Exercise in the treatment of obesity: Effects of four interventions on body composition, resting energy expenditure, appetite, and mood.
Abstract
This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 +/- 6.8 kg at Week 24, which decreased to 15.1 +/- 8.4 kg at Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite and mood.
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In a similarly designed randomized study that produced a loss of about 15% with a 925-kcal/day meal-replacement diet, exercise did not preserve lean mass significantly better.
“The same lack of benefit was observed in a similarly designed randomized study that produced a loss of ~ 15% with a 925-kcal/day meal-replacement diet [95].”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [95]
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“The same lack of benefit was observed in a similarly designed randomized study that produced a loss of ~ 15% with a 925-kcal/day meal-replacement diet [95].”
BackgroundSelf-citationTreatment and prevention of obesity: what is the role of exercise?
Jakicic, J., & Otto, A. D. (2006) · Nutrition reviews · doi:10.1111/j.1753-4887.2006.tb00235.x · Cited by 144 · see citing works
Weight Loss Treatment and Psychological Well-being: A Review and Meta-analysis
Blaine, B. E., Rodman, J., & Newman, J. M. (2007) · Journal of Health Psychology · doi:10.1177/1359105307071741 · Cited by 123 · see citing works
Exercise and the maintenance of weight loss: 1-year follow-up of a controlled clinical trial.
Wadden, T. A., Vogt, R. A., Foster, G. D., & Anderson, D. A. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.66.2.429 · Cited by 119 · see citing works
Self-citationFood Provision as a Strategy to Promote Weight Loss
Wing, R. R., & Jeffery, R. W. (2001) · Obesity Research · doi:10.1038/oby.2001.130 · Cited by 116 · see citing works
Wadden, T. A., Anderson, D. A., & Foster, G. D. (1999) · Obesity Research · doi:10.1002/j.1550-8528.1999.tb00699.x · Cited by 116 · see citing works
Self-citationHansen, D., Dendale, P., van Loon, L. J. C., & MEEUSEN, R. R. (2010) · Sports Medicine · doi:10.2165/11535930-000000000-00000 · Cited by 105 · see citing works
The Effects of Exercise Training on Fat-Mass Loss in Obese Patients During Energy Intake Restriction
Hansen, D., Dendale, P., Berger, J., van Loon, L. J. C., & Meeusen, R. (2007) · Sports Medicine · doi:10.2165/00007256-200737010-00003 · Cited by 106 · see citing works
“[10,12,14,16,18,19,23,25-34] This is confirmed in a This is unfortunate as it has been speculated that meta-analysis by Miller et al.”
BackgroundCELIK, O., & Yıldız, B. O. (2021) · Minerva Endocrinology · doi:10.23736/s2724-6507.20.03361-1 · Cited by 106 · see citing works
Managing obesity in primary care practice: a narrative review
Carvajal, R., Wadden, T. A., Tsai, A. G., Peck, K., & Moran, C. H. (2013) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.12004 · Cited by 105 · see citing works
Self-citationStrength training for obesity prevention in midlife women
Schmitz, K. H., Jensen, M. D., Kugler, K. C., Jeffery, R. W., & Leon, A. S. (2003) · International Journal of Obesity · doi:10.1038/sj.ijo.0802198 · Cited by 103 · see citing works
Palmeira, A. L., Branco, T. L., Martins, S. C., Minderico, C. S., Silva, M. N., Vieira, P. N., Barata, J. T., Serpa, S. O., Sardinha, L. B., & Teixeira, P. J. (2010) · Body Image · doi:10.1016/j.bodyim.2010.03.002 · Cited by 101 · see citing works
“For example, Wadden and Tanco reported lower depression symptoms after treatment in obese women (Tanco, Linden, & Earle, 1998; Wadden et al., 1997).”
BackgroundObesity and Osteoarthritis: Disease Genesis and Nonpharmacologic Weight Management
Messier, S. P. (2008) · Rheumatic Disease Clinics of North America · doi:10.1016/j.rdc.2008.04.007 · Cited by 99 · see citing works
Behavioral treatment of obese binge eaters: do they need different care?
Gladis, M., Wadden, T. A., Vogt, R. A., Foster, G. D., Kuehnel, R. H., & Bartlett, S. J. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00262-6 · Cited by 98 · see citing works
Self-citationChanges in resting energy expenditure after weight loss in obese African American and white women
Foster, G. D., Wadden, T. A., Swain, R. M., Anderson, D. A., & Vogt, R. A. (1999) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/69.1.13 · Cited by 85 · see citing works
Self-citationExercise and the maintenance of weight loss: 1-year follow-up of a controlled clinical trial.
Wadden, T. A., Vogt, R. A., Foster, G. D., & Anderson, D. A. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.66.2.429 · Cited by 119 · see citing works
“possible visits f rom Weeks 25 to 40 (Wadden et al., 1997).”
BackgroundMethodInfluentialSelf-citationFenkçi, S. M., Sarsan, A., Rota, S., & Ardıç, F. (2006) · Advances in Therapy · doi:10.1007/bf02850161 · Cited by 82 · see citing works
Pharmacological and surgical treatment of obesity.
Shekelle, P., Morton, S. C., Maglione, M., Suttorp, M. J., Tu, W., Li, Z., Maggard, M. A., Mojica, W., Shugarman, L. R., & Solomon, V. (2004) · PubMed Central · Cited by 80 · see citing works
Carroll, S., Borkoles, E., & Polman, R. C. J. (2007) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h06-093 · Cited by 74 · see citing works
“However, intensive behavioural interventions (incorporating self-selected hypocaloric dietary and exercise components) have only been efficacious in improving psychological well-being and reducing depressive symptoms in selected studies (Klem et al. 1997; Wadden et al. 1997; Rippe et al. 1998; Fontaine et al. 1999).”
BackgroundLong-term effects of provided low and high glycemic load low energy diets on mood and cognition
Cheatham, R. A., Roberts, S. B., Das, S. K., Gilhooly, C. H., Golden, J. K., Hyatt, R. R., Lerner, D., Saltzman, E. J., & Lieberman, H. R. (2009) · Physiology & Behavior · doi:10.1016/j.physbeh.2009.06.015 · Cited by 70 · see citing works
“There remains controversy over whether weight loss impacts mood and cognition [1] and [2], and intentional weight loss has been associated with both positive and negative mood and cognition outcomes [3], [4], [5], [6], [7], [8], [9], [10], [11] and [12].”
Jeffery, R. W., Wing, R. R., Thorson, C., & Burton, L. R. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.66.5.777 · Cited by 204 · see citing works
Psychological response to exercise training and/or energy restriction in obese women
Nieman, D. C., Custer, W. F., Butterworth, D. E., Utter, A. C., & Henson, D. A. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00066-5 · Cited by 67 · see citing works
Promoting More Modest Weight Losses: A Pilot Study
Foster, G. D., Phelan, S., Wadden, T. A., Gill, D. S., Ermold, J., & Didie, E. R. (2004) · Obesity Research · doi:10.1038/oby.2004.161 · Cited by 67 · see citing works
“Unfortunately, efforts to increase the magnitude of weight loss, including very low-calorie diets (9), structured exercise and food provisions (10,11), and longer treatment (12,13), have produced long-term results that are no differ ent from those of standard behavioral treatments.”
BackgroundSelf-citationDeLany, J. P., Kelley, D. E., Hames, K. C., Jakicic, J. M., & Goodpaster, B. H. (2014) · Obesity · doi:10.1002/oby.20525 · Cited by 60 · see citing works
“There was no minimization of the decrease in EE in the group receiving the prescribed increase in PA, similar to previous reports (11-14).”
Estimating Health-Related Quality of Life in Obese Individuals
Fontaine, K. R., & Bartlett, S. J. (1998) · Disease Management & Health Outcomes · doi:10.2165/00115677-199803020-00002 · Cited by 60 · see citing works
Self-citationBehavioral Treatment of the Patient with Obesity
Alamuddin, N., & Wadden, T. A. (2016) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2016.04.008 · Cited by 59 · see citing works
“Physical activity may improve long-term weight loss by multiple mechanisms, including exercise’s positive effects on mood, body composition, and resting metabolic rate.(38) Compelling findings indicate that high levels of physical activity are needed to compensate for increased energy efficiency following weight loss.”
BackgroundSelf-citationfor the CALERIE Study Group, Dorling, J. L., Das, S. K., Racette, S. B., Apolzan, J. W., Zhang, D., Pieper, C. F., & Martin, C. K. (2020) · European Journal of Clinical Nutrition · doi:10.1038/s41430-020-0593-8 · Cited by 59 · see citing works
Characterization of the Improvement in Depressive Symptoms Following Bariatric Surgery
Hayden, M. J., Dixon, J. B., Dixon, M. E., Shea, T. L., & O’Brien, P. E. (2010) · Obesity Surgery · doi:10.1007/s11695-010-0215-y · Cited by 59 · see citing works
“Improvement in depressive symptoms has often been reported following weight loss achieved via bariatric surgery [16, 17, 25–28], pharmacological interventions [29] and behavioural and dietary interventions [30–36].”
BackgroundSimpson, S. A., McNamara, R. L., Shaw, C., Kelson, M. J., Moriarty, Y., Randell, E., Cohen, D. R., Alam, M. F., Copeland, L., Duncan, D., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19500 · Cited by 58 · see citing works
Batterham, M. J. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/81.3.702 · Cited by 58 · see citing works
Diet and Exercise for Obese Adults with Knee Osteoarthritis
Messier, S. P. (2010) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2010.05.001 · Cited by 57 · see citing works
Alfaris, N., Wadden, T. A., Sarwer, D. B., Diwald, L., Volger, S., Hong, P., Baxely, A., Minnick, A. M., Vetter, M. L., Berkowitz, R. I., et al. (2015) · Obesity · doi:10.1002/oby.20996 · Cited by 57 · see citing works
“Findings of reduced symptoms of depression confirm results of earlier behavioral weight loss studies (4-7), and are important because depression is an independent risk factor for CVD morbidity and mortality (8-11).”
BackgroundResultSelf-citationEffect of calorie restriction on subjective ratings of appetite
Anton, S. D., Han, H., York, E., Martin, C. K., Ravussin, É., & Williamson, D. A. (2009) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2008.00943.x · Cited by 56 · see citing works
“Few studies, however, have directly tested the effect that energy restriction has on subjective hunger and satiety levels (Wadden et al., 1997; Doucet et al., 2003).”
BackgroundContribution of Behavior Intervention Components to 24-Month Weight Loss
Unick, J. L., Jakicic, J. M., & Marcus, B. H. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181bd1a57 · Cited by 55 · see citing works
“Despite the short-term success of initiatives to reduce body weight (8,10,23), the maintenance of weight loss is more difficult to achieve (24,29).”
BackgroundInfluence of Diet and/or Exercise on Body Composition and Cardiorespiratory Fitness in Obese Women
UTTER, A. C., Nieman, D. C., Shannonhouse, E., Butterworth, D. E., & Nieman, C. N. (1998) · International Journal of Sport Nutrition · doi:10.1123/ijsn.8.3.213 · Cited by 55 · see citing works
Economic Evaluation of Weight Loss Interventions in Overweight and Obese Women
Roux, L., Kuntz, K. M., Donaldson, C., & Goldie, S. J. (2006) · Obesity · doi:10.1038/oby.2006.125 · Cited by 56 · see citing works
Psychological Functioning of Obese Individuals
Fabricatore, A. N., & Wadden, T. A. (2003) · Diabetes Spectrum · doi:10.2337/diaspect.16.4.245 · Cited by 54 · see citing works
Self-citationKlein, S. (2001) · Surgical Clinics of North America · doi:10.1016/s0039-6109(05)70182-1 · Cited by 54 · see citing works
Maintenance of weight loss after obesity treatment: is continuous support necessary?
Leibbrand, R., & Fichter, M. M. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00099-7 · Cited by 52 · see citing works
Maintenance of Weight Loss in Adolescents: Current Status and Future Directions
Butryn, M. L., Wadden, T. A., Rukstalis, M. R., Bishop‐Gilyard, C. T., Xanthopoulos, M. S., Louden, D. M., & Berkowitz, R. I. (2010) · Journal of Obesity · doi:10.1155/2010/789280 · Cited by 51 · see citing works
Self-citationPredictors of feelings of energy differ from predictors of fatigue
Boolani, A., O’Connor, P. J., Reid, J., Ma, S., & Mondal, S. (2018) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2018.1558733 · Cited by 53 · see citing works
“regardless of the type of treatment received [47].”
BackgroundMuscle Strengthening, Aerobic Exercise, and Obesity: A Pooled Analysis of 1.7 Million US Adults
Bennie, J. A., Cocker, K. A. D., Pavey, T., Stamatakis, E. A., Biddle, S., & Ding, D. (2019) · Obesity · doi:10.1002/oby.22673 · Cited by 49 · see citing works
“Although it is limited, there is some clinical evidence suggesting that MSE combined with MVPA may increase lean body mass, more than either activity alone (30), thus resulting in an increased metabolic rate and/or total energy expenditure among those who engage in both physical activity modes (30,31).”
BackgroundBehavioural treatment of the overweight patient
Wadden, T. A., Sarwer, D. B., & Berkowitz, R. I. (1999) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1053/beem.1999.0008 · Cited by 48 · see citing works
Self-citationObesity and Osteoarthritis: Disease Genesis and Nonpharmacologic Weight Management
Messier, S. P. (2008) · Medical Clinics of North America · doi:10.1016/j.mcna.2008.09.011 · Cited by 45 · see citing works
Men Gain Additional Psychological Benefits by Adding Exercise to a Weight‐Loss Program
Kiernan, M., King, A. C., Stefanick, M. L., & Killen, J. D. (2001) · Obesity Research · doi:10.1038/oby.2001.106 · Cited by 44 · see citing works
- Authors
- Wadden, T. A., Vogt, R. A., Andersen, R. E., Bartlett, S. J., Foster, G. D., Kuehnel, R. H., Wilk, J., Weinstock, R., Buckenmeyer, P., Berkowitz, R. I., & Steen, S. N.
- Affiliations
- University of Pennsylvania (US)
- Johns Hopkins University (US)
- Syracuse University (US)
- University of Maryland, College Park (US)
- SUNY Upstate Medical University (US)
- Immaculata University (US)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 1997
- Volume
- 65
- Issue
- 2
- Pages
- 269-277
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2111175328
- Cited by
- 212
- References
- 39
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 8 · 2012: 8
- FWCI
- 11.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh049451-04, 5k02mh000702-10)
- National Institute of Mental Health (R01-MH-49451, KO2 MH00702-07)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- obesity, exercise intervention, aerobic exercise, resistance training, concurrent training, diet, body composition, resting energy expenditure, appetite, mood, weight loss, women, behavioral weight management
- MeSH terms
- Adult, Analysis of Variance, Combined Modality Therapy, Diet, Reducing, Female, Humans, Longitudinal Studies, Obesity, Exercise, Treatment Outcome
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