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Women with PCOS report ‘sense of inevitability’ regarding weight gain, adverse outcomes
Women with polycystic ovary syndrome were more likely to report they had concerns regarding long-term health risks, including cardiovascular disease, diabetes and weight gain, compared with women without the condition. Yet, fewer than half of this group reported attempting to follow U.S. government diet recommendations for healthy eating, according to an analysis of survey data published in Human Reproduction.
“Our survey results indicated that women living with PCOS believed they were at increased risk for adverse health problems but felt less control over their ability to curb these risks than women without PCOS,” Marla Lujan, PhD, assistant professor of nutritional sciences at Cornell University in Ithaca, New York, told Endocrine Today. “In particular, women with PCOS were less likely to view the adoption of healthy behaviors as effective approaches to reduce their risk of weight gain. These findings tell us that women with PCOS are receiving and internalizing the message that PCOS has serious implications for their long-term health. However, PCOS appears to be associated with a sense of inevitability to prevent progression to weight gain, cardiovascular disease or other chronic diseases — beliefs which need to be addressed by researchers and clinicians.”
Lujan, Annie W. Lin, RD, PhD, of the division of nutritional sciences at Cornell University, and colleagues analyzed data from 255 women with self-reported PCOS and 220 women without PCOS (self-reported regular menstrual cycles), all aged 18 to 38 years, participating in an ancillary study of a larger observational investigation regarding the differences in diet and physical activity in women with and without PCOS. All participants completed a 77-item survey regarding health-related knowledge, beliefs and self-efficacy. The majority of items were formatted as multiple-choice questions or 5-point rating scales; items related to beliefs about the severity and inevitability of adverse health outcomes and the evaluation of lifestyle behaviors were assessed on a continuous scale, from 1 (disagree) to 5 (agree). For items about perceived susceptibility to adverse health outcomes, a value of 1 indicated “much lower than average” and 5 indicated “much higher than average.”
Among PCOS patients, more than 76% correctly answered knowledge items relating to ovarian physiology and function, and 51.4% correctly identified the three established diagnostic features of PCOS. Features that were incorrectly identified as PCOS criteria included weight gain (64%), insulin resistance (81%) and trouble losing weight (86%).
Patients with PCOS also had high scores regarding their perceived severity of CVD, diabetes and endometrial cancer, and reported they were at higher risk for developing adverse health outcomes. The patients with PCOS were more likely to report that CVD, diabetes and weight gain were preventable, but they were also more likely to report that endometrial cancer and infertility were not. Similarly, these patients reported that meeting diet and physical activity guidelines would help prevent adverse health outcomes, apart from endometrial cancer and infertility.
Despite the reported findings, many patients with PCOS reported they did not follow government guidelines for healthy eating, with 64% reporting they searched for MyPlate recommendations and only 47% reporting attempting to follow the recommendations.
Women with PCOS were also less likely to agree that a healthy diet or physical activity could reduce the risk for weight gain relative to those without PCOS (P = .03 for both), although patients with PCOS reported a greater importance for meeting national physical activity recommendations vs. those without PCOS (P < .01).
Lujan said the findings have important implications for the counseling of patients with PCOS.
“In addition to informing patients about their long-term health risks, women with PCOS would benefit from receiving information about the known positive effects of diet and physical activity for women with their condition,” Lujan said. “While benefits on reproductive outcomes are less clear, there is substantial evidence to support global improvements in metabolic health in women with PCOS engaged in lifestyle/behavioral interventions. Further, there is little evidence to support that women with PCOS are less responsive to these interventions compared to women without PCOS. As such, women with PCOS should feel greater confidence in the beneficial effects of healthy behavioral practices.”
Lujan said future research should focus on the impact of diet and physical activity on the health and well-being of women with PCOS across the life span, data on long-term weight maintenance and the prevention of weight gain, and analysis on how health-related knowledge and beliefs change over the life span in women with PCOS.
“Understanding factors that affect patient perceptions, and resources whereby patients secure health-related knowledge, may aid in identifying critical junctures and/or avenues to enhance adoption of healthy behaviors,” Lujan said. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.