BMJ  2006;332:609 (11 March), doi:10.1136/bmj.332.7541.609-b

Letter

Obesity, polycystic ovary syndrome, infertility treatment

Asking obese women to lose weight before treatment increases stigmatisation

EDITOR—As Balen et al say,¹ epidemiological data show that obesity is associated with adverse pregnancy outcomes. However, long term maintenance of weight loss among obese populations is low, estimated at 15% over at least three years of follow-up in one systematic review.² Weight loss in shorter term studies, whether of dietary or pharmacologic treatments, six months to two years in duration, does not generally exceed a mean of 5-10 kg, and typically is closer to 3 kg, after accounting for placebo effects.

This translates to less than a 2-4 kg/m² reduction (or in more typical results, just over 1 kg/m²) in body mass index (BMI) for a woman of average height. These estimates are generous, because typical lifestyle and drug trials for weight loss suffer from non-compliance or dropout rates exceeding 30%,³ and participants who drop out of weight loss trials frequently do so because of treatment failure.⁴ This magnitude of weight loss is unlikely to be sufficient to alter the decision of a clinician who has already chosen to withhold treatment because of obesity, although as the authors indicate, it may be sufficient to improve ovulatory function in women with polycystic ovary syndrome.

To suggest therefore that obese women defer treatment until they achieve a particular BMI is equivalent to refusing most of these women reproductive care. Women are entitled to choose a less than ideal treatment if they have received appropriate information on risks, benefits, and effectiveness.

A health related quality of life measure has identified body weight, fertility, and menstrual problems as three of the five most important areas of concern for women with polycystic ovary syndrome.⁵ Although recommending weight loss is reasonable and prudent for all the reasons put forth by Balen et al, to suggest that obese women with the syndrome and infertility defer fertility treatment for a potentially indefinite period of time will only add to their sense of stigmatisation.

Sunnybrook and Women's College Health Sciences Centre, 790 Bay St, Ste 855 Toronto, ON, Canada, M5G 1N8 sheila.laredo{at}sw.ca

---

Competing interests: None declared.

References

1. Balen AH, Dresner M, Scott EM, Drife JO. Should obese women with polycystic ovary syndrome receive treatment for infertility? BMJ 2006;332: 434-5. (25 February.)[Free Full Text]
2. Ayyad C, Anderson T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931-1999. Obes Rev 2000;1: 113-9.[CrossRef][Medline]
3. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004;140: 778-85.[Abstract/Free Full Text]
4. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabet Care 2004;27: 155-61.[Abstract/Free Full Text]
5. Cronin L, Guyatt G, Griffith L, Wong E, Azziz R, Futterweit W, et al. Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome. J Clin Endocrinol Metabol 1998;83: 1976-87.[Abstract/Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Article

Should obese women with polycystic ovary syndrome receive treatment for infertility?

Adam H Balen, Martin Dresner, Eleanor M Scott, and James O Drife
BMJ 2006 332: 434-435. [Extract] [Full Text] [PDF]