Effects of Diet and Physical Activity Interventions on Weight Loss and Cardiometabolic Risk Factors in Severely Obese Adults: A Randomized Trial
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CONTEXT: The prevalence of severe obesity is increasing markedly, as is prevalence of comorbid conditions such as hypertension and type 2 diabetes mellitus; however, apart from bariatric surgery and pharmacotherapy, few clinical trials have evaluated the treatment of severe obesity. OBJECTIVE: To determine the efficacy of a weight loss and physical activity intervention on the adverse health risks of severe obesity. DESIGN, SETTING, AND PARTICIPANTS: Single-blind randomized trial conducted from February 2007 through April 2010 at the University of Pittsburgh. Participants were 130 (37% African American) severely obese (class II or III) adult participants without diabetes recruited from the community. INTERVENTIONS: One-year intensive lifestyle intervention consisting of diet and physical activity. One group (initial physical activity) was randomized to diet and physical activity for the entire 12 months; the other group (delayed physical activity) had the identical dietary intervention but with physical activity delayed for 6 months. MAIN OUTCOME MEASURES: Changes in weight. Secondary outcomes were additional components comprising cardiometabolic risk, including waist circumference, abdominal adipose tissue, and hepatic fat content. RESULTS: Of 130 participants randomized, 101 (78%) completed the 12-month follow-up assessments. Although both intervention groups lost a significant amount of weight at 6 months, the initial-activity group lost significantly more weight in the first 6 months compared with the delayed-activity group (10.9 kg [95% confidence interval {CI}, 9.1-12.7] vs 8.2 kg [95% CI, 6.4-9.9], P = .02 for group × time interaction). Weight loss at 12 months, however, was similar in the 2 groups (12.1 kg [95% CI, 10.0-14.2] vs 9.9 kg [95% CI, 8.0-11.7], P = .25 for group × time interaction). Waist circumference, visceral abdominal fat, hepatic fat content, blood pressure, and insulin resistance were all reduced in both groups. The addition of physical activity promoted greater reductions in waist circumference and hepatic fat content. CONCLUSION: Among patients with severe obesity, a lifestyle intervention involving diet combined with initial or delayed initiation of physical activity resulted in clinically significant weight loss and favorable changes in cardiometabolic risk factors. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00712127.
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Several exercise trials combined with weight loss reported larger improvements in CVD risk factors.
“Several exercise trials combined with weight loss reported larger improvements in CVD risk factors.21,40,41”
From Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial (2024) · cites this paper as [21]
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- Authors
- Goodpaster, B. H., DeLany, J. P., Otto, A. D., Kuller, L., Vockley, J., South-Paul, J. E., Thomas, S. B., Brown, J., McTigue, K., Hames, K. C., Lang, W., & Jakicic, J. M.
- Affiliations
- University of Pittsburgh (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2010-10-27
- Volume
- 304
- Issue
- 16
- Pages
- 1795
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3082279
- OpenAlex
- W2093609715
- Cited by
- 558
- References
- 41
- Citations by year
- 2026: 15 · 2025: 16 · 2024: 14 · 2023: 22 · 2022: 24 · 2021: 32 · 2020: 20 · 2019: 28 · 2018: 27 · 2017: 33 · 2016: 46 · 2015: 59 · 2014: 60 · 2013: 53 · 2012: 56
- FWCI
- 51.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Pennsylvania Department of Health
- University of Pittsburgh
- National Institutes of Health (UL1TR000005)
- Medical Center, University of Pittsburgh
- National Institute on Aging (P30AG024827)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32-DK07052, R01DK078775, T32DK007052)
- National Center for Research Resources (UL1RR024153)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- morbid obesity, weight loss, lifestyle intervention, dietary intervention, physical activity, cardiometabolic risk factors, hepatic fat content, visceral adipose tissue, waist circumference, insulin resistance, blood pressure, hypertension, type 2 diabetes prevention, African American adults, bariatric surgery alternatives, obesity-related comorbidities
- MeSH terms
- Adult, Blood Pressure, Cardiovascular Diseases, Diet, Exercise Therapy, Female, Humans, Insulin Resistance, Life Style, Liver, Male, Middle Aged, Obesity, Morbid, Risk Factors, Time Factors, Weight Loss, Single-Blind Method, Treatment Outcome, Intra-Abdominal Fat, Waist Circumference
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