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On a background of genetic susceptibility, PCOS often becomes clinically manifest following weight gain, commonly during adolescence. A common endocrinopathy affecting between 6%\u201010% of reproductive\u2010age women, PCOS presents with the cardinal features of hyperandrogenism, reproductive and metabolic dysfunction. PCOS associates with insulin resistance, independently of (but amplified by) obesity. Insulin resistance in PCOS is characterized by abnormal post\u2010receptor signalling within the phosphatidylinositol\u2010kinase (PI3\u2010K) pathway. Multiple factors (including most notably, weight gain) contribute towards the severity of insulin resistance in PCOS. Compensatory hyperinsulinaemia ensues, resulting in over\u2010stimulation of the (intact) post\u2010receptor mitogen\u2010activated protein kinase (MAP\u2010K) insulin pathway, with consequent implications for steroidogenesis and ovarian function. In this concise review, we explore the effects of weight gain and obesity on the pathogenesis of PCOS from the perspective of its three cardinal features of hyperandrogenism, reproductive and metabolic dysfunction, with a focus on the central mediating role of the insulin pathway. We also consider key lifestyle strategies for the effective management of obese and overweight women with PCOS.<\/jats:p>","DOI":"10.1111\/cen.14421","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T16:51:38Z","timestamp":1610988698000},"page":"531-541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":264,"title":["Obesity and polycystic ovary syndrome"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-9195","authenticated-orcid":false,"given":"Thomas M.","family":"Barber","sequence":"first","affiliation":[{"name":"Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK"},{"name":"Warwick Medical School University of Warwick Coventry 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