Abstract
Polycystic ovary syndrome (PCOS) is an endocrinological disorder characterized by weight-loss resistance. Time-restricted eating (TRE) has become a popular weight-loss tool. However, the efficacy of TRE for weight management in PCOS remains understudied. We evaluated the effectiveness of TRE compared with standard care (daily calorie restriction (CR)) and a no-intervention control in women with PCOS. Seventy-six participants were randomly assigned to one of three groups for 6 months: a 6-hour TRE regimen (all meals consumed between 1 p.m. and 7 p.m., without calorie tracking), a CR plan (25% daily energy restriction) or a control group with no dietary changes. The primary endpoint was percent change in body weight at 6 months. By month 6, body weight significantly decreased in the TRE group (−4.32% (95% CI, −6.20, −2.44), P < 0.01) and the CR group (−4.66% (95% CI, −7.13, −2.19), P < 0.01), relative to controls, with no difference between the TRE and CR groups (0.34% (95% CI, −2.15, 2.83), P = 0.79). No serious adverse events were reported. Our results show that in women with PCOS, TRE induced greater weight loss than the controls and was comparable to that achieved with daily CR. ClinicalTrials.gov registration: NCT05629858.
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Data availability
Due to privacy concerns, the datasets used in this study are not publicly available. However, researchers can request access to specific data for academic use only within 24 months of the publication date. Data will be anonymized and provided in summary format (not individual-level data) before sharing. Data access requests should be directed to the corresponding author (varady@uic.edu) to discuss the data of interest and obtain approval. The corresponding author will reply to data requests within a 1-month time frame. Source data are provided with this paper.
Code availability
The scripts for the statistical analysis are available upon request. Access requests should be directed to the study statistician (shaina.alexandria@northwestern.edu).
References
Dumesic, D. A. et al. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr. Rev. 36, 487–525 (2015).
McCartney, C. R. & Marshall, J. C. Polycystic ovary syndrome. N. Engl. J. Med. 375, 1398–1399 (2016).
Aboeldalyl, S. et al. The role of chronic inflammation in polycystic ovarian syndrome-a systematic review and meta-analysis. Int. J. Mol. Sci. 22, 2734 (2021).
Legro, R. S. et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 98, 4565–4592 (2013).
Domecq, J. P. et al. Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 98, 4646–4654 (2013).
Sills, E. S. et al. Diagnostic and treatment characteristics of polycystic ovary syndrome: descriptive measurements of patient perception and awareness from 657 confidential self-reports. BMC Womens Health 1, 3 (2001).
Moran, L. J., Pasquali, R., Teede, H. J., Hoeger, K. M. & Norman, R. J. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil. Steril. 92, 1966–1982 (2009).
Tolino, A. et al. Evaluation of ovarian functionality after a dietary treatment in obese women with polycystic ovary syndrome. Eur. J. Obstet. Gynecol. Reprod. Biol. 119, 87–93 (2005).
Pasquali, R. et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J. Clin. Endocrinol. Metab. 68, 173–179 (1989).
Nicolas, M. H., Crave, J. C., Fimbel, S., Simean, A. & Pugeat, M. Hyperandrogenism in hirsute and obese women. Effects of a low calorie diet. Presse Med. 22, 19–22 (1993).
Kiddy, D. S. et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 36, 105–111 (1992).
Hernandez Garcia, I. A., Gutierrez Gutierrez, A. M. & Gallardo Lozano, E. Effect of weight reduction on the clinical and hormonal condition of obese anovulatory women. Ginecol. Obstet. Mex. 67, 433–437 (1999).
Calcaterra, V. et al. Polycystic ovary syndrome in insulin-resistant adolescents with obesity: the role of nutrition therapy and food supplements as a strategy to protect fertility. Nutrients 13, 1848 (2021).
Kazemi, M. et al. A comparison of a pulse-based diet and the therapeutic lifestyle changes diet in combination with exercise and health counselling on the cardio-metabolic risk profile in women with polycystic ovary syndrome: a randomized controlled trial. Nutrients 10, 1387 (2018).
Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P. & Brand-Miller, J. C. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am. J. Clin. Nutr. 92, 83–92 (2010).
Turner-McGrievy, G. M., Davidson, C. R., Wingard, E. E. & Billings, D. L. Low glycemic index vegan or low-calorie weight loss diets for women with polycystic ovary syndrome: a randomized controlled feasibility study. Nutr. Res. 34, 552–558 (2014).
Fernandes-Alves, D., Teixeira, G. P., Guimaraes, K. C. & Crispim, C. A. Systematic review and meta-analysis of randomized clinical trials comparing time-restricted eating with and without caloric restriction for weight loss. Nutr. Rev. 84, 463–486 (2025).
Ezpeleta, M. et al. Time-restricted eating: watching the clock to treat obesity. Cell Metab. 36, 301–314 (2024).
Chang, Y., Du, T., Zhuang, X. & Ma, G. Time-restricted eating improves health because of energy deficit and circadian rhythm: a systematic review and meta-analysis. iScience 27, 109000 (2024).
Sun, M. L. et al. Intermittent fasting and health outcomes: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials. EClinicalMedicine 70, 102519 (2024).
Moreira, E. A., Most, M., Howard, J. & Ravussin, E. Dietary adherence to long-term controlled feeding in a calorie-restriction study in overweight men and women. Nutr. Clin. Pract. 26, 309–315 (2011).
Lemstra, M., Bird, Y., Nwankwo, C., Rogers, M. & Moraros, J. Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer. Adherence 10, 1547–1559 (2016).
O’Connor, S. G. et al. Perspective: time-restricted eating compared with caloric restriction: potential facilitators and barriers of long-term weight loss maintenance. Adv. Nutr. 12, 325–333 (2021).
Feyzioglu, B. S., Guven, C. M. & Avul, Z. Eight-hour time-restricted feeding: a strong candidate diet protocol for first-line therapy in polycystic ovary syndrome. Nutrients 15, 2260 (2023).
Li, C. et al. Eight-hour time-restricted feeding improves endocrine and metabolic profiles in women with anovulatory polycystic ovary syndrome. J. Transl. Med. 19, 148 (2021).
Talebi, S., Shab-Bidar, S., Moini, A., Mohammadi, H. & Djafarian, K. The effects of time-restricted eating alone or in combination with probiotic supplementation in comparison with a calorie-restricted diet on endocrine and metabolic profiles in women with polycystic ovary syndrome: a randomized clinical trial. Diabetes Obes. Metab. 26, 4468–4479 (2024).
Hall, K. D. et al. Energy balance and its components: implications for body weight regulation. Am. J. Clin. Nutr. 95, 989–994 (2012).
Cienfuegos, S. et al. Effects of 4- and 6-h time-restricted feeding on weight and cardiometabolic health: a randomized controlled trial in adults with obesity. Cell Metab. 32, 366–378 e363 (2020).
Lin, S. et al. Time-restricted eating without calorie counting for weight loss in a racially diverse population: a randomized controlled trial. Ann. Intern. Med. 176, 885–895 (2023).
American Diabetes Association Professional Practice Committee 2. Diagnosis and classification of diabetes: standards of care in diabetes—2025. Diabetes Care 48, S27–S49 (2025).
De Leon, A., Roemmich, J. N. & Casperson, S. L. Identification of barriers to adherence to a weight loss diet in women using the nominal group technique. Nutrients 12, 3750 (2020).
Bailey, C. P. et al. Time-restricted eating in community-dwelling adults: correlates of adherence and discontinuation in a cross-sectional online survey study. J. Acad. Nutr. Diet 124, 1029–1040 (2024).
Das, S. K. et al. Diet composition, adherence to calorie restriction, and cardiometabolic disease risk modification. Aging Cell 22, e14018 (2023).
Headland, M., Clifton, P. M., Carter, S. & Keogh, J. B. Weight-loss outcomes: a systematic review and meta-analysis of intermittent energy restriction trials lasting a minimum of 6 months. Nutrients 8, 354 (2016).
Hill, B. R., Rolls, B. J., Roe, L. S., De Souza, M. J. & Williams, N. I. Ghrelin and peptide YY increase with weight loss during a 12-month intervention to reduce dietary energy density in obese women. Peptides 49, 138–144 (2013).
Egan, A. M. & Collins, A. L. Dynamic changes in energy expenditure in response to underfeeding: a review. Proc. Nutr. Soc. 81, 199–212 (2022).
Speakman, J. R. & Hall, K. D. Models of body weight and fatness regulation. Philos. Trans. R. Soc. B 378, 20220231 (2023).
Lopez, P. et al. Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: a systematic review and meta-analysis. Obes. Rev. 23, e13428 (2022).
LeBlanc, E. S. et al. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: updated evidence report and systematic review for the US preventive services task force. JAMA 320, 1172–1191 (2018).
Rubino, D. et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the step 4 randomized clinical trial. JAMA 325, 1414–1425 (2021).
Naboush, A. & Hamdy, O. Measuring visceral and hepatic fat in clinical practice and clinical research. Endocr. Pract. 19, 587–589 (2013).
Bohler, H. Jr., Mokshagundam, S. & Winters, S. J. Adipose tissue and reproduction in women. Fertil. Steril. 94, 795–825 (2010).
Franks, S. et al. The role of nutrition and insulin in the regulation of sex hormone binding globulin. J. Steroid Biochem. Mol. Biol. 39, 835–838 (1991).
Poretsky, L. On the paradox of insulin-induced hyperandrogenism in insulin-resistant states. Endocr. Rev. 12, 3–13 (1991).
Borg, R. et al. Associations between features of glucose exposure and A1C: the A1C-derived average glucose (ADAG) study. Diabetes 59, 1585–1590 (2010).
Pavlou, V. et al. Effect of time-restricted eating on weight loss in adults with type 2 diabetes: a randomized clinical trial. JAMA Netw. Open 6, e2339337 (2023).
Cienfuegos, S., McStay, M., Gabel, K. & Varady, K. A. Time restricted eating for the prevention of type 2 diabetes. J. Physiol. 600, 1253–1264 (2022).
Mei, S., Ding, J., Wang, K., Ni, Z. & Yu, J. Mediterranean diet combined with a low-carbohydrate dietary pattern in the treatment of overweight polycystic ovary syndrome patients. Front. Nutr. 9, 876620 (2022).
Moran, L. J. et al. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 88, 812–819 (2003).
Thomson, R. L. et al. The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 93, 3373–3380 (2008).
Sorensen, L. B., Soe, M., Halkier, K. H., Stigsby, B. & Astrup, A. Effects of increased dietary protein-to-carbohydrate ratios in women with polycystic ovary syndrome. Am. J. Clin. Nutr. 95, 39–48 (2012).
Maczka, K., Stasiak, O., Przybysz, P., Grymowicz, M. & Smolarczyk, R. The impact of the endocrine and immunological function of adipose tissue on reproduction in women with obesity. Int. J. Mol. Sci. 25, 9391 (2024).
Hopewell, S. et al. CONSORT 2025 statement: updated guideline for reporting randomized trials. Nat. Med. 31, 1776–1783 (2025).
Teede, H. J. et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur. J. Endocrinol. 189, G43–G64 (2023).
Evert, A. B. et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 42, 731–754 (2019).
Mifflin, M. D. et al. A new predictive equation for resting energy expenditure in healthy individuals. Am. J. Clin. Nutr. 51, 241–247 (1990).
Ma, W. Y. et al. Measurement of waist circumference: midabdominal or iliac crest? Diabetes Care 36, 1660–1666 (2013).
Matthews, D. R. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412–419 (1985).
Katz, A. et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J. Clin. Endocrinol. Metab. 85, 2402–2410 (2000).
Huber, P. Under nonstandard conditions. In Proc. 5th Berkeley Symposium on Mathematical Statistics and Probability 221–233 (Univ. California Press, 1967).
Acknowledgements
We thank the trial participants for all their time and effort in participating in this study. The trial was supported by the Department of Kinesiology and Nutrition at the University of Illinois Chicago. The funders were not involved in the design, conduct or analysis of the trial. Neither the participants nor the public were involved with the design, conduct or reporting of the trial.
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Conceptualization: S. Cienfuegos, S. Corapi and K.A.V. Funding acquisition: K.A.V. Investigation: S. Cienfuegos, S. Corapi, M.-C.R., J.L., M.A.d.L., V.P., S.L., M.E., K.G., L.T.-H., V.M.O., J.S. and A.P.V. Project administration: S. Cienfuegos and S. Corapi. Formal analysis: S.J.A. Writing—original draft: K.A.V., S. Cienfuegos and S. Corapi. All authors reviewed, revised and agreed the final version of the paper.
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K.A.V. received author fees from Hachette Book Group for the book The Every Other Day Diet and from Pan MacMillan Publishing for the book The Fastest Diet. The other authors declare no competing interests.
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Extended data
Extended Data Fig. 1 Adherence to the diet interventions.
Panel A represents adherence to the time restricted eating (TRE) intervention. Data are expressed as mean (SD) days per week that participants reported being adherent with the 1:00 pm to 7:00 pm eating window; only observed values included. A total of 20/26 TRE participants returned adherence logs. Panel B represents adherence to the daily calorie restriction (CR) intervention. Data are expressed as the proportion of participants whose actual energy intake, determined via food recalls, was within 200 kcal of their prescribed daily energy goal; only observed values included. A total of 19/26 CR participants returned food records. Abbreviations: CR: Calorie restriction group, TRE: Time restricted eating group.
Extended Data Fig. 2 Difficulty in adhering to the time restricted eating versus calorie restriction intervention.
Panel A represents the proportion of time restricted eating participants who reported finding their assigned diet intervention easy, moderately easy, moderately difficult, or difficult to adhere to. A total of 19/26 TRE participants returned the survey. Panel B represents proportion of calorie restriction participants who reported finding their assigned diet intervention easy, moderately easy, moderately difficult, or difficult to adhere to. A total of 18/26 CR participants returned the survey. The proportion of TRE participants (39%) who reported finding their diet intervention “easy to adhere to” did not differ significantly (P = 0.093) from the proportion of CR participants (17%) who reported finding their diet intervention “easy to adhere to.” Two-sided P value from chi-square test.
Extended Data Fig. 3 Experimental design.
Abbreviations: CON: control group, CR: Calorie restriction group, PCOS: Polycystic ovary syndrome, TRE: Time restricted eating group.
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Corapi, S., Runchey, MC., Lyons, J. et al. Time-restricted eating for body weight management in women with polycystic ovary syndrome: a randomized controlled trial. Nat Med (2026). https://doi.org/10.1038/s41591-026-04316-7
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DOI: https://doi.org/10.1038/s41591-026-04316-7