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Polycystic ovary syndrome (PCOS) is variously reported to affect between 5% and 26% of reproductive age women in the UK and accounts for up to 75% of women attending fertility clinics due to anovulation. The first-line treatment option for overweight/obese women with PCOS is diet and lifestyle interventions. However, optimal dietary guidelines are...
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Citations
... [21][22][23][24] To address these qualitative concerns and inform healthcare professionals on how VLEDs are experienced by users, we undertook a systematic review of qualitative research on experiences during and after undertaking a VLED using total meal replacement. [25][26][27][28] Across all three studies available for inclusion in that review, VLED was generally reported by participants to be a positive experience, easy to follow, with decreased requirements to make decisions about food, and rapid weight loss increasing motivation for, and adherence to, the intervention. 28 Another study on using a LED with total diet replacement for weight loss, also showed that total diet replacement is well tolerated by participants. ...
... 29 Whilst these studies highlighted important aspects of using VLEDs for weight loss and reported that VLEDs and total diet replacement low energy diets are well tolerated in the specific populations studied, the significance of a VLED to the weight maintenance period was poorly described. [25][26][27][28] Therefore, this study was conducted to explore the experiences and behaviors of women who have undertaken a VLED intervention, with a specific focus on the weight maintenance phase. Acknowledgment by health researchers that the perspectives and experiences of participants and consumers have been neglected and are an important aspect of intervention acceptability, has progressed qualitative research as an important adjunct to quantitative findings of clinical research. ...
Introduction
Very low energy diets (VLEDs) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. There is a belief that such diets do not teach the lifestyle behaviour changes needed for long-term weight maintenance. However, little is known about the lived experiences of people who have lost weight on a VLED in the long term.
Methods
This study aimed to explore the behaviours and experiences of postmenopausal women who had followed a 4-month VLED (using total meal replacement products), followed by a food-based, moderately energy-restricted diet for an additional 8 months, as part of the TEMPO Diet Trial. Qualitative in-depth semi-structured interviews were conducted with 15 participants at 12 or 24 months (i.e., at 8 or 20 months post diet completion). Transcribed interviews were analysed thematically using an inductive approach.
Results
Undertaking a VLED was reported by participants to confer advantages in weight maintenance that previous weight loss attempts had not been able to do for them. Firstly, the rapid and significant weight loss, in conjunction with ease of use, was motivational and helped instill confidence in the participants. Secondly, the cessation of a normal diet during the VLED was reported by participants to break weight gain-inducing habits, allowing them to abandon unhelpful habits and to introduce in their place more appropriate attitudes towards weight maintenance. Lastly, the new identity, helpful habits and increased self-efficacy around weight loss supported participants during weight maintenance. Additionally, participants reported that ongoing occasional use of meal replacement products provided a useful and easy new strategy for countering weight regain and supporting their weight maintenance regimen.
Conclusion
Among the participants in this qualitative study, most of whom had maintained a loss of over 10% of their baseline body weight at the time of interview, using a VLED in the context of a clinical weight loss trial conferred confidence, motivation and skills for weight maintenance. These findings indicate that VLEDs with clinical support could be successfully leveraged to set up behaviours that will support weight maintenance in the long term.
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... [29] Lifestyle modifications are the most challenging, yielding slow results; low commitment and poor patient motivation are additional barriers. [30,31] A study conducted in Australia recommends personalised, long-term care over 6 to 12 months by healthcare workers, which is flexible, suiting the woman's time, and cost-effective to overcome these barriers. [19] However, more research needs to be carried out in the Indian context to design a suitable and culturally acceptable strategy that addresses these barriers, thus enabling primary care physicians to deliver quality care to these women. ...
Background: Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects women of the reproductive age group. Itstreatment regimen comprises medication and lifestyle modifications. However, non-adherence to the treatment regimen is the mostcommonly faced problem among women due to various barriers, resulting in complications like insulin resistance, hyperlipidemia,obesity, and infertility. Primary care physicians see patients with this disorder either at the initiation of treatment or on follow-upcare after specialist consultation. So, understanding the barriers to treatment compliance, from a woman’s perspective and findingthe solution to the same is crucial to successful therapy. Objectives: The present study aims to assess adherence to the treatmentregimen and its barriers among women with PCOS and its associated factors. Methods: A cross-sectional study among 224 womenwho met the inclusion criteria responded through a Google form. Self-reports were obtained by a demographic proforma, medicationadherence rating scale, and barriers assessment questionnaire. Results: Only a third of the women (32.1%) were fully adherent, 36.3%were partially adherent, and 31.6% were non-adherent. The most common barriers among women were lack of knowledge regardingthe disease and its management, side effects of the treatment, long duration of the therapy, no relief of symptoms, bland diet, andlack of physical exercise. Treatment adherence was associated with socioeconomic status (P = 0.001) among women with PCOS.Conclusion: Adherence to the treatment regimen in PCOS was poor. Successful adherence depends on how patients understand thesevere implications of non-adherence to the prescribed treatment and adjust to lifestyle modifications related barriers. It is alsovital for health care providers and patients to identify these barriers, address them and refine treatment strategies.
... [29] Lifestyle modifications are the most challenging, yielding slow results; low commitment and poor patient motivation are additional barriers. [30,31] A study conducted in Australia recommends personalised, long-term care over 6 to 12 months by healthcare workers, which is flexible, suiting the woman's time, and cost-effective to overcome these barriers. [19] However, more research needs to be carried out in the Indian context to design a suitable and culturally acceptable strategy that addresses these barriers, thus enabling primary care physicians to deliver quality care to these women. ...
Background:
Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects women of the reproductive age group. Its treatment regimen comprises medication and lifestyle modifications. However, non-adherence to the treatment regimen is the most commonly faced problem among women due to various barriers, resulting in complications like insulin resistance, hyperlipidemia, obesity, and infertility. Primary care physicians see patients with this disorder either at the initiation of treatment or on follow-up care after specialist consultation. So, understanding the barriers to treatment compliance, from a woman's perspective and finding the solution to the same is crucial to successful therapy.
Objectives:
The present study aims to assess adherence to the treatment regimen and its barriers among women with PCOS and its associated factors.
Methods:
A cross-sectional study among 224 women who met the inclusion criteria responded through a Google form. Self-reports were obtained by a demographic proforma, medication adherence rating scale, and barriers assessment questionnaire.
Results:
Only a third of the women (32.1%) were fully adherent, 36.3% were partially adherent, and 31.6% were non-adherent. The most common barriers among women were lack of knowledge regarding the disease and its management, side effects of the treatment, long duration of the therapy, no relief of symptoms, bland diet, and lack of physical exercise. Treatment adherence was associated with socioeconomic status (P = 0.001) among women with PCOS.
Conclusion:
Adherence to the treatment regimen in PCOS was poor. Successful adherence depends on how patients understand the severe implications of non-adherence to the prescribed treatment and adjust to lifestyle modifications related barriers. It is also vital for health care providers and patients to identify these barriers, address them and refine treatment strategies.
... In this regard, variables such as weight, body composition, body fat distribution, and the effects of diet and physical exercise have been investigated in women with alterations in sexual maturation, menstrual cycle, and fertility. [2][3][4] Extremes in body size, such as thinness and obesity, are considered risk factors for ovulatory infertility among women. 5 Excess body weight is also associated with disorders of the menstrual cycle and infertility, especially ovulation disorders. ...
Objective:
It has been suggested that excess body weight could represent a risk factor for infertility outcomes. The present study aimed to evaluate the association of overweight and anovulation among infertile women with regular menstrual cycles.
Methods:
We conducted a retrospective case-control study with consistently anovulatory patients undergoing assisted reproduction treatment. The patients were stratified into normal weight (body mass index [BMI]: 18.5-24.9kg/m2) and overweight (BMI: 25.0-29.9kg/m2).Those with polycystic ovary syndrome or obesity were excluded. The groups were matched for age, duration of infertility, prolactin, follicle stimulating hormone (FSH), thydroid stimulating hormone (TSH), luteinizing hormone (LH), and estradiol levels.
Results:
Overweight was significantly associated with anovulation, when using the World Health Organization (WHO) criteria for anovulation: progesterone levels > 5.65 ng/ml and ultrasonography evidence of follicle collapse (odds ratio [OR]: 2.69; 95% confidence interval [CI95%]: 1.04-6.98).
Conclusion:
Body mass index above the normal range jeopardizes ovulation among non-obese infertile women with regular menstrual cycles.
... As suggested by the data of the DiRECT study, achieving, and maintaining weight loss is a critical factor for the remission of type 2 diabetes. The rapid weight loss achieved by the uptake of a very low-calorie diet (VLCD) such as that used in the DiRECT study and the associated health improvements one experiences serve as a major motive for diet adherence (9)(10)(11). However, one can encounter several threats (such as tempting situations and environments, emotional distress, and high costs of meal replacements) which can negatively impact one's ability to adhere to such a diet. ...
... It is thus critical that behaviour change strategies are deployed to increase adherence to the VLCD. The implementation of behavioural strategies such as the removal of temptations from immediate environments, avoidance of tempting social situations and places, and meal planning are critical for countering barriers to VLCD (9,10). Furthermore, though individual behavioural factors may fundamentally impact one's health outcomes, interpersonal and organizational factors can also ultimately affect one's health behaviours (12)(13)(14). ...
... Furthermore, though individual behavioural factors may fundamentally impact one's health outcomes, interpersonal and organizational factors can also ultimately affect one's health behaviours (12)(13)(14). One such factor is a supportive social network which facilitates adherence to VLCD (9)(10)(11) and has been increasingly recognized as having an integral role in enhancing health outcomes for persons with a wide range of conditions (15)(16)(17)(18)(19)(20). ...
Background: Remission of type 2 diabetes through weight loss is possible in a high proportion of persons with a recent diagnosis, but a major challenge is achieving sufficient weight loss.
Objectives: In the first study of this type in the Caribbean, we investigated factors associated with successful weight loss in adults in a diabetes remission intervention. We hypothesized that differences in social support may have influenced differences in weight loss achieved by participants in the Barbados Diabetes Reversal Study (BDRS).
Methods: A comparative case study was conducted. Quantitative data for the primary outcome measure of weight reduction (the participants baseline and 8-month weights) were assessed to identify the 6 participants with the highest and 6 participants with the lowest weight loss. The 8-week (low-calorie diet phase) and 8-month (weight maintenance phase) interview transcripts for each participant were then analyzed via qualitative thematic analysis to explore factors related to social support.
Results: Informal and formal support were identified for both categories of participants. Cases were similar with respect to their sources of support however dissimilarities were found in (1) the depth of support received; (2) access to supportive environments and (3) diversity of social supportive networks. Participants in the top weight loss group reported consistency in the levels of support received over the low-calorie diet and weight maintenance phases of the study while the converse was true for those of the bottom weight loss group.
Conclusion: Study findings suggest that individuals aiming at type 2 diabetes remission benefit from strong social support networks. These networks provide tangible assistance and facilitate the sharing and discussion of strategies for weight reduction. Future studies should facilitate in-depth understanding of how formal and informal supportive networks can aid sustained dietary diabetes remission and long-term weight maintenance.
... In addition, it has been shown that the other forms of low and intermediate molecular weight are less effective. 5,6 It has been reported that metabolic disorders such as PCOS is associated with hypoadiponectinemia. 7,8,9 In addition, it has been reported by many studies related to nutrition and PCOS that energy management and weight loss in overweight patients can modify biochemical parameters. 8 Omega-3 is one of the supplements that regulate obesity, inflammation and insulin resistance. ...
... 5,6 It has been reported that metabolic disorders such as PCOS is associated with hypoadiponectinemia. 7,8,9 In addition, it has been reported by many studies related to nutrition and PCOS that energy management and weight loss in overweight patients can modify biochemical parameters. 8 Omega-3 is one of the supplements that regulate obesity, inflammation and insulin resistance. 9 The relationship between adiponectin level and omega-3 supplement has been reported at the experimental level. ...
Polycystic ovary syndrome (PCOS) is a significant health problem affecting women during the reproductive
age and characterized by hormonal disturbance resulting in irregular menstrual periods and infertility.
Adiponectin is a protein produced by adipocytes and involved in glucose and lipid metabolism. This study
included the evaluation of two doses of omega-3 (300 and 600mg/day for 14 weeks). Age, body mass
index (BMI), fasting blood glucose level, homeostatic model assessment (HOMA), lipid profile, luteinizing
hormone (LH), follicle-stimulating hormone (FSH), prolactin, estrogen and HMW adiponectin levels were
evaluated. Our data showed no significant differences between control group and treatment groups in BMI,
age, sex hormones, fasting blood glucose, and HOMA levels. However, the level of HMW adiponectin was
significantly higher in women treated with 600mg/day for 14 weeks (p < 0.0001) but not 300mg / day of
Omega-3 fatty acids for the same period.
... As in previous studies, the majority of those interviewed reported undertaking (several) previous weight loss attempts [15,16,25]. These previous weight loss attempts had been unsuccessful, or if they had managed to lose some weight in the past, they had reported that over time they had gradually regained any weight previously lost. ...
... Most often, previous weight loss attempts included attending community weight-loss groups. A 12 week referral to such programmes have been shown in clinical trials to achieve approximately 3kg weight loss over a 1 year period [26,27] and its' possible that slow weight losses were one of the reasons that participants believed their past weight loss attempts had been unsuccessful [16,25]. ...
Introduction
The participants’ experience of low-energy total diet replacement (TDR) programmes delivered by lay counsellors in the community for the routine treatment of obesity is currently unclear. We interviewed a sample of twelve participants who took part in the Doctor Referral of Overweight People to Low-Energy total diet replacement Treatment (DROPLET) trial and were randomised to the TDR programme.
Methods
We purposively sampled twelve patients who took part in the DROPLET trial, and conducted in-depth telephone interviews, which were audio-recorded and transcribed verbatim. Interview questions focused on participants’ experiences and perceptions of the TDR programme. We conducted a thematic analysis, actively developing themes from the data, and used the one sheet of paper (OSOP) technique to develop higher-level concepts.
Results
Nine key themes were identified; Reasons for taking part, Expectations, Support and guidance from the counsellor, Time to build a personal relationship, Following the TDR Programme, Adverse events, Outcomes from the TDR, Weight Loss Maintenance, Recommending TDR to others. The relationship between participants and the counsellor was central to many of the themes. Close relationships with counsellors facilitated TDR adherence through providing one-to-one support (including during difficult times), sharing expert knowledge, and building a close relationship. Adherence was also supported by the rapid weight loss that patients reported experiencing. Overall participants reported positive experiences of the TDR, and emphasised the positive impact on their wellbeing.
Discussion
Patients reported that a TDR programme delivered by lay counsellors in the community was a positive experience and effective in helping them to lose weight. Future trials should consider the central role of the person providing support and advice as a key component in the programme.
... These studies suggested chromium [19], zinc [20], magnesium and selenium [21], co-utilization of vitamin D and calcium [11], v-3 [22], consumption of fiber from legumes, whole grains, fruit, and vegetable, along with the intake of carbohydrate with the low glycemic index (GI) to improve PCOS [21]. Additionally, high protein and low glycemic load [23,24], index foods [25], low-calorie diets, and diet recommendations with increasing the ratio of the protein to carbohydrates are some instances of interfering the diets [26,27]. As the nutrients or foods are consumed together and interact with each other, the evaluation of nutrients and foods individually or in groups cannot accurately reveal the association between diet and diseases such as PCOS [28]. ...
Background
Polycystic Ovary Syndrome (PCOS) is defined as a common metabolic and endocrine abnormality in reproductive-aged women. This study aimed to investigate the relevance between major dietary patterns and PCOS.
Methods
This is a case-control study of 108 newly diagnosed women with PCOS and 108 age-, and BMI-matched women without PCOS, as a control group, in Yazd, Iran. The PCOS was diagnosed based on Rotterdam criteria. Subsequently, the validated 168-item food frequency questionnaire was used to evaluate the usual dietary intake. Moreover, the Principal Component Analysis (PCA) was used for driving dietary patterns, and logistic regression assessed the relationship between dietary patterns and PCOS.
Results
Three major dietary patterns were identified, namely a high glycemic index (high fat), a low glycemic index (low fat), and an anti-inflammatory dietary pattern. After adjustment for potential confounders, the high glycemic index (high fat) dietary pattern significantly increased the odds of PCOS (OR for the highest and. lowest quartile = 3.94; 95% CI: 1.65, 9.38), and demonstrated a significant increase in body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), and visceral fat. Then, having adjusted the potential confounders, the moderate adherence to the anti-inflammatory dietary pattern had a protective effect on the odds of PCOS (OR = 0.38; 95% CI = 0.15, 0.95). However, no significant relation was found between low glycemic index (low fat) dietary pattern and the odds of PCOS.
Conclusions
The results indicated that the high glycemic index (high fat) dietary pattern had an incremental effect on the odds of PCOS. Moreover, the anti-inflammatory dietary pattern had a reduction effect on the risk of PCOS. It's worth noting that more prospective studies are required to confirm the findings of this study.
... In general, women with bulimic behaviors are ashamed of their eating habits and reluctant to reveal them [23]. They reported entrance into the quilt cycle of after food intake [24]. For these reasons, women with PCOS are concerned about eating excessively. ...
Data on eating disorders in women with PCOS is insufficient. The objective of this case study was to examine the hypothesis that women with PCOS exhibit more impaired eating than healthy women. Women diagnosed with PCOS under the 2003 Rotterdam Diagnostic Criteria (n = 40) were compared with a healthy control group (n = 40). The groups also were divided into two as normal body weight and overweight/obese. The Eating Disorders Assessment Questionnaire (EDE-Q) and the Three Factor Eating Questionnaire (TFEQ-R21), were completed by all participants in order to evaluate eating behaviors in addition to eating disorders. Among the overweight/obese group, the average total and subscale scores of the EDE-Q as well as the total and sub-factor scores of the TFEQ-R21 were higher in women with PCOS compared to controls (p < .05). However, this statistically significant result was not shown among the women with normal weight (p > .05). In comparison to the controls, the PCOS women displayed higher values of the tool scores indicating abnormal restraint eating, body shape concern and weight concern subscale scores (p < .05). This result suggests that the evaluation of eating disorders should be added to routine screening and the monitoring of women with PCOS.
... As a result, weight cycling was a common experience in women with PCOS in the current study. Difficulty losing weight, weight cycling and unexplained weight gain were also reported by other women with PCOS in previous studies [8,[27][28][29]. This was further supported by a longitudinal study which also found women with PCOS having greater weight gain than age-matched women without PCOS [13]. ...
... Apart from these behavioural factors with possible upstream causes, women with PCOS do not appear to have a metabolic basis for being more resistant to weight loss [20]. Weight regain following weight loss can have a detrimental effect on the mental well-being of women with PCOS including feelings of guilt, low self-esteem and poor selfimage [8,28,29]. These can further erode the motivation to maintain efforts to manage weight, preventing recovery from the relapse. ...
... Women in the current study reported a range of barriers to lifestyle modification. Most of these barriers were also reported by young women without PCOS, with the key barriers being work commitments, time, cost and difficulty with children [22,29,[41][42][43]. Personal barriers such as disliking the taste of certain foods were also similar across women with and without PCOS in current and previous studies [41,44]. ...
Background:
Lifestyle modification targeting weight management is the first-line treatment for women with Polycystic Ovary Syndrome (PCOS) regardless of presenting symptoms. Women with PCOS are more likely to gain more weight compared with women without PCOS, which may be related to barriers in engaging in lifestyle modification. The aim of this study is to explore the experience of women with PCOS in weight management and to determine the facilitators and barriers to lifestyle modifications in women with PCOS.
Methods:
Ten women with PCOS participated in focus groups and semi-structured telephone interviews on lifestyle and weight management in PCOS. Discussions were audio-recorded and transcribed verbatim. Thematic analysis of the transcripts was conducted. Thematic analysis of the transcripts were conducted using the method of constant comparison.
Results:
Women in the current study attempted a wide range of weight loss interventions, but had difficulties losing weight and preventing weight regain. Women felt that having PCOS affected their ability to lose weight and to keep it off. Facilitators to lifestyle modification for weight management were reported as structured approaches such as having balanced meals and support by health professionals, peers, friends or family. Barriers to lifestyle changes in women with PCOS included logistical barriers such as time and cost, motivational barriers including tiredness or feeling unrewarded, environmental barriers such as not having access to safe places to exercise, emotional barriers such as having depressive and defeating thoughts, and relational barriers such as having unsupportive partner or prioritising children's meal preferences.
Conclusions:
Women with PCOS face a number of personal, environmental and social facilitators and barriers to lifestyle modification for weight loss. While many of these are also experienced by women without PCOS, women with PCOS face additional barriers in having low sense of self-confidence and high prevalence of negative thoughts which may impair their ability to maintain efforts in lifestyle modification over the long term. Future research should further explore the impact of the emotional and mental burden of PCOS on the management of weight and other aspects of PCOS. Future lifestyle intervention should also address the psychosocial aspect of PCOS.
