The criteria set was that a woman must have two out of three of the following to be diagnosed with PCOS: abnormal ovulation, elevated androgen levels, and/or enlarged ovaries with 12 or more follicles each.
This study took those three criteria and found that BMI and insulin levels were the highest in the group that displayed both elevated androgens and irregular/absent ovulation, regardless of whether she had polycystic ovaries.
Subjects with PCOS defined by [irregular menses & hyperandrogenism] are the most severely affected women on the basis of androgen levels, ovarian volumes, and insulin levels. Their higher body mass index partially accounts for the increased insulin levels, suggesting that weight gain exacerbates the symptoms of PCOS.
I'm not so sure about the conclusion. We already know that weight exacerbates PCOS symptoms, but the study seems to assume that it's the weight causing the elevated androgens and irregular ovulation, and not the other way around, with no information to suggest that they looked into that, or insulin's role in causation at all.
Still, it does reaffirm what many suspect - that PCO part of PCOS is really not the main feature. Perhaps the Rotterdam criteria should be revisited?
