Table 1.

Highlights of the evidence for weight management in adolescents with PCOS by domain

Domain
Nutrition	Primary intervention: caloric restriction (reduction of ∼500–1000kcal/day from baseline)	Secondary interventions: low glycemic index/load; high protein/fiber & low carbohydrate; anti-inflammatory pattern	Complementary: supplementation with cinnamon, curcumin, B vitamins, omega 3 PUFAs
Physical Activity	60 minutes ≥3x/week moderate-vigorous activity including strength training	Consider high intensity interval training (HIIT) to reduce time burden	Tailor activity plan to maximize engagement and self-efficacy
Pharmacotherapy	Individualize based on phenotype and personal health risks	Consider anti-obesity medications as an adjunct to lifestyle	Avoid weight-promoting medications
Bariatric Surgery	T2D risk is higher in PCOS and adolescents with T2D experience premature short and long-term mortality; MBS leads to greater T2D remission when performed in adolescence versus adulthood	Risks of MBS include micronutrient deficiencies; pregnancy/infant outcomes are mixed and need to be repeated prospectively	MBS requires additional study specifically among adolescents with PCOS
Mood	Screen at PCOS diagnosis for depression, low self-esteem, unhealthy body image, disordered eating, and quality of life, all of which are more common in PCOS	Include a pediatric clinical psychologist as a core member of the interdisciplinary adolescent PCOS management team	Consider cognitive behavioral therapy for weight loss and improved mood/emotional outcomes
Sleep	Sleep-disordered breathing and poor sleep behaviors are more prevalent in adolescents with versus without PCOS	Circadian misalignment with late melatonin offset in adolescents with PCOS may exacerbate weight-related and metabolic complications	Sleep represents an understudied target of PCOS research

Major domains for achieving weight loss in youth with PCOS and overweight or obesity are shown, with leading recommendations listed