Polycystic ovary syndrome (PCOS) is a common condition in women with reproductive age associated with reproductive and metabolic dysfunction. Treatment has traditionally focused on fertility and hormonal therapy. However, obesity, central obesity, and insulin resistance (IR) are strongly implicated in its etiology, and improving these factors has become a treatment target in PCOS. Lifestyle modification programs with an emphasis on behavioral management and dietary and exercise interventions have been successful in reducing the risk of diabetes and the metabolic syndrome in the general population and improving reproductive and metabolic features in PCOS, although as yet there is limited evidence for specific dietary and exercise approaches and guidelines for use in PCOS and requires further investigation. The use of antiobesity pharmacologic agents and bariatric surgery has been recently studied in PCOS and may offer additional treatment options for the future. Future research should focus on the optimal dietary strategies and exercise regimens for PCOS treatment and the relative efficacy and appropriate use of lifestyle management versus antiobesity pharmacologic agents and surgery.