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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
... While the role of PA and exercise in weight management has been questioned [14], interventions combining both dietary-energy restriction and changes in PA usually promote a greater WL which is better sustained over time [15]. For instance, a systematic-review observed that combining dietary-energy restriction and exercise lead to a 20% greater total WL in comparison to dietary modifications alone [16]. Furthermore, during 6 months of a lifestyle WL intervention, participants on the higher PA group had an increase of 47min/day (and a reduction in sedentary time of 52min/day), achieving a greater total WL [17]. ...
... These findings are in agreement with a previous WL study (meal plan and instructions to increase PA) in which the group of individuals that had greater increases in moderate-to-vigorous PA lost more weight after 6 months [6], suggesting that maintaining or increasing PA during periods of dietary-induced energy restriction may be an important behavioural strategy to facilitate WL. Overall, these findings corroborate previous literature reporting that the combination of diet and PA leads to better WL outcomes [16,18]. ...
This secondary analysis examined the influence of changes in physical activity (PA), sedentary time and energy expenditure (EE) during dietary energy restriction on the rate of weight loss (WL) and 1-year follow-up weight change in women with overweight/obesity. Measurements of body weight and composition (air-displacement plethysmography), resting metabolic rate (indirect calorimetry), total daily (TDEE) and activity EE (AEE), minutes of PA and sedentary time (PA monitor) were taken at baseline, after 2 weeks, after ≥5% WL or 12 weeks of continuous (25% daily energy deficit) or intermittent (75% daily energy deficit alternated with ad libitum day) energy restriction, and at 1-year post-WL. The rate of WL was calculated as total %WL/number of dieting weeks. Data from both groups were combined for analyses. Thirty-seven participants (age=35±10y; BMI=29.1±2.3kg/m ² ) completed the intervention (WL=−5.9±1.6%) and 18 returned at 1-year post-WL (weight change=+4.5±5.2%). Changes in sedentary time at 2 weeks were associated with the rate of WL during energy restriction (r=−0.38; p=0.03). Changes in total (r=0.54; p<0.01), light (r=0.43; p=0.01) and moderate-to-vigorous PA (r=0.55; p<0.01), sedentary time (r=−0.52; p<0.01), steps per day (r=0.39; p=0.02), TDEE (r=0.46; p<0.01) and AEE (r=0.51; p<0.01) during energy restriction were associated with the rate of WL. Changes in total (r=−0.50; p=0.04) and moderate-to-vigorous PA (r=−0.61; p=0.01) between post-WL and follow-up were associated with 1-year weight change (r=−0.51; p=0.04). These findings highlight that PA and sedentary time could act as modifiable behavioural targets to promote better weight outcomes during dietary energy restriction and/or weight maintenance.
... Lifestyle and behavioral therapy including increased physical activity and a high-quality diet with limited calories provide only limited benefit in losing weight for a person who already gained heavy weight. Moreover, the impact of diet and exercise interventions to reduce obesity and related disease burden was questioned by several findings [33][34][35][36]. Besides this, pharmaceutical intermediations such as liraglutide, empagliflozin, beloranib, and rimonabant were identified as giving good acute weight loss and prevention of obesity-related commodities, but the use of them is limited due to unavoidable side effects and rapid regain of weight after the termination of therapy [36,37]. ...
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Obesity and overweight have posed a severe threat to humanity, needing urgent efforts for the development of safe and effective therapeutic interventions. In this research work, we have developed two polyherbal formulations A and B basically consisting of Helianthus tuberosus root powder (also called inulin of synanthrin) along with other herbs for the treatment of obesity. Evaluation of the antioxidant activity of both formulations using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2, 2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) free radical scavenging assays showed good antioxidant potentials. Both formulations A and B showed good antiobesity activity on a diet-induced obesity (DIO) model of mice by effectively lowering the body weight of mice compared to the high-fat diet (HFD) control mice, mainly by reducing the food efficiency ratio (FER). Furthermore, both formulations ameliorated lipoprotein misbalances induced by obesity and thus decreased the atherogenic index. Treatment with both formulations significantly decreased the liver and epididymal white adipose tissue (WAT) weight. This was supported by the improvement in steatosis of the liver and reduced hypertrophy in WAT on histological examination. In addition, formulations A and B have been seen as effective in controlling fasting blood glucose levels probably by alleviating HFD-induced insulin resistance. All of these results collectively suggest that formulations A and B serve as potentially safe and effective herbal interventions to control obesity and its comorbidities.
... There are a large number of systematic reviews and metaanalyses directly comparing the effects of diet alone or in conjunction with exercise on the improvement of health outcomes [20][21][22][23][24]. However, to the best of our knowledge, only one systematic review compares energy-restricted diets and combined energy-restricted diet and exercise on HRQOL [25]; and no meta-analysis was performed. ...
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Background and aim Obesity and related co-morbidities lead to a decrease in health-related quality of life (HRQOL) and mood. Lifestyle strategies may improve these outcomes. However, the efficacy of exercise in conjunction with a weight-loss diet on HRQOL and mood is unclear. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to examine whether the addition of exercise to energy-restricted dietary programs improves HRQOL and mood status when compared with energy-restricted diets alone in overweight and obese adults. Methods Eligible RCTs were identified by searching PubMed/MEDLINE, EMBASE, ISI (Web of sciences), Scopus, and Google Scholar up to April 2021. Summary effects were derived using a random-effects model. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Results The meta-analysis revealed that an energy-restricted diet plus exercise compared with an energy-restricted diet alone had no significant effects on depression (n = 6, hedges’g = − 0.04, 95% CI: − 0.28,0.20), MOS 36-Item Short-Form Health Survey (SF-36)-physical component summary scores (n = 8, weighted mean difference (WMD) = 1.51, 95% CI: − 0.16, 3.18), SF36-mental component summary scores (n = 7, WMD = 0.64, 95% CI: − 1.00, 2.28), and HRQOL disease-specific questionnaire scores (n = 5, hedges’g = 0.16, 95% CI: − 0.09, 0.40). The GRADE revealed that the quality of evidence was low for disease-specific HRQOL scores, and depression status; and high for physical and mental health assessed by SF-36. Conclusion In our sample of overweight and obese adults, no beneficial effect of adding exercise to an energy-restricted diet was found in terms of HRQOL and Depression.
To discover a novel series of potent inhibitors of enteropeptidase, a membrane-bound serine protease localized to the duodenal brush border, 4-guanidinobenzoate derivatives were evaluated with minimal systemic exposure. The 1c docking model enabled the installation of an additional carboxylic acid moiety to obtain an extra interaction with enteropeptidase, yielding 2a. The oral administration of 2a significantly elevated the fecal protein output, a pharmacodynamic marker, in diet-induced obese (DIO) mice, whereas subcutaneous administration did not change this parameter. Thus, systemic exposure of 2a was not required for its pharmacological effects. Further optimization focusing on the in vitro IC50 value and T1/2, an indicator of dissociation time, followed by enhanced in vivo pharmacological activity based on the ester stability of the compounds, revealed two series of potent enteropeptidase inhibitors, a dihydrobenzofuran analogue ((S)-5b, SCO-792) and phenylisoxazoline (6b), which exhibited potent anti-obesity effects despite their low systemic exposure following their oral administration to DIO rats.
Purpose: Because coaction (a favorable change in one behavior increasing the probability of a similarly favorable change in another behavior) associated with health behaviors has been identified, directionalities of such relationships within weight-loss behaviors (e.g., exercise, healthy eating) and their theory-based psychological mechanisms requires more investigation. Method: Women with obesity and either disturbed mood (n = 61) or normal mood (n = 58) participated in a cogntive-behavioral weight-management treatment within a community setting. Analyses of both group differences, and mediation models using aggregate data of behavioral and psychological variables, were conducted. Results: Improvements in measures of self-regulation, self-efficacy, mood, exercise, and fruit/vegetable intake were significant overall; with fruit/vegetable increase greater in the disturbed mood group. The prediction of increase in fruits/vegetables from baseline-Month 6 by increase in exercise from bascline-Month 3 (β = .24) was stronger than effects of change in fruit/vegetabe intake on exercise (β = .16). Overall mediation models were significant where changes in self-regulation and self-efficacy were entered as serial mediators of predictions of fruit/vegetable change by change in exercise (R2= .35 and .32), and vice versa (R2= .24 and .23). Paths demonstrating effects through self-regulation change and self-efficacy change were significant in the prediction of eating and exercise changes, respectively. Conclusion: Contributions to advancements in behavioral theory and treatment curricula targeting self-regulation and self-efficacy to improve exercse-eating change relationships were suggested. .
Antecedentes: La enfermedad por hígado graso no alcohólico (EHGNA) tiene una elevada prevalencia a nivel mundial, y puede ir desde la esteatosis simple hasta hepatocarcinoma. Su origen es multifactorial, siendo la dieta poco saludable un factor clave en su patogenia y progresión. Los polifenoles son antioxidantes que han mostrado beneficios en el tratamiento de la EHGNA. Una fuente emergente de estos compuestos son los residuos agroindustriales, entre ellos, la cáscara de granada. La cáscara de granada tiene un alto contenido de polifenoles, específicamente de elagitaninos. Su extracto fenólico (extracto de cáscara de granada; ECG) ha mostrado efectos promisorios a nivel metabólico. Sin embargo, su uso presenta algunas limitantes que deben ser consideradas antes de recomendar su ingesta mediante alimentos funcionales o nutracéuticos para prevención o tratamiento de EHGNA. Objetivo: Discutir a partir de datos obtenidos en estudios in vitro y modelos animales, el potencial terapéutico de los polifenoles obtenidos de la cáscara de granada para prevención y tratamiento de la EHGNA. Metodología: Se realizó una búsqueda bibliográfica en bases de datos PubMed y Web of Science (2015 a la fecha) de estudios en modelos de esteatosis hepática in vitro y en animales, además de ensayos clínicos relacionados. Conclusión: Existen datos promisorios sobre el uso del ECG en alteraciones metabólicas propias de la EHGNA y esteatosis hepática, principalmente a nivel de perfil lipídico. Se deben discutir las dosis y formas de administración, con el fin de mejorar su estabilidad y biodisponibilidad. Se requieren ensayos clínicos controlados que confirmen los efectos en humanos.
This chapter describes behavioral treatment for adults with obesity. It reviews the components and structure of treatment, presents weight loss outcomes, discusses methods to improve long‐term weight loss, and describes strategies to improve dissemination and implementation of behavioral treatments. The goal of behavioral treatment is to help patients with obesity identify and modify their eating and physical activity habits. Behavioral treatment is typically delivered as a multicomponent package that includes self‐monitoring, functional analyses, stimulus control, cognitive restructuring, problem‐solving, and relapse prevention. Weight loss requires the induction of a negative energy balance. Physical activity contributes principally to the maintenance, rather than the induction, of weight loss. Behavioral treatment may be delivered using a variety of different formats, though the most common are individual or group sessions delivered in‐person or remotely. Long‐term weight loss requires continued work, but patients report that maintaining a loss is far less rewarding than losing weight.
Exercise/physical activity (PA) can reduce susceptibility to many chronic conditions including obesity and associated metabolic disorders (type 2 diabetes, nonalcoholic fatty liver disease), cardiovascular disease, and certain cancers with benefits on cognition, mood, and general well‐being. The premise that exercise/PA is associated with significant weight loss dates is linked with an observation in 1958 that adipose tissue is energy‐dense containing 3500 calories/pound. To achieve energy balance, EI must equal EE. Strategies to combat excess weight gain, aside from the obvious reduction of EI, would also include increased EE through PA. The chapter examines the relationship between weight loss and improvements in weight‐related comorbidities. Multiple short bouts of walking have been assessed as a tool for weight loss modality on the assumption that multiple SB of walking may achieve more weight loss or be easier to finish than one LB of walking.
Voluntary training and food modulate the fecal microbiota in humans and mice. Although there are some reports of the timing effects of voluntary training and feeding on metabolism, the timing effects of these factors on microbiota have not been investigated. Therefore, we investigated the effects of the timing of voluntary training and feeding on the gut microbiota. The ICR mice were housed under conditions with an early (in the morning) or late (evening) active phase of increased physical activity. Furthermore, to investigate why voluntary training affects the gut microbiota, mice were housed in a cold environment and received propranolol administration with increased physical activity. After that, we collected cecal contents and feces and measured cecal pH. Short-chain fatty acids (SCFA) were measured from cecal contents. Microbiota was determined using sequencing of the V3-V4 region of the 16S rDNA gene. This study found that increased evening physical activity rather than morning activity decreases cecal pH, increases SCFA, and changes the microbiota. It is especially important that increased evening physical activity is induced under the post-prandial voluntary training condition. Also, we found that cold room housing, sympathetic blockade, or both suppressed the increased physical activity-induced changes in cecal pH, SCFA, and microbiota. Allobaculum responded to increased physical activity through body temperature increases and sympathetic activation. Post-prandial increased physical activity, rather than pre-prandial increased physical activity by evening voluntary wheel training, altered the microbiota composition, which may be related to the increase in body temperature and sympathetic nervous system activation.
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Objective: The aim of this study was to determine whether the hormone changes following weight loss are proportional to the degree of weight loss and to starting BMI. Methods: A very low-energy diet was used to achieve 15% weight loss. Fasting and postprandial gut hormones and leptin were measured during a meal test at baseline and at 5% (1%), 10% (2%), and 15% (2.5%) weight loss. Linear mixed-effects models were used to analyze hormone changes. Results: From baseline to 5% weight loss, decreases were seen in fasting concentrations of leptin (-8.25 ng/mL; p < 0.001), amylin (-21.3 pg/mL; p < 0.001), and glucagon-like peptide 1 (-59.55 pg/mL; p < 0.001). There was a small further reduction in leptin between 5% and 15% weight loss (-1.88 ng/mL; p = 0.019) but not in glucagon-like peptide 1 and amylin. Fasting ghrelin showed a significant increase at 10% weight loss (41.64 pg/mL; p = 0.002), with a nonsignificant increase from 10% to 15% loss (26.03 pg/mL; p = 0.065). Postprandial changes in hormone levels were variable. There was no correlation between baseline weight and the degree of hormone changes. Conclusions: The majority of changes in fasting gut hormones and leptin occurred in early weight loss, with minor further changes up to 15% weight loss. Starting weight did not affect the degree of hormone change.
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.