Psychological well-being and personality in relation to weight loss following behavioral modification intervention in obese women with polycystic ovary syndrome: a randomized controlled trial

in European Journal of Endocrinology
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  • 1 Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  • 2 Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
  • 3 Department of Obstetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
  • 4 Department of Clinical Science, Intervention and Technology (CLINTEC), Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden

Correspondence should be addressed to A L Hirschberg; Email: angelica.linden-hirschberg@sll.se

*(E Oberg and C Lundell contributed equally to this work)

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Objective

Little is known about how lifestyle affects psychological well-being in overweight women with polycystic ovary syndrome (PCOS). We investigated the effects of behavioral modification on psychological well-being and the impact of well-being and personality traits on successful weight loss.

Design

A 4-month randomized controlled trial with a 12-month follow-up at a University Hospital.

Methods

Sixty-eight women with PCOS, aged 18 to 40 years with a BMI ≥27 kg/m2, were randomized (1:1) into a behavioral modification program (intervention) or minimal intervention (control). The outcome measures were the psychological well being index and the Swedish universities scales of personality.

Results

At baseline, 60% had a global psychological well being index corresponding to severe distress and 40% to moderate distress. There was no significant change in mean global well-being score at 4 months within or between groups. However, after 4 months, the intervention group expressed less anxiety (P = .035), higher general health (P = .012) and lower depressed mood (P = .033). Anxiety and general health tended to differ between groups (P = .06, respectively) favoring intervention. In the whole population, women achieving ≥5% weight loss at 12 months (n = 18) were less anxious at baseline compared to those who had not (P = .004). Personality trait-analysis showed that the weight-loss group had higher social desirability (P = .033) and lower embitterment (P = .023).

Conclusions

Psychological well-being is severely impacted in overweight women with PCOS. Behavioral modification can positively impact dimensions of well-being, although not fully significant, compared to control treatment. Personality factors could contribute to the understanding of successful weight loss.

Supplementary Materials

    • Supplementary Table 1: The global normalized mean PGWBI as well as the individual dimensions after 4 months of intervention
    • Supplementary Table 2: Baseline and 12 months global mean PGWBI as well as the individual dimensions for the whole study population (n=49)
    • Supplementary Table 3: The baseline mean T-scores for all personality traits split by successful loss of &#x2265; 5% weight and < 5% weight loss at 12 months.

 

     European Society of Endocrinology

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  • 1

    March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 2010 25 544551. (https://doi.org/10.1093/humrep/dep399)

    • Search Google Scholar
    • Export Citation
  • 2

    Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction 2016 31 28412855. (https://doi.org/10.1093/humrep/dew218)

    • Search Google Scholar
    • Export Citation
  • 3

    Rotterdam EA-SPCWG. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility 2004 81 1925.

    • Search Google Scholar
    • Export Citation
  • 4

    Teede H, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T & Norman RJ. International Evidence-Based Guidelines for the Assessment and Managment of Polycystic Ovary Syndrome 2018. Monash University: Melbourne Australia, 2018.

    • Search Google Scholar
    • Export Citation
  • 5

    Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocrine Reviews 2012 33 9811030. (https://doi.org/10.1210/er.2011-1034)

    • Search Google Scholar
    • Export Citation
  • 6

    Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update 2010 16 347363. (https://doi.org/10.1093/humupd/dmq001)

    • Search Google Scholar
    • Export Citation
  • 7

    Dokras A, Stener-Victorin E, Yildiz BO, Li R, Ottey S, Shah D, Epperson N, Teede H. Androgen Excess-Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertility and Sterility 2018 109 888899. (https://doi.org/10.1016/j.fertnstert.2018.01.038)

    • Search Google Scholar
    • Export Citation
  • 8

    Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction 2017 32 10751091. (https://doi.org/10.1093/humrep/dex044)

    • Search Google Scholar
    • Export Citation
  • 9

    Cesta CE, Mansson M, Palm C, Lichtenstein P, Iliadou AN, Landen M. Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology 2016 73 196203. (https://doi.org/10.1016/j.psyneuen.2016.08.005)

    • Search Google Scholar
    • Export Citation
  • 10

    Bazarganipour F, Taghavi SA, Montazeri A, Ahmadi F, Chaman R, Khosravi A. The impact of polycystic ovary syndrome on the health-related quality of life: a systematic review and meta-analysis. Iranian Journal of Reproductive Medicine 2015 13 6170.

    • Search Google Scholar
    • Export Citation
  • 11

    Barnard L, Ferriday D, Guenther N, Strauss B, Balen AH, Dye L. Quality of life and psychological well being in polycystic ovary syndrome. Human Reproduction 2007 22 22792286. (https://doi.org/10.1093/humrep/dem108)

    • Search Google Scholar
    • Export Citation
  • 12

    Lundgren-Nilsson Å, Jonsdottir IH, Ahlborg G Jr, Tennant A. Construct validity of the psychological general well being index (PGWBI) in a sample of patients undergoing treatment for stress-related exhaustion: a Rasch analysis. Health and Quality of Life Outcomes 2013 11 2. (https://doi.org/10.1186/1477-7525-11-2)

    • Search Google Scholar
    • Export Citation
  • 13

    Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Human Reproduction Update 2012 18 638651. (https://doi.org/10.1093/humupd/dms029)

    • Search Google Scholar
    • Export Citation
  • 14

    Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine 2018 62 318325. (https://doi.org/10.1007/s12020-018-1692-3)

    • Search Google Scholar
    • Export Citation
  • 15

    F, Karaderi T, Jones MR, Meun C, He C, Drong A, Kraft P, Lin N, Huang H & Broer L Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genetics 2018 14 e1007813. (https://doi.org/10.1371/journal.pgen.1007813)

    • Search Google Scholar
    • Export Citation
  • 16

    Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ & International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility 2018 110 364379. (https://doi.org/10.1016/j.fertnstert.2018.05.004)

    • Search Google Scholar
    • Export Citation
  • 17

    Stener-Victorin E, Holm G, Janson PO, Gustafson D, Waern M. Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial. BMC Complementary and Alternative Medicine 2013 13 131. (https://doi.org/10.1186/1472-6882-13-131)

    • Search Google Scholar
    • Export Citation
  • 18

    Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, Diamanti-Kandarakis E. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress 2015 18 5766. (https://doi.org/10.3109/10253890.2014.974030)

    • Search Google Scholar
    • Export Citation
  • 19

    Vizza L, Smith CA, Swaraj S, Agho K, Cheema BS. The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation 2016 8 14. (https://doi.org/10.1186/s13102-016-0039-8)

    • Search Google Scholar
    • Export Citation
  • 20

    Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2019 3 CD007506. (https://doi.org/10.1002/14651858.CD007506.pub4)

    • Search Google Scholar
    • Export Citation
  • 21

    De Panfilis C, Torre M, Cero S, Salvatore P, Dall'Aglio E, Marchesi C, Cabrino C, Aprile S, Maggini C. Personality and attrition from behavioral weight-loss treatment for obesity. General Hospital Psychiatry 2008 30 515520. (https://doi.org/10.1016/j.genhosppsych.2008.06.003)

    • Search Google Scholar
    • Export Citation
  • 22

    Dalle Grave R, Calugi S, Compare A, El Ghoch M, Petroni ML, Colombari S, Minniti A, Marchesini G. Personality, attrition and weight loss in treatment seeking women with obesity. Clinical Obesity 2015 5 266272.

    • Search Google Scholar
    • Export Citation
  • 23

    Elfhag K. Personality correlates of obese eating behaviour: Swedish universities scales of personality and the three factor eating questionnaire. Eating and Weight Disorders 2005 10 210215. (https://doi.org/10.1007/BF03327487)

    • Search Google Scholar
    • Export Citation
  • 24

    Sullivan S, Cloninger CR, Przybeck TR, Klein S. Personality characteristics in obesity and relationship with successful weight loss. International Journal of Obesity 2007 31 669674. (https://doi.org/10.1038/sj.ijo.0803464)

    • Search Google Scholar
    • Export Citation
  • 25

    Gerlach G, Herpertz S, Loeber S. Personality traits and obesity: a systematic review. Obesity Reviews 2015 16 3263. (https://doi.org/10.1111/obr.12235)

    • Search Google Scholar
    • Export Citation
  • 26

    Oberg E, Gidlof S, Jakson I, Mitsell M, Tollet Egnell P, Hirschberg AL. Improved menstrual function in obese women with polycystic ovary syndrome after behavioural modification intervention-a randomized controlled trial. Clinical Endocrinology 2019 90 468478. (https://doi.org/10.1111/cen.13919)

    • Search Google Scholar
    • Export Citation
  • 27

    Labrie F, Cusan L, Gomez JL, Cote I, Berube R, Belanger P, Martel C, Labrie C. Effect of intravaginal DHEA on serum DHEA and eleven of its metabolites in postmenopausal women. Journal of Steroid Biochemistry and Molecular Biology 2008 111 178194. (https://doi.org/10.1016/j.jsbmb.2008.06.003)

    • Search Google Scholar
    • Export Citation
  • 28

    Ingvar M, Eldh G. Hjärnkoll på vikten. Natur and Kultur 2010.

  • 29

    Chassany O, Dimenas E, Dubois D, Wu A & Dupuy H The Psychological General Well-Being Index (PGWBI) User Manual. Lyon, France: MAPI Research Institute, 2004.

    • Search Google Scholar
    • Export Citation
  • 30

    Gustavsson JP, Bergman H, Edman G, Ekselius L, von Knorring L, Linder J. Swedish universities scales of personality (SSP): construction, internal consistency and normative data. Acta Psychiatrica Scandinavica 2000 102 217225. (https://doi.org/10.1034/j.1600-0447.2000.102003217.x)

    • Search Google Scholar
    • Export Citation
  • 31

    Coffey S, Bano G, Mason HD. Health-related quality of life in women with polycystic ovary syndrome: a comparison with the general population using the Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36). Gynecological Endocrinology 2006 22 8086. (https://doi.org/10.1080/09513590600604541)

    • Search Google Scholar
    • Export Citation
  • 32

    Ching HL, Burke V, Stuckey BG. Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers. Clinical Endocrinology 2007 66 373379. (https://doi.org/10.1111/j.1365-2265.2007.02742.x)

    • Search Google Scholar
    • Export Citation
  • 33

    Dokras A, Sarwer DB, Allison KC, Milman L, Kris-Etherton PM, Kunselman AR, Stetter CM, Williams NI, Gnatuk CL & Estes SJ Weight loss and lowering androgens predict improvements in health-related quality of life in women with PCOS. Journal of Clinical Endocrinology and Metabolism 2016 101 29662974. (https://doi.org/10.1210/jc.2016-1896)

    • Search Google Scholar
    • Export Citation
  • 34

    Petta CA, Ferriani RA, Abrao MS, Hassan D, Rosa E Silva JC, Podgaec S, Bahamondes L. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Human Reproduction 2005 20 19931998. (https://doi.org/10.1093/humrep/deh869)

    • Search Google Scholar
    • Export Citation
  • 35

    Isidoro SI, Salvaggio A, Lo Bue A, Romano S, Marrone O, Insalaco G. Effect of obstructive sleep apnea diagnosis on health related quality of life. Health and Quality of Life Outcomes 2015 13 68. (https://doi.org/10.1186/s12955-015-0253-1)

    • Search Google Scholar
    • Export Citation
  • 36

    Thomson RL, Buckley JD, Lim SS, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertility and Sterility 2010 94 18121816. (https://doi.org/10.1016/j.fertnstert.2009.11.001)

    • Search Google Scholar
    • Export Citation
  • 37

    De Frene V, Verhofstadt L, Lammertyn J, Stuyver I, Buysse A, De Sutter P. Quality of life and body mass index in overweight adult women with polycystic ovary syndrome during a lifestyle modification program. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2015 44 587599. (https://doi.org/10.1111/1552-6909.12739)

    • Search Google Scholar
    • Export Citation
  • 38

    Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. Journal of Clinical Endocrinology and Metabolism 2008 93 42994306. (https://doi.org/10.1210/jc.2008-0461)

    • Search Google Scholar
    • Export Citation
  • 39

    Turan V, Mutlu EK, Solmaz U, Ekin A, Tosun O, Tosun G, Mat E, Gezer C, Malkoc M. Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study. Journal of Physical Therapy Science 2015 27 22932297. (https://doi.org/10.1589/jpts.27.2293)

    • Search Google Scholar
    • Export Citation
  • 40

    Palomba S, Giallauria F, Falbo A, Russo T, Oppedisano R, Tolino A, Colao A, Vigorito C, Zullo F, Orio F. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Human Reproduction 2008 23 642650. (https://doi.org/10.1093/humrep/dem391)

    • Search Google Scholar
    • Export Citation
  • 41

    Moran LJ, Noakes M, Clifton PM, Wittert GA, Williams G, Norman RJ. Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome. American Journal of Clinical Nutrition 2006 84 7787. (https://doi.org/10.1093/ajcn/84.1.77)

    • Search Google Scholar
    • Export Citation
  • 42

    Scaruffi E, Franzoi IG, Civilotti C, Guglielmucci F, La Marca L, Tomelini M, Veglia F, Granieri A. Body image, personality profiles and alexithymia in patients with polycystic ovary syndrome (PCOS). Journal of Psychosomatic Obstetrics and Gynecology 2018 110.

    • Search Google Scholar
    • Export Citation
  • 43

    Jedel E, Labrie F, Oden A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. American Journal of Physiology: Endocrinology and Metabolism 2011 300 E37E45. (https://doi.org/10.1152/ajpendo.00495.2010)

    • Search Google Scholar
    • Export Citation