This review discusses the role of central obesity in polycystic ovary syndrome. There is increasing evidence that intraabdominal or visceral fat is either causative or a very early effect of polycystic ovary syndrome. The clinical implications of this are discussed. The simplest technique for assessing visceral fat and monitoring treatment is to measure waist circumference rather than waist:hip ratio or body weight. Weight loss is an effective treatment even where there is only a very modest reduction. The key element in lifestyle modification is regular exercise.
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