- Ambivalence towards future complications
- Suboptimal risk perceptions
- Lack of intrinsic motivation/personal fulfillment regarding lifestyle change
- Low prioritization of health

Grand Valley State University

 Barriers are defined as factors that obstruct or prevent behavior changes. Physical and psychological comorbidities as well as percieved lack of opportunity due to suboptimal risk assessment and internal motivation present a complex and interconnected set of challenges to the long-term management of PCOS.

Viewing Barriers to PCOS Treatment Through the COM-B Model

- Altered gut hormone regulation, energy expenditure, and metabolic dysfunction in PCOS complicates traditional weight loss strategies
- Excess weight contributes to difficulties with movement and exercise
- Higher prevalence of eating disorders, disordered eating, fatigue and sleep disturbances like sleep apnea

Barriers to Physical Capability in PCOS

- Feeling overwhelmed due to lack of health literacy or self-efficacy
- Mental health comorbidities such as depression, anxiety, and BDD
- Psychological distress in response to symptoms

Barriers to Psychological Capability in PCOS

- Aversion to "mundaneness" of restrictive diet
- Inaccessible/unsuitable exercise conditions to anxiety or embarrassment
- Family and work commitments 
- Lack of social support and advocacy

Barriers to Opportunity in PCOS

- Screening for and management of eating disorders, disordered eating, depression, and Obstructive Sleep Apnoea 
- Prioritizing the treatment of depressive symptoms prior to pursuing weight loss
- Promoting a weight neutral approach, especially for patients with a history of disordered eating and/or body image issues
- Increasing social support resources and greater coordination of care within the community
- Focusing on self-management strategies and finding enjoyable aspects of lifestyle change
- Training endocrinologists, dieticians, and other essential health providers how to be sensitive to the needs of individuals with chronic hormonal disorders

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