on PROSPERO.

    “We also did not prospectively register this review on PROSPERO; however, it was designed in 2012 at which time PROSPERO had only been active for a relatively short amount of time, and it was not yet standard practice for all systematic reviews to be prospectively registered.”
    Quote in the paperNot a substantial claim
39 of 39

  • The paper relies on this without support.

    The literature on weight management interventions in women with PCOS compared to women without PCOS is limited and contradictory.

    “However, the literature is limited and contradictory.”

  • The paper relies on this without support.

    The included studies are sufficiently similar in design, population and outcome measurement to permit a meaningful narrative comparison of weight management effects between women with and without PCOS.

    “The weaknesses of this review include the inability to statistically combine study results due to clinical heterogeneity.”
    “Many did not strictly exclude PCOS status in their controls.”

  • The paper relies on this without support.

    The absence of statistically significant differences in the included studies indicates that structured weight management interventions have similar efficacy in women with PCOS and the general population, rather than reflecting inadequate statistical power or bias.

    “Our findings are that there is insufficient evidence to indicate significant differences in weight loss in women with PCOS compared to women without PCOS with lifestyle or weight management strategies.”
    “The identified studies also had moderate to high risk of bias and were generally small with significant drop-outs.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract says secondary outcomes did not differ, but results report a significant difference

    Major

    The abstract says secondary outcomes did not differ significantly between groups, whereas the results report a statistically significant difference in ovulatory events. The results also report significant between-group differences in BMI and several other secondary outcomes.

  • Maximum study sample size exceeds the reported total

    Minor

    The reported maximum sample size of a single included study is 1016, which exceeds the reported total of 933 women across all 14 studies.

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References 65 · Cited by 58

Authors
Kataoka, J., Tassone, E., Misso, M., Joham, A., Stener-Victorin, E., Teede, H., & Moran, L.
Affiliations
  • NU Hospital Group (SE)
  • Monash University (AU)
  • Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
Corresponding author
Moran, Lisa
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2017-09-08
Volume
9
Issue
9
Pages
996
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu9090996
PMC
PMC5622756
OpenAlex
W2751063086
Semantic Scholar
c1805abc3a30039ae1e7247e3a3fb820b270c83b
Cited by
58
References
65
Citations by year
2025: 6 · 2024: 3 · 2023: 8 · 2022: 6 · 2021: 9 · 2020: 11 · 2019: 11 · 2018: 3 · 2017: 1
FWCI
1.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Monash University Research Portal (Monash University) (submittedVersion, other-oa)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Novo Nordisk Fonden (NNF15OC0015902, NNF16OC0020744, NNF17OC0026724)
  • National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
polycystic ovary syndrome, weight management interventions, weight loss, women, anthropometric outcomes, reproductive outcomes, metabolic outcomes, psychological outcomes, intervention efficacy
MeSH terms
Adult, Diet, Female, Humans, Obesity, Polycystic Ovary Syndrome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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