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To assess the effectiveness of dietary interventions and exercise in long-term weight loss in overweight and obese people. A systematic review with meta-analysis. Overweight and obese adults-18 years old or older with body mass index (calculated as weight divided by the square of height in meters)>25. Medline, Cochrane Library and Lilacs databases up to March 2003. Also, published reviews and all relevant studies and their reference lists were reviewed in search for other pertinent publications. No language restrictions were imposed. Randomised clinical trials comparing diet and exercise interventions vs diet alone. All trials included a follow-up of 1 y after intervention. Two reviewers independently abstracted data and evaluated the studies' quality with criteria adapted from the Jadad Scale and the Delphi list. The estimate of the intervention's effect size was based on the differences between the comparison groups, and then the overall effect was calculated. A chi-squared test was used to assess statistical heterogeneity. A total of 33 trials evaluating diet, exercise or diet and exercise were found. Only 6 studies directly comparing diet and exercise vs diet alone were included (3 additional studies reporting repeated observations were excluded). The active intervention period ranged between 10 and 52 weeks across studies. Diet associated with exercise produced a 20% greater initial weight loss. (13 kg vs 9.9 kg; z=1.86-p=0.063, 95%CI). The combined intervention also resulted in a 20% greater sustained weight loss after 1 y (6.7 kg vs 4.5 kg; z=1.89-p=0.058, 95%CI) than diet alone. In both groups, almost half of the initial weight loss was regained after 1 y. Diet associated with exercise results in significant and clinically meaningful initial weight loss. This is partially sustained after 1 y.
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Long-term weight loss after diet and exercise:
a systematic review
CC Curioni
* and PM Lourenc- o
Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Brazil
OBJECTIVE: To assess the effectiveness of dietary interventions and exercise in long-term weight loss in overweight and obese
DESIGN: A systematic review with meta-analysis.
SUBJECTS: Overweight and obese adultsF18 years old or older with body mass index (calculated as weight divided by the
square of height in meters)425.
DATA SOURCE: Medline, Cochrane Library and Lilacs databases up to March 2003. Also, published reviews and all relevant
studies and their reference lists were reviewed in search for other pertinent publications. No language restrictions were imposed.
STUDY SELECTION: Randomised clinical trials comparing diet and exercise interventions vs diet alone. All trials included a
follow-up of 1 y after intervention.
DATA EXTRACTION: Two reviewers independently abstracted data and evaluated the studies’ quality with criteria adapted from
the Jadad Scale and the Delphi list.
DATA SYNTHESIS: The estimate of the intervention’s effect size was based on the differences between the comparison groups,
and then the overall effect was calculated. A chi-squared test was used to assess statistical heterogeneity.
RESULTS: A total of 33 trials evaluating diet, exercise or diet and exercise were found. Only 6 studies directly comparing diet and
exercise vs diet alone were included (3 additional studies reporting repeated observations were excluded). The active
intervention period ranged between 10 and 52 weeks across studies. Diet associated with exercise produced a 20% greater
initial weight loss. (13 kg vs 9.9 kg; z ¼ 1.86Fp ¼ 0.063, 95%CI). The combined intervention also resulted in a 20% greater
sustained weight loss after 1 y (6.7 kg vs 4.5 kg; z ¼ 1.89Fp ¼ 0.058, 95%CI) than diet alone. In both groups, almost half of the
initial weight loss was regained after 1 y.
CONCLUSION: Diet associated with exercise results in significant and clinically meaningful initial weight loss. This is partially
sustained after 1 y.
International Journal of Obesity (2005) 29, 11681174. doi:10.1038/sj.ijo.0803015; published online 31 May 2005
Keywords: diet; exercise; systematic review; meta-analysis
Obesity is a chronic disease that has reached epidemic
proportions in both developed and developing countries.
Brazil, prevalence of overweight and obesity increased more
than 50% in 30 y. About 40% of adults present some
degree of weight excess, and 10% are obese. However, the
best strategies to control the epidemic have not been settled
Obesity should be recognised as a disease and treated
accordingly, because it increases the risk of several diseases.
Weight loss (5–15% of the body weight) in obese individuals
reduces the risk factors associated with obesity.
Among the several strategies for obesity treatment, diet
and exercise are considered useful for losing weight in
moderately obese adults. However, it seems that even losing
weight with these approaches, most obese individuals do not
maintain the loss for long periods.
Unfortunately, there
are no accepted rules to guide interventions promoting
behaviour and lifestyle changes for an effective and perma-
nent weight loss.
The aim of the present study was to carry out a systematic
review with meta-analysis of randomised clinical trials
assessing the effectiveness of exercise combined with dietary
interventions in initial weight loss and its long-term
maintenance among overweight and obese people.
Received 22 September 2004; revised 13 April 2005; accepted 27 April
2005; published online 31 May 2005
*Correspondence: CC Curioni, Instituto de Medicina Social, Universidade
do Estado do Rio de Janeiro, Rua Sa
o Francisco Xavier, 524, pavilha
Lyra Filho, 71 andar, blocos D e E, Maracana
Rio de Janeiro-RJ-CEP. 20559-
900, Brasil.
International Journal of Obesity (2005) 29, 11681174
2005 Nature Publishing Group All rights reserved 0307-0565/05
Randomised controlled clinical trials of diet, exercise or both
in overweight or obese adult (lowest acceptable age 18 y)
patientsFbody mass index (weight divided by the square
of height in meters) 425 as defined by the World Health
Fwere considered for inclusion. The follow-
ing sources were included in the literature search process:
The Cochrane Controlled Trials Register (Cochrane Library),
Medline (US National Library of Medicine), and Lilacs (Latin
American and Caribbean Literature in Health Sciences), up
to March 2003. The search strategy used the following
keywords and variations: obesity, overweight, diet, exercise,
randomised clinical trial. Also, published reviews and all
relevant studies and their reference lists were reviewed in
search for other pertinent publications. No language restric-
tions were imposed. Studies were included if they had a
follow-up period after intervention of at least 1 y.
We compared data obtained immediately after interven-
tion period and after 1 y of unsupervised follow-up. Data
obtained after periods greater than 1 y were only considered
if the 1 y results were not described. Sensitivity analysis was
performed to explore differences resulting from the exclu-
sion of such studies.
Diet included any type of caloric restriction, and exercise
included any type of exercise in which it was possible to
quantify the recommended activity. Studies including
pregnant woman or children or the use of any medication
were excluded. Diet and exercise interventions could be
associated with behavioural therapy. However, studies of
behavioural therapy as the only intervention were excluded.
No restriction about health status was made. No pre-
specified weight loss after intervention was required.
Both authors independently considered studies for inclu-
sion. Initially, the reviewers scanned the titles, abstracts and
keywords of every article retrieved to determine whether it
met the predetermined eligibility criteria. In the presence of
any doubt about article inclusion, a final consensus decision
was taken after the full text was jointly reviewed.
The study quality was rated using specific quality criteria
adapted from the Jadad Scale and the Delphi list.
Sensitivity analyses were planned to evaluate the possible
influence of studies with methodological flaws such as high
dropout rates. Of all, 33 trials evaluating diet, exercise or diet
and exercise were found. A table with the excluded studies is
presented at the end of the article (Appendix A ).
For meta-analysis, three values were obtained in each
group: the sample size, the mean and its standard deviation.
The individual effect size of the intervention was obtained
from the magnitude of the differences between groups
(reduced weight in the combined intervention group in
relation to diet alone controls). The global effect was then
calculated with the respective 95% confidence intervals
through the inverse variance method. Initially a fixed effects
model was used presuming homogeneity among studies.
Heterogeneity between trial results was tested using a
standard chi-squared test with a significance level of
alpha ¼ 0.1 in view of the low power of such test. Data were
analysed using the statistical software Stata 6.0.
Weight loss percentage (and variance) immediately after
intervention and after 1 y was obtained through w. Where w:
(w1) early weight loss after intervention ¼ weight loss
immediately after intervention (post-intervention)/ baseline
(w2) weight loss after 1 y ¼ weight loss after 1 y follow-up/
baseline weight,
(w3) weight maintenance ¼ weight loss after 1 y follow-up/
early weight loss after intervention.
The standard deviation (SD) was calculated through the
¼ N (a/b) (1[a/b]); and SD ¼ Os
, where S
Descriptive data of the included studies are presented in
Table 1. The sample size of the studies varied from 40 to 127
individuals with age ranging from 21 to 65 y. Three studies
were performed only with women, one only with men, and
two with patients of both genders. The length of the
intervention varied from 10 to 52 weeks, and follow-up
Table 1 Descriptive data of studies included in this paper
Reference Country n Sex Age Intervention Dropout rate (%) Length of treatment (weeks) Follow-up (months)
1. Borg et al
Finland 90 M 35–50 D D+E 24 32 24
2. Fogelholm et al
Finland 82 F 30–45 D D+E 9.4 40 24
3. Wadden et al
USA 120 F 30–50 D D+E 17 48 12
4. Fogelholm et al
Finland 82 F 30–45 D D+E 9.4 40 24
5. Andersen et al
USA 40 F 21–60 D D+E 17.5 16 12
6. Weinstock et al
USA 120 F 30–50 D D+E 17 48 12
7. Wadden et al
USA 120 F 30–50 D D+E 17 48 12
8. Skender et al
USA 127 F & M 25–45 D E D+E 19 52 12
9. Wing et al
USA 55 F & M 30–65 D D+E 14.5 10 12
Abbreviations: USA, United States of America; F, female; M, male; D, diet; E, exercise; D+E, diet and exercise; studies excluded from analysis due to data duplicity are
in boldface.
Two groups with variable intensities of exercise in the original paper were grouped in a single group (using t-test) and compared to the diet only group.
Three groups with variable intensities of exercise in the original paper were grouped in a single group (using t-test) and compared to the diet only group.
Long-term weight loss after diet and exercise
CC Curioni and PM Lourenc- o
International Journal of Obesity
from 12 to 24 months. In all but one study, patients were
seen once a week during the entire period of intervention,
usually in small groups. Among the included studies, some
presented duplicated data (12 and 14; 13, 16 and 17). For
data analysis, only the last published trials were included.
Therefore, six trials were analysed. With regard to the follow-
up, the end point chosen for the present analysis was 1 y
after the end of the intervention.
The baseline weight average varied from 83.5 to 106 kg
(Table 2). The dropout rate was less than 20% in all studies
except that from Borg et alF24% dropout rate.
This same
study only presented results at the end of a 23 months
follow-up (no data in 1 y after intervention). Therefore, a
sensitivity analysis was performed excluding this study.
Most studies only mentioned that that they constituted
a randomised controlled trial, only two actually describing
the randomising process.
No study gave information
about the blinding process nor made an intention-to-treat
Individuals in the diet and exercise group had a mean
weight loss after intervention approximately 20% greater
than individuals in the diet group: 13.0710.4 kg vs
9.979.6 kg, p ¼ 0.063. Heterogeneity was not detected
through the chi-square test (Figure 1). The results are not
significantly changed if the study N.1
is excluded from the
analysis (22% greater mean weight loss in the diet and
exercise group: 12.9710.2 vs 9.477.7, p ¼ 0.066, 0.46–
0.01; 95%CI).
Table 2 Comparison of diet and exercise vs diet
Diet and exercise Diet
(reference) N
Baseline weight
Initial weight loss
Weight loss after 1 y
(kg) N
Baseline weight
Weight loss
intervention (kg)
Weight loss after 1 y
Study 1
53 106.079.9 13.7713.6 5.1715.6
29 106.079.9 12.1714.9 5.3720.4
Study 2
53 91.372.0 13.8711.0 5.6714.0 29 93.271.6 11.2710.3 3.579.7
Study 3
91 96.0713.9 15.479.1 9.179.6 21 96.378.8 14.476.2 6.976.3
Study 5
20 83.678.6 8.373.8 6.776.7 20 90.5713.5 7.974.2 7.876.2
Study 8
21 100.1727.4 8.9711.5 2.276.7 15 98.5725.9 6.877.8 +0.977.7
Study 9
27 105.375.8 8.976.2 7.976.9 28 100.174.9 6.475.2 3.975.2
Total 265 97.4716.1 13.0710.4 6.778.3 142 97.8 710.7 9.979.6 4.5711.3
The follow-up period was 23 months (unsupervised).
ll l
Figure 1 Meta analysis of weight-loss after intervention comparing diet and exercise vs diet.
Long-term weight loss after diet and exercise
CC Curioni and PM Lourenc- o
International Journal of Obesity
As to weight loss maintenance after 1 y, diet and exercise
also resulted in 20% greater weight loss than diet alone:
6.778.3 vs 4.5711.3 kg, p ¼ 0.058 (Figure 2). The exclu-
sion of the previously mentioned study
resulted in slightly
different findings of the meta-analysis, however, with more
marked differences favouring the diet and exercise group
(26% greater weight reduction with diet and exercise
group: 7.1710.3 vs 4.477.7, p ¼ 0.03, 0.50 to 0.03;
95% CI).
The percentages of weight loss from baseline weight were:
w1 (immediately after intervention)F1375.5% for the diet
and exercise group and 1073.6% for the diet group; w2
(after 1 y)F6.874.1 and 4.672.5%, respectively. There was a
similar weight regain in both groups after 1 y: w3F5078.2
and 5075.9%. These results are not influenced if study N.1
is excluded (data not shown).
The present study indicates that programs including both
diet and exercise produce greater weight loss than diet alone
in obese and overweight individuals soon after the interven-
tion period and after 1 y of follow-up. In both groups, the
magnitude of weight reduction immediately after interven-
tion as after 1 y of follow-up is compatible with clinically
significant benefitsFreduction of cardiovascular risk factors;
improvement of glicemic control and hyperinsulinemia in
diabetics; decrease of blood pressure, total cholesterol, LDL-
cholesterol and triglyceride levels; increase of HDL-choles-
terol concentrations.
Weight regain in individuals in both interventions
approached 50%. Adding exercise to diet did not produce a
better long-term maintenance of the lost weight. Fogelholm
and Kukkonen-Harjula
published a review of physical
activity to prevent weight gain analysing both observational
studies and randomised clinical trials. Results from observa-
tional studies (but not those from the clinical trials also
analysed) suggested that exercise leads to successful weight
loss maintenance.
Also, in contrast to some studies,
observed that an initial greater weight loss was very hard to
sustain. Our results suggest that individuals changed their
lifestyle, but just for a short period, since they partially
returned to their previous patterns. This study only evalu-
ated weight loss, which did not allow us to determine the
reasons for weight regain. Additional outcomes would be
necessary to evaluate possible associationsFbehavioural and
physiologic factors, among others. It would be also impor-
tant to explore differences among individuals that regained
weight and those who maintained the lost weight.
The great difficulty and limitation of weight loss studies
is that they only report the mean group weight changes and
not the frequency of expected responses to the interven-
tions, ie, how many people actually lost weight. Means are
not appropriate to evaluate how many people attained a
clinically significant weight loss.
A number of systematic reviews on weight loss and
maintenance related to diet and physical activity have been
published. McTigue et al
reported that counselling on diet
or physical exercise and behavioural interventions resulted
in small to moderate degrees of sustained weight loss (3–5 kg)
Figure 2 Meta analysis of weight-loss maintenance after 1 y of follow-up comparing diet and exercise vs diet.
Long-term weight loss after diet and exercise
CC Curioni and PM Lourenc- o
International Journal of Obesity
over at least 1 y. However, the results of the studies could not
be grouped, and those reporting some success in weight
maintenance were commented on individually. Miller et al
reported an initial weight loss of 11% of the baseline weight,
and of 7–9% after 1 y of follow-up. Anderson et al
maintenance of 11% reduction in initial weight after 1 y of
follow-up. All these systematic reviews included only cohort
studies. The present study, on the other hand, included only
controlled clinical trials, which evaluate more accurately the
true intervention effect on the long-term weight loss.
Other systematic reviews on obesity management are
worth mentioning. In general, their results support our
own findings. In the review from Fogelholm and Kukkonen-
most clinical trials did not find that exercise
training improve weight maintenance. Glennny et al
another review evaluating many aspects of obesity treatment
and prevention, reported that most trials included demon-
strate weight regain either during or after the intervention
A number of limitations of the present analysis should
be acknowledged. Most studies were of poor quality: few
described clearly the randomising process and none included
intention-to-treat analyses. In addition, subgroup analyses
by sex, age and initial weight would be important to explore
effect size differences. The funnel plot to investigate the
existence of publication bias could not be evaluated. With a
limited number of studies included, this analysis has limited
power to detect bias and the results can be distorted.
In conclusion, the present study confirms the important
role of diet and exercise in short and long-term weight loss.
Diet associated with exercise can provide greater initial
weight-loss than diet alone. Most importantly, we have
shown that after 1 y the combined approach is also
associated with greater weight loss than diet alone, in a
range compatible with clinically relevant benefits. Both
types of studied interventions are, however, associated with
partial long-term weight regain (50% in 1 y). Programs to
treat obese and overweight individuals should explore the
best strategies to promote prolonged changes in lifestyle
leading to caloric adequacy and increase in physical activity.
Future researchers should identify program patterns that
are more effective in the long-term. Although dropouts
cannot always be controlled, all effort should be made to
verify their reasons. This would allow a better knowledge of
the factors that affect adherence to therapeutic programs.
The results should also include outcomes such as frequency
of pre-established responses to interventions. In order to
attain higher levels of scientific evidence, future randomised
clinical trials should also describe the randomisation and
blinding processes and include intention-to-treat analyses.
The authors thank: Rosely Sichieri, MD, PhD, Instituto de
Medicina SocialFUniversidade do Estado do Rio de Janeiro;
and Charles Andre
, MD, PhD, Universidade Federal do Rio de
Janeiro for valuable suggestions.
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Long-term weight loss after diet and exercise
CC Curioni and PM Lourenc- o
International Journal of Obesity
Appendix A
Table A1 Table of excluded trials
Study reference
Baseline BMI (kg/m
% of ideal weight Age(Y) Intervention
Duration of
(Months) Reason for exclusion
King et al
120–160% 30–59 D E C 52 12 There is no diet+exercise group
Jeffery et al
14–32 kg over ideal
25–45 D+E C 52 18 There is no diet only group
Pavlou et al
122% 26–52 D D+E 8 18 Information only available in graph, with
values not described
Perri et al
160% 22–60 BT+E+M BT+E BT+
20 18 There is no diet intervention, only behavioral
therapy (BT) in groups; the M group was
periodically contacted during follow-up.
Sikand et al
170–200% 21–60 D D+E 20 24 The follow-up weight is self-reported; poor
methodological quality
Tuomilehto et al
26.5–35.9 40–65 D+E C 52 12 There is no diet only group
Uusitupa et al
26.5–35.9 40–65 D+E C 52 12 There is no diet only group
van Dale et al
32.3 (mean) 34 (mean) D D+E 12–14 18–42 Not a randomized clinical trial: subjects
entered in three different diet-exercise studies
BT, behavioral therapy; C, control; D, diet; E, exercise; M, multicomponent maintenance program. Other studies exclusively comparing two different interventions
of diet were also excluded.
Long-term weight loss after diet and exercise
CC Curioni and PM Lourenc- o
International Journal of Obesity
... At each timepoint, exercising or being physically active was the most reported weight management strategy, ranging from 54% at timepoint 1, to 40% at timepoint 8. Further, the findings indicated that those who were physically active or exercised, reduced their bodyweight by -1.21 kg more, than those who were not physically active. Whilst weight maintenance is a recognised benefit of physical activity, most research comparing the relative benefits of diet versus exercise for weight loss identify diet as the more potent strategy [33,34]. Therefore, it was somewhat surprising that physical activity was associated with weight loss in this study, while dietary strategies were not. ...
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Background Obesity is a growing, global public health issue. This study aimed to describe the weight management strategies used by a sample of Australian adults; examine the socio-demographic characteristics of using each strategy; and examine whether use of each strategy was associated with 12-month weight change. Methods This observational study involved a community-based sample of 375 healthy adults (mean age: 40.1 ± 5.8 years, 56.8% female). Participants wore a Fitbit activity monitor, weighed themselves daily, and completed eight online surveys on socio-demographic characteristics. Participants also recalled their use of weight management strategies over the past month, at 8 timepoints during the 12-month study period. Results Most participants (81%) reported using at least one weight management strategy, with exercise/physical activity being the most common strategy at each timepoint (40–54%). Those who accepted their current bodyweight were less likely to use at least one weight management strategy (Odds ratio = 0.38, 95% CI = 0.22–0.64, p < 0.01) and those who reported being physically active for weight maintenance had a greater reduction in bodyweight, than those who did not (between group difference: -1.2 kg, p < 0.01). The use of supplements and fasting were associated with poorer mental health and quality of life outcomes (p < 0.01). Conclusions The use of weight management strategies appears to be common. Being physically active was associated with greater weight loss. Individuals who accepted their current body weight were less likely to use weight management strategies. Fasting and the use of supplements were associated with poorer mental health. Promoting physical activity as a weight management strategy appears important, particularly considering its multiple health benefits.
... Also, obesity is considered a major risk factor for several non-communicable diseases, such as cardiovascular disease, hypertension, diabetes mellitus II, and non-alcoholic fatty liver disease (3). There are various strategies for obesity management, with lifestyle modifications including a healthy diet and being physically active are the key players (4). Other methods are used, such as the use of medications and herbs and bariatric surgery. ...
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Background: Obesity is a global pandemic health problem. Attempting weight reduction, excess weight people commonly seek herbal products in addition to claim diets. We aimed to assess the prevalence of consuming herbal and dietary products for weight loss purposes and to assess weight reduction attitudes and beliefs among a group of excess-weight adults in Jordan. Methods: A cross-sectional study was conducted on a sample of 477 Jordanian adults (81.6% females), between Feb-Apr/2021. The study data collection was completed by using a validated online structured questionnaire. Results: 28.9% of the male participants reported that the most common source of diets they followed was by themselves (43.2%) and by dietitians (25%). Whereas female participants followed the weight reduction diets prescribed by dietitians, by themselves, and on the internet (31.1%; 26.5%, and 23.7; respectively, P=0.011). The majority of participants from both genders do not believe in using weight reduction herbs alone for losing weight; it must be done along with diet and exercise (P=0.018). Females who use herbs for weight reduction were more than males. In addition, green tea was the most used herb by all participants (8%). The main advisor for using weight reduction herbs and dietary products in females was the internet (30.1%) followed by their own (24.2%). However, in males, it was by their own (21.6%), then by a dietitian (12.6%), and by the internet (12.5%) (P=0.001). Moreover, a quarter of male participants and 21.6% of females did not feel that using herbs to lose weight was efficient. Conclusion: The excess weight adults in Jordan seek to use diet, herbs, and dietary products for weight reduction, advised by unreliable sources. Although the majority are convinced that it is not effective alone, further studies are needed to assess the side effects and safety of such consumption among the population.
... However, evidence for the sustainability of behaviour change in response to interventions is limited (Avenell et al., 2004;Carpenter et al., 2013;Dombrowski et al., 2014;Fjeldsoe et al., 2011). This is partly because few studies evaluate long-term effects and partly because intervention effects diminish over time (Curioni & Lourenco, 2005;Dombrowski et al., 2010). ...
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Student behaviour, in general, is still a problem. Many students still need to be responsible for school assignments and do not do homework or other assignments. Concern for the environment is still very low. Like they were throwing trash in its place. Therefore, the ability of the teacher to intervene in modifying student behaviour is essential. This research was carried out to provide Behavior Modification Models for improving children's social skills. It was divided into four parts: (1) a preliminary study, (2) a workshop on behaviour modification, (3) a field test on the behaviour modification models and (4) improvement to the models following the test results. The participants consisted of 225 Islamic elementary school students in Indonesia. The data were examined by SEM (Structural Equation Modeling). The students' skills were developed using behaviour modification techniques, namely modelling, reinforcement, token economy, punishment, prompt, relaxation and shaping. The result suggested the importance of cognitive process (awareness) and learning contracts through class discussion for improving children's social skills. An interesting finding is that there is a significant increase in the application of behaviour modification techniques when students are involved in thinking and being involved in determining activities or actions that disturb the class and the consequences that will be given if students commit several violations in class through contract learning or agreement techniques, modelling, reinforcement, token economy, punishment, time out, relaxation and awareness of cognition.
... Thus, an effective and durable treatment of severe obesity in patients with DM, preventing and improving its comorbidities of MACE, may be crucial to decrease the cost and mortality. Lifestyle-based behavioral and pharmacological interventions for weight loss remain the major approaches to obesity prevention and management [12,13] but with limited success. Metabolic and bariatric surgery (MBS) has become one of the most commonly performed operations in general surgery. ...
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Purpose Metabolic and bariatric surgery (MBS) can exert effective function on glycemic control. The present study aimed to estimate the risk of MACE among obese patients with diabetes after MBS. Materials and Methods Systematic search of PubMed, Embase, Medline, and Web of Science was performed for studies published before 20th February 2023. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the outcome. The statistical heterogeneity among studies was assessed with the Q-test and I² statistics. Results Fifteen cohort studies with 122,361 obese patients with diabetes were available for analysis. Our meta-analysis found significantly decreased morbidity and mortality of MACE (OR = 0.65, 95% CI = 0.59–0.72, I² = 62.8% for morbidity, OR = 0.49, 95% CI = 0.36–0.67, I² = 68.7% for mortality). Subgroup analysis revealed MBS decreased cerebrovascular disease, coronary artery disease, atrial fibrillation, heart failure, myocardial infarction, and stroke risk. Conclusion Our meta-analysis indicated that MBS for obese patients with diabetes is beneficial to decreasing MACE risk. Moreover, further studies estimating the functional effect may eventually provide a better and comprehensive understanding of the effect on different populations. Graphical Abstract
... Type 2 diabetes mellitus (T2DM) is preventable by lifestyle interventions targeting weight reduction by changes in diet and physical activity [1,2]. Meta-analyses of randomized controlled trials (RCTs) have, however, shown that a large proportion of people are unable to maintain achieved weight loss [3,4]. Body weight is a result of a variety of factors, some of which are more and some less modifiable [5]. ...
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Background Behavioral processes through which lifestyle interventions influence risk factors for type 2 diabetes (T2DM), e.g., body weight, are not well-understood. We examined whether changes in psychological dimensions of eating behavior during the first year of lifestyle intervention would mediate the effects of intervention on body weight during a 9-year period. Methods Middle-aged participants (38 men, 60 women) with overweight and impaired glucose tolerance (IGT) were randomized to an intensive, individualized lifestyle intervention group (n = 51) or a control group (n = 47). At baseline and annually thereafter until nine years body weight was measured and the Three Factor Eating Questionnaire assessing cognitive restraint of eating with flexible and rigid components, disinhibition and susceptibility to hunger was completed. This was a sub-study of the Finnish Diabetes Prevention Study, conducted in Kuopio research center. Results During the first year of the intervention total cognitive (4.6 vs. 1.7 scores; p < 0.001), flexible (1.7 vs. 0.9; p = 0.018) and rigid (1.6 vs. 0.5; p = 0.001) restraint of eating increased, and body weight decreased (−5.2 vs. −1.2 kg; p < 0.001) more in the intervention group compared with the control group. The difference between the groups remained significant up to nine years regarding total (2.6 vs. 0.1 scores; p = 0.002) and rigid restraint (1.0 vs. 0.4; p = 0.004), and weight loss (−3.0 vs. 0.1 kg; p = 0.046). The first-year increases in total, flexible and rigid restraint statistically mediated the impact of intervention on weight loss during the 9-year study period. Conclusions Lifestyle intervention with intensive and individually tailored, professional counselling had long-lasting effects on cognitive restraint of eating and body weight in middle-aged participants with overweight and IGT. The mediation analyses suggest that early phase increase in cognitive restraint could have a role in long-term weight loss maintenance. This is important because long-term weight loss maintenance has various health benefits, including reduced risk of T2DM.
Context: The T4DM study randomized 1007 men with impaired glucose tolerance or newly diagnosed diabetes to testosterone undecanoate (TU, 1000 mg) or matching placebo (P) injections every 12 weeks for 24 months with a lifestyle program with T treatment reducing diabetes diagnosis by 40%. Design: A follow-up email survey after a median of 5.1 years since last injection obtained 599 (59%) completed surveys (316 T, 283 P) with participants in follow-up survey like non-participants in 23 anthropometric and demographic variables. Results: Randomization to TU associated with stronger belief in study benefits during (64% vs 49%, p < 0.001) but no longer after the study (44% vs 40%, p = 0.07) and high interest in future studies. At T4DM entry, 25% had sleep apnea with new diagnosis more frequent on TU (3.0% vs 0.4%, p = 0.03) during, but not after, the study. Post-study resuming prescribed testosterone treatment was more frequent among TU treated men (6% vs 2.8%, p = 0.03). Five years after cessation of TU treatment there was no difference in self-reported rates of new diagnosis of diabetes, prostate or cardiovascular disease nor change in weight maintenance or weight loss behaviours. Conclusions: We conclude that randomized T treatment for 24 months in men with impaired glucose tolerance or new diabetes but without pathological hypogonadism was associated with higher levels of self-reported benefits and diagnosis of sleep apnea during, but not after, the study as well as more frequent prescribed post-study testosterone treatment consistent with androgen dependence in some men receiving prolonged injectable TU.
In most lifestyle, pharmacological and surgical interventions, weight loss occurs over an approximately 6- to 9-month period and is followed by a weight plateau and then weight regain. Overall, only about 15% of individuals can sustain a 10% or greater non-surgical, non-pharmacological, weight loss. A key question is the degree to which the genotypes, phenotypes and environmental correlates of success in weight loss and weight loss maintenance are continuous or dichotomous. This Perspective is a comparison of the interactions of weight loss and maintenance with genetic, behavioural, physiological and environmental homeostatic systems and a discussion of the implications of these findings for research in, and treatment of, obesity. Data suggest that weight loss and weight loss maintenance are physiologically and psychologically different in many ways. Consequently, individuals may require different interventions designed for temporarily sustaining a negative energy balance during weight loss versus permanently maintaining energy balance after weight loss.
The prevalence of obesity has been increasing globally. Due to the negative health effects, obesity has been recognized as a major public health concern. Obesity is defined as a body mass index (BMI) of greater than or equal to 30 kg/m2. The location (i.e., abdominal) and type of excess weight contributes to ill-health; thus, methods such as waist circumference and body fat measurements are used in the assessment of obesity. In relation to obesity and type 2 diabetes (T2D), genetics, physical activity, and diet are key predictors to the development of these chronic conditions. Fortunately, treatment options for obesity and T2D are similar and can be categorized as lifestyle, pharmacological, or surgical. When medications or surgery is added to lifestyle interventions, there is much greater benefit in terms of weight loss and diabetes control over lifestyle interventions on their own.KeywordsObesityType 2 diabetes (T2D)Weight managementLifestyleBehavioralPharmacologicalBariatric surgeryPhysical activityDiet
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Background: Currently available treatment options for Parkinson's disease are symptomatic and do not alter the course of the disease. Recent studies have raised the possibility that cardiovascular risk management may slow the progression of the disease. Objectives: We estimated the effect of baseline cardiovascular risk factors on the progression of Parkinson's disease, using measures for PD-specific motor signs and cognitive functions. Methods: We used data from 424 de novo Parkinson's disease patients and 199 age-matched controls from the observational, multicenter Parkinson's Progression Markers Initiative (PPMI) study, which included follow-up of up to 9 years. The primary outcome was the severity of PD-specific motor signs, assessed with the MDS-UPDRS part III in the "OFF"-state. The secondary outcome was cognitive function, measured with the Montreal Cognitive Assessment, Symbol Digit Modalities Test, and Letter-Number Sequencing task. Exposures of interest were diabetes mellitus, hypertension, body mass index, cardiovascular event history and hypercholesterolemia, and a modified Framingham risk score, measured at baseline. The effect of each of these exposures on disease progression was modeled using linear mixed models, including adjustment for identified confounders. A secondary analysis on the Tracking Parkinson's cohort including 1,841 patients was performed to validate our findings in an independent patient cohort. Results: Mean age was 61.4 years, and the average follow-up was 5.5 years. We found no statistically significant effect of any individual cardiovascular risk factor on the MDS-UPDRS part III progression (all 95% confidence intervals (CIs) included zero), with one exception: in the PD group, the estimated effect of a one-point increase in body mass index was 0.059 points on the MDS-UPDRS part III per year (95% CI: 0.017 to 0.102). We found no evidence for an effect of any of the exposures on the rate of change in cognitive functioning in the PD group. Similar results were observed for the Tracking Parkinson's cohort (all 95% CIs overlapped with PPMI), but the 95% CI of the effect of body mass index on the MDS-UPDRS part III progression included zero. Conclusions: Based on this analysis of two large cohorts of de novo PD patients, we found no evidence to support clinically relevant effects of cardiovascular risk factors on the clinical progression of Parkinson's disease.
Background: Obesity is a chronic disease that has become one of the most serious health problems in Western society. Objective: We assessed the long-term effects of an energy-restricted diet combined with 1 or 2 daily meal replacements on body weight and biomarkers of disease risk in 100 obese patients. Design: Phase 1 consisted of a 3-mo, prospective, randomized, parallel intervention study of 2 dietary interventions to reduce weight. The energy-restricted diet (5.2–6.3 MJ/d) consisted of conventional foods (group A) or an isoenergetic diet with 2 meals and 2 snacks replaced daily by energy-controlled, vitamin-and-mineral-supplemented prepared foods (group B). Phase 2 consisted of a 24-mo, case-control, weight-maintenance study with an energy-restricted diet and 1 meal and 1 snack replaced daily for all patients. Results: Total weight loss (as a percentage of initial body weight) was 5.9 ± 5.0% in group A and 11.3 ± 6.8% in group B (P < 0.0001). During phase 1, mean weight loss in group B (n = 50) was 7.1 ± 3.5 kg, with significant reductions in plasma triacylglycerol, glucose, and insulin concentrations (P < 0.0001). Group A patients (n = 50) lost an average of 1.3 ± 2.2 kg with no significant improvements in these biomarkers. During phase 2, both groups lost on average an additional 0.07% of their initial body weight every month (P < 0.01). During the 27-mo study, both groups experienced significant reductions in systolic blood pressure and plasma concentrations of triacylglycerol, glucose, and insulin (P < 0.01). Conclusion: These findings support the hypothesis that defined meal replacements can be used for successful, long-term weight control and improvements in certain biomarkers of disease risk.
Tested whether the efficacy of behavior therapy for obesity might be improved by the programmatic additions of an aerobic exercise regimen during treatment and a multicomponent maintenance program following treatment. 14 male and 76 female obese 22–60 yr olds were randomly assigned to 2 treatment conditions (behavior therapy or behavior therapy plus aerobic exercise) and 2 posttreatment conditions (no further contact or a multicomponent maintenance program). The exercise regimen consisted of 80 min/week of brisk walking or stationary cycling. The maintenance program included therapist contact by telephone and mail and peer self-help group meetings. At posttreatment, Ss in the behavior therapy plus aerobic exercise condition lost significantly more weight than those who received behavior therapy only. Over an 18-mo follow-up period, maintenance program participants demonstrated significantly better weight-loss progress than Ss in the no-further-contact condition. (29 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background: Obesity poses a considerable and growing health burden. This review examines evidence for screening and treating obesity in adults. Data Sources: MEDLINE and Cochrane Library (January 1994 through February 2003). Study Selection: Systematic reviews; randomized, controlled trials; and observational studies of obesity's health outcomes or efficacy of obesity treatment. Data Extraction: Two reviewers independently abstracted data on study design, sample, sample size, treatment, outcomes, and quality. Data Synthesis: No trials evaluated mass screening for obesity, so the authors evaluated indirect evidence for efficacy. Pharmacotherapy or counseling interventions produced modest (generally 3 to 5 kg) weight loss over at least 6 or 12 months, respectively. Counseling was most effective when intensive and combined with behavioral therapy. Maintenance strategies helped retain weight loss. Selected surgical patients lost substantial weight (10 to 159 kg over 1 to 5 years). Weight reduction improved blood pressure, lipid levels, and glucose metabolism and decreased diabetes incidence. The internal validity of the treatment trials was fair to good, and external validity was limited by the minimal ethnic or gender diversity of volunteer participants. No data evaluated counseling harms. Primary adverse drug effects included hypertension with sibutramine (mean increase, 0 mm Hg to 3.5 mm Hg) and gastrointestinal distress with orlistat (1% to 37% of patients). Fewer than 1% (pooled samples) of surgical patients died; up to 25% needed surgery again over 5 years. Conclusions: Counseling and pharmacotherapy can promote modest sustained weight loss, improving clinical outcomes. Pharmacotherapy appears safe in the short term; long-term safety has not been as strongly established. In selected patients, surgery promotes large amounts of weight loss with rare but sometimes severe complications.
We tested the hypothesis that the use of a very-low-calorie diet (VLCD) in combination with behavior modification would promote long-term glycemic control in obese type 2 diabetic subjects. Thirty-six diabetic subjects were randomly assigned to a standard behavior therapy program or to a behavior therapy program that included an 8-week period of VLCD. The behavior therapy group consumed a balanced diet of 4200 to 6300 J/d throughout the 20-week program. The VLCD group consumed a balanced diet of 4200 to 6300 J for weeks 1 to 4, followed by a VLCD (1680 J/d of lean meat, fish, and fowl) for weeks 5 to 12. The VLCD group then gradually reintroduced other foods during weeks 13 to 16 and consumed a balanced diet of 4200 to 6300 J/d for weeks 17 to 20. Thirty-three of the 36 subjects completed the 20-week program and the 1-year follow-up. Use of the VLCD produced greater decreases in fasting glucose at the end of the 20-week program and at 1-year follow-up and greater long-term reductions in HbA1. The VLCD group also had greater weight losses at week 20, but weight losses from pretreatment to 1-year follow-up were similar in the two treatment groups. The improved glycemic control with the VLCD appeared to be due to increased insulin secretion, but further research is needed to confirm this. (Arch Intern Med. 1991;151:1334-1340)
About 97 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. The aim of this guideline is to provide useful advice on how to achieve weight reduction and maintenance of a lower body weight. It is also important to note that prevention of further weight gain can be a goal for some patients. Obesity is a chronic disease, and both the patient and the practitioner need to understand that successful treatment requires a life-long effort. Assessment of Weight and Body Fat Two measures important for assessing overweight and total body fat content are; determining body mass index (BMI) and measuring waist circumference. 1. Body Mass Index: The BMI, which describes relative weight for height, is significantly correlated with total body fat content. The BMI should be used to assess overweight and obesity and to monitor changes in body weight. Measurements of body weight alone can be used to determine efficacy of weight loss therapy. BMI is calculated as weight (kg)/height squared (m 2). To estimate BMI using pounds and inches, use: [weight (pounds)/height (inches) 2 ] x 703. Weight classifications by BMI, selected for use in this report, are shown in the table below. • Pregnant women who, on the basis of their pre-pregnant weight, would be classified as obese may encounter certain obstetrical risks. However, the inappropriateness of weight reduction during pregnancy is well recognized (Thomas, 1995). Hence, this guideline specifically excludes pregnant women. Source (adapted from): Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997.