(P20-062-25) Effects of Pharmacologic, Lifestyle, and Combined Interventions on Body Mass Index in Women With Obesity and PCOS: A Systematic Review and Network Meta-analysis

Objectives: This study aims to evaluate the effects of pharmacologic, lifestyle, and combined interventions on body mass index (BMI) in women with PCOS and excess adiposity, with the goal of identifying the most effective strategies for BMI reduction.

Methods: A systematic review of randomized controlled trials (RCTs) was conducted by searching EMBASE, MEDLINE, CENTRAL, PsycINFO, and PubMed up to September 2024. Eligible studies evaluated pharmacologic treatments (e.g., metformin, anti-androgen therapies), lifestyle interventions (e.g., dietary and physical activity modifications), or their combinations compared to each other or to control groups (placebo or no treatment). The primary outcome was BMI, with waist circumference (WC), and waist-to-hip ratio (WHR). A frequentist random-effects model was used for the network meta-analysis (NMA) as secondary outcomes, and the certainty of evidence and inferences regarding relative effectiveness was assessed using the GRADE approach.

Results: A total of 57 studies were included, with 41 studies involving 2,378 participants included in the network meta-analysis. Combined interventions (lifestyle and pharmacotherapy) were the most effective in reducing BMI and improving adiposity distribution. Compared to control groups, combined interventions significantly reduced BMI (MD: -1.97 kg/m²; 95% CI: -2.66 to -1.28), WC (MD: -6.49 cm; 95% CI: -8.65 to -4.33), and WHR (MD: -0.06; 95% CI: -0.09 to -0.02). Lifestyle interventions alone, which included both dietary and physical activity components, also demonstrated substantial benefits, reducing BMI (MD: -1.14 kg/m²; 95% CI: -1.60 to -0.68), WC (MD: -4.10 cm; 95% CI: -5.65 to -2.55), and WHR (MD: -0.03; 95% CI: -0.06 to -0.01). Pharmacologic treatments alone showed more modest reductions in BMI (MD: -0.42 kg/m²; 95% CI: -1.02 to 0.18) and WC (MD: -2.75 cm; 95% CI: -4.72 to -0.79). The certainty of evidence ranged from very low to moderate across outcomes.

Conclusions: Combined interventions appear to offer the most promise for reducing BMI and improving adiposity distribution in women with PCOS and obesity. These findings emphasize the potential value of integrating lifestyle modifications with pharmacotherapy in managing PCOS-related obesity and body composition abnormalities.

Funding Sources: Not applicable