Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS), a common condition in women, improves with weight loss. Meal replacements in short-term weight loss and strategies for weight maintenance have not been investigated in PCOS. Objective: We compared in overweight women with PCOS the effects of meal replacements in short-term weight-loss and longer-term carbohydrate- or fat-restriction strategies on weight maintenance and improvements in reproductive and metabolic variables. Design: Overweight women with PCOS (n = 43; x^- ± SD age: 32.1 ± 5.2 y; weight: 96.1 ± 18.4 kg) followed an 8-wk weight-loss regimen (2 meal replacements/d, 4904.4 ± 127 kJ; phase 1) and then a 6-mo weight-maintenance carbohydrate- (<120 g/d) or fat- (<50 g/d) restriction regimen (phase 2). Results: Thirty-four women completed phase 1, and 23 women completed phase 2; the proportion of dropouts was similar in the 2 groups. During phase 1, significant (P < 0.05) reductions in weight (5.6 ± 2.4 kg), waist circumference (6.1 ± 2.5 cm), body fat (4.1 ± 2.2 kg), insulin (2.8 ± 1.1 mU/L), total testosterone (0.3 ± 0.7 nmol/L), and free androgen index (3.1 ± 4.6) occurred; these changes were sustained during phase 2. No significant differences between diet groups were seen for any variables. At 6 mo, both approaches resulted in a net weight loss of 4.7 ± 4.6 kg. Improvements in menstrual cyclicity occurred for 16 (57.1%) of 28 subjects. Conclusions: Meal replacements are an effective strategy for the short-term management of PCOS. Advice on moderate fat or carbohydrate restriction was equally effective in maintaining weight reduction and improving reproductive and metabolic variables.