Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis
Open accessAbstract
Summary: Diet and exercise are two of the commonest strategies to reduce weight. Whether a diet‐plus‐exercise intervention is more effective for weight loss than a diet‐only intervention in the long‐term has not been conclusively established. The objective of this study was to systemically review the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on both long‐term and short‐term weight loss. Studies were retrieved by searching MEDLINE and Cochrane Library (1966 – June 2008). Studies were included if they were randomized controlled trials comparing the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on weight loss for a minimum of 6 months among obese or overweight adults. Eighteen studies met our inclusion criteria. Data were independently extracted by two investigators using a standardized protocol. We found that the overall standardized mean differences between diet‐plus‐exercise interventions and diet‐only interventions at the end of follow‐up were −0.25 (95% confidence interval [CI]−0.36 to −0.14), with a P‐value for heterogeneity of 0.4. Because there were two outcome measurements, weight (kg) and body mass index (kg m−2), we also stratified the results by weight and body mass index outcome. The pooled weight loss was 1.14 kg (95% CI 0.21 to 2.07) or 0.50 kg m−2 (95% CI 0.21 to 0.79) greater for the diet‐plus‐exercise group than the diet‐only group. We did not detect significant heterogeneity in either stratum. Even in studies lasting 2 years or longer, diet‐plus‐exercise interventions provided significantly greater weight loss than diet‐only interventions. In summary, a combined diet‐plus‐exercise programme provided greater long‐term weight loss than a diet‐only programme. However, both diet‐only and diet‐plus‐exercise programmes are associated with partial weight regain, and future studies should explore better strategies to limit weight regain and achieve greater long‐term weight loss.
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Obesity interventions usually produce rapid early weight loss, then a plateau, then gradual regain.
“Obesity interventions typically result in early rapid weight loss followed by a weight plateau and progressive regain.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [3]
The Discussion reports partial long-term weight regain in both diet-only and diet-plus-exercise programmes. It does not establish the claimed typical sequence of rapid early loss, a plateau, and progressive regain. (LLM, conf=0.86)
Experimental — accuracy not yet measuredParticipation in an exercise training program favors weight loss, although of only modest magnitude.
“concluding that participation in an exercise training program does favor weight loss, although of only modest magnitude.”
From Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies (2021) · cites this paper as [28]
The Abstract reports a modest additional weight loss of 1.14 kg when exercise was added to a diet intervention, compared with diet alone. The Discussion likewise concludes that including exercise improves long-term weight loss. The source does not establish the effect of participation in an exercise training program without the accompanying diet intervention. (LLM, conf=0.84)
Experimental — accuracy not yet measuredLong-term maintenance of lost weight is more difficult than initial weight loss, which can be achieved by various treatment methods.
“Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [3]
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“Diet alone has shown limited effectiveness for long term weight loss [ 86 ].”
BackgroundEffect of Weight Loss, Diet, Exercise, and Bariatric Surgery on Nonalcoholic Fatty Liver Disease
Hannah, W. N., & Harrison, S. A. (2016) · Clinics in Liver Disease · doi:10.1016/j.cld.2015.10.008 · Cited by 145 · see citing works
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“and meta-analyses on the efficacy of PA interventions on obesity and its co-morbidities [24, 25], systematic reviews on the effectiveness of PA interventions to induce changes in body composition, physical fitness components, and CVD risk factors among overweight and obese adolescents remain sparse.”
BackgroundWesterterp, K. R. (2010) · Nutrition Reviews · doi:10.1111/j.1753-4887.2010.00270.x · Cited by 141 · see citing works
Schmidt, S. K., Hemmestad, L., MacDonald, C. S., Langberg, H., & Valentiner, L. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17207454 · Cited by 140 · see citing works
“It is clearly difficult to sustain long-term lifestyle changes [7,16,17].”
BackgroundLong-Term Weight Loss Strategies for Obesity
Kheniser, K., Saxon, D. R., & Kashyap, S. R. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab091 · Cited by 139 · see citing works
“The additive effects of exercise on weight loss can be numerically modest, but statistically significant [+1.14 kgs lost (95% CI 0.21-2.07)] (51).”
InfluentialInterdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas”
Hauner, H., Moss, A., Berg, A., Bischoff, S. C., Colombo‐Benkmann, M., Ellrott, T., Heintze, C., Kanthak, U., Kunze, D., Stefan, N., et al. (2014) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/s-0037-1618857 · Cited by 137 · see citing works
“LoE 1++ bis 1+; starker Konsens Literatur: [2; 155; 200; 201; 232] A”
BackgroundChristensen, J. R., Faber, A., Ekner, D., Overgaard, K., Holtermann, A., & Søgaard, K. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-671 · Cited by 133 · see citing works
Schwingshackl, L., Dias, S., & HOFFMANN, G. E. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-130 · Cited by 135 · see citing works
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Bonfioli, E., Berti, L., Goss, C., Muraro, F., & Burti, L. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-78 · Cited by 154 · see citing works
“hypertension, type II diabetes, and dyslipidemia [34-36], Gabriele et al.”
BackgroundThe role of gut hormone peptide YY in energy and glucose homeostasis: Twelve years on
Manning, S., & Batterham, R. L. (2014) · Annual Review of Physiology · doi:10.1146/annurev-physiol-021113-170404 · Cited by 124 · see citing works
Lifestyle and Dietary Interventions in the Management of Nonalcoholic Fatty Liver Disease
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“[36], diet and exercise interventions resulted in a loss of 1.”
BackgroundBaillot, A., Romain, A. J., Boisvert-Vigneault, K., Audet, M., Baillargeon, J., Dionne, I. J., Valiquette, L., Chakra, C. N. A., Avignon, A., & Langlois, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0119017 · Cited by 123 · see citing works
“In accordance with other studies in overweight and obese subjects [99,100], anthropometric outcomes (weight, BMI, fat mass and waist circumference) decrease over time after lifestyle intervention in class II and III obese individuals.”
ResultEngagement and outcomes in a digital Diabetes Prevention Program: 3-year update
Sepah, S. C., Jiang, L., Ellis, R. J., McDermott, K., & Peters, A. L. (2017) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2017-000422 · Cited by 122 · see citing works
Kazemi, M., McBreairty, L. E., Chizen, D. R., Pierson, R. A., Chilibeck, P. D., & Zello, G. A. (2018) · Nutrients · doi:10.3390/nu10101387 · Cited by 118 · see citing works
“Women tended to regain weight in the long-term consistent with previous studies [106,107].”
ResultWang, H., Troy, L. M., Rogers, G. T., Fox, C. S., McKeown, N. M., Meigs, J. B., & Jacques, P. F. (2014) · International Journal of Obesity · doi:10.1038/ijo.2013.78 · Cited by 115 · see citing works
Fernández, T., Viñuela, M., Vidal, C., & Barrera, F. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263931 · Cited by 117 · see citing works
“Together diet and exercise can enhance weight loss and maintain it in the long-term [76]; this is the most recommended strategy to achieve weight loss in different metabolic diseases guidelines [11, 77].”
BackgroundMetabolomic profiles as reliable biomarkers of dietary composition
Esko, T., Hirschhorn, J. N., Feldman, H. A., Hsu, Y.-H. H., Deik, A., Clish, C. B., Ebbeling, C. B., & Ludwig, D. S. (2017) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.144428 · Cited by 115 · see citing works
Scott, E. J., Daley, A., Doll, H., Woodroofe, M. N., Coleman, R., Mutrie, N., Crank, H., Powers, H. J., & Saxton, J. (2012) · Cancer Causes & Control · doi:10.1007/s10552-012-0104-x · Cited by 110 · see citing works
“However, long-term maintenance of a healthy body weight is more commonly observed when hypocaloric diets are combined with regular exercise in overweight and obese individuals [16–18].”
BackgroundNaimark, J. S., Madar, Z., & Shahar, D. R. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3682 · Cited by 108 · see citing works
“Exercise offers a way to mitigate the health-damaging effects of obesity, even without weight loss [35,36].”
BackgroundGrémeaux, V., Drigny, J., Nigam, A., Juneau, M., Guilbeault, V., Latour, É., & Gayda, M. (2012) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3182643ce0 · Cited by 105 · see citing works
“2 kg/m(2)) decrease are consistent with those generally reported in studies in obese subjects using nutritional counselling and MICET, either alone or combined.(5)”
Resultvan Dammen, L., Wekker, V., van Oers, A. M., Mutsaerts, M. A. Q., Painter, R. C., Zwinderman, A. H., Groen, H., van de Beek, C., Kobold, A. C. M., Kuchenbecker, W. K. H., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0190662 · Cited by 102 · see citing works
“Lifestyle improvements are difficult for patients to realize and the effects on weight reduction and retention are disappointing.(15) The success of a lifestyle intervention depends on several factors including intrinsic motivation, but also timing, duration, and intensity of the intervention are important.”
BackgroundSupervised Obesity Reduction Trial for AF ablation patients: results from the SORT-AF trial
Geßler, N., Willems, S., Steven, D., Aberle, J., Akbulak, R. Ö., Gosau, N., Hoffmann, B. A., Meyer, C. G., Sultan, A., Tilz, R. R., et al. (2021) · EP Europace · doi:10.1093/europace/euab122 · Cited by 98 · see citing works
Hussain, S. R., Macaluso, A., & Pearson, S. J. (2016) · Cardiology in Review · doi:10.1097/crd.0000000000000124 · Cited by 95 · see citing works
Stojek, M. M., & MacKillop, J. M. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.04.007 · Cited by 93 · see citing works
Hillier-Brown, F. C., Bambra, C. L., Cairns, J., Kasim, A., Moore, H. J., & Summerbell, C. D. (2014) · International Journal of Obesity · doi:10.1038/ijo.2014.75 · Cited by 92 · see citing works
Improvement in histological endpoints of MAFLD following a 12-week aerobic exercise intervention
O’Gorman, P., Naimimohasses, S., Monaghan, A., Kennedy, M., Melo, A. M., Ní Fhloinn, D., Doherty, D. G., Beddy, P., Finn, S. P., Moore, J. B., et al. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15989 · Cited by 94 · see citing works
Sigmund, E., Ansari, W. E., & Sigmundová, D. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-570 · Cited by 86 · see citing works
“Globally, efforts aimed at the prevention of childhood obesity have led to the implementation of a range of school-based interventions [10,11,23-26].”
Bollinger, L. M. (2017) · Gait & Posture · doi:10.1016/j.gaitpost.2017.05.003 · Cited by 88 · see citing works
Gourlan, M., Trouilloud, D. O., & Sarrazin, P. G. (2011) · Obesity Reviews · doi:10.1111/j.1467-789x.2011.00874.x · Cited by 86 · see citing works
Domaszewski, P., Konieczny, M., Pakosz, P., Bączkowicz, D., & Sadowska-Krępa, E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17114138 · Cited by 80 · see citing works
Kim, K.-B., Kim, K., Kim, C., Kang, S.-J., Kim, H. J., Yoon, S., & Shin, Y.-A. (2019) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes.2019.28.4.278 · Cited by 79 · see citing works
Kim, B., Choi, D., Jung, C., Kang, S., Mok, J., & Kim, C. (2017) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes.2017.26.1.15 · Cited by 79 · see citing works
Washburn, R. A., Szabo, A. N., Lambourne, K., Willis, E. A., Ptomey, L. T., Honas, J. J., Herrmann, S. D., & Donnelly, J. E. (2014) · PLoS ONE · doi:10.1371/journal.pone.0109849 · Cited by 74 · see citing works
Stephens, S., Cobiac, L. J., & Veerman, L. J. (2014) · Preventive Medicine · doi:10.1016/j.ypmed.2014.02.008 · Cited by 76 · see citing works
“5 (LeBlanc et al., 2011; Wu et al., 2009; Shaw et al., 2006; Cho et al., 2009; Orozco et al., 2008; Shaw et al., 2005; Thorogood et al., 2011; Reed et al., 2012; Esposito et al., 2011; Armstrong et al., 2011; Park et al., 2009; Gonzalez-Suarez et al., 2009; Paul-Ebhohimhen & Avenell., 2008; Jull et…”
Mutch, D. M., Pers, T. H., Temanni, M.-R., Pelloux, V., Márquez-Quiñones, A., Holst, C., Martínez, J. A., Babalis, D. K., van Baak, M. A., Handjieva‐Darlenska, T., et al. (2011) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.006858 · Cited by 75 · see citing works
“Numerous factors have been shown to influence successful weight maintenance, including behavior (4), physical activity (2), eating habits (5), the length of time an individual has maintained weight loss (6), the”
BackgroundThe long‐term effect of energy restricted diets for treating obesity
Langeveld, M., & DeVries, J. H. (2015) · Obesity · doi:10.1002/oby.21146 · Cited by 74 · see citing works
“In published systematic reviews of ‘‘long-term’’ effects of diets on weight loss, the median follow-up duration ranges from 12 to 36 months (see Supporting Information Table 1) (6-12).”
BackgroundKennett, G. A., & Clifton, P. G. (2010) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2010.07.020 · Cited by 74 · see citing works
Lee, B., Lee, Y., Park, C., Rhee, E., Lee, W., Kim, N. H., Choi, K. M., Park, K., Choi, Y., Soo, B., et al. (2020) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2020.0010 · Cited by 73 · see citing works
Gates, J., Killackey, E., Phillips, L., & Álvarez-Jiménez, M. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00213-8 · Cited by 72 · see citing works
Dose response of exercise training following roux‐en‐Y gastric bypass surgery: A randomized trial
Woodlief, T., Carnero, E. Á., Standley, R. A., Distéfano, G., Anthony, S. J., Dubis, G., Jakicic, J. M., Houmard, J. A., Coen, P. M., & Goodpaster, B. H. (2015) · Obesity · doi:10.1002/oby.21332 · Cited by 72 · see citing works
Rodgers, R. F. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2016.06.004 · Cited by 72 · see citing works
Persistence of newer anti-obesity medications in a real-world setting
Ganguly, R., Tian, Y., Kong, S. X., Hersloev, M., Hobbs, T., Smolarz, B. G., Ramasamy, A., Haase, C. L., & Weng, W. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.07.017 · Cited by 68 · see citing works
Bambra, C. L., Hillier-Brown, F. C., Cairns, J., Kasim, A., Moore, H. J., & Summerbell, C. D. (2015) · Public Health Research · doi:10.3310/phr03010 · Cited by 70 · see citing works
Thomson, R. L., Buckley, J. D., & Brinkworth, G. D. (2011) · Obesity Reviews · doi:10.1111/j.1467-789x.2010.00758.x · Cited by 70 · see citing works
“The combination of exercise and dieting has been extensively reported to substantially increase weight loss compared with dieting or exercise alone (46,47), with the addition of exercise providing better longer-term weight maintenance (48,49).”
BackgroundImpact of Obesity on Gynecology
Pandey, S., & Bhattacharya, S. (2010) · Women s Health · doi:10.2217/whe.09.77 · Cited by 69 · see citing works
“However, sustained weight loss is difficult to achieve and both diet-only and diet-plus-exercise programs are a ssociated with partial weight gain over time [103].”
BackgroundHarris, L., McGarty, A. M., Hutchison, L., Ells, L. J., & Hankey, C. R. (2017) · Obesity Reviews · doi:10.1111/obr.12593 · Cited by 68 · see citing works
“Therefore, future studies should aim to actively provide weight maintenance support to tackle the chronic relapsing nature of obesity (1,2,20).”
BackgroundSkinner, R., Gonet, V., Currie, S., Hoddinott, P., & Dombrowski, S. (2020) · Obesity Reviews · doi:10.1111/obr.12999 · Cited by 48 · see citing works
Exercising the hepatobiliary‐gut axis. The impact of physical activity performance
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Weight Loss Intervention for Breast Cancer Survivors: A Systematic Review
Playdon, M., Thomas, G., Sanft, T., Harrigan, M., Ligibel, J., & Irwin, M. (2013) · Current Breast Cancer Reports · doi:10.1007/s12609-013-0113-0 · Cited by 62 · see citing works
“Multi-component weight loss intervention (diet plus physical activity) has been shown to achieve significantly greater weight loss than single component intervention (diet or exercise only) [40, 48].”
BackgroundCauses and solutions to “globesity”: The new fa(s)t alarming global epidemic
Mihaylova, L. V., Marchev, A. S., & Georgiev, M. I. (2018) · Food and Chemical Toxicology · doi:10.1016/j.fct.2018.08.071 · Cited by 61 · see citing works
“5 kg lost weight over 12 months than a dietary intervention alone (Wu et al., 2009).”
BackgroundInfluentialHealth Effects of Alternate-Day Fasting in Adults: A Systematic Review and Meta-Analysis
Cui, Y., Cai, T., Zhou, Z., Mu, Y., Lu, Y., Gao, Z., Wu, J., & Zhang, Y. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.586036 · Cited by 61 · see citing works
Khalafi, M., Sakhaei, M. H., Kheradmand, S., Symonds, M. E., & Rosenkranz, S. K. (2022) · Advances in Nutrition · doi:10.1016/j.advnut.2022.10.001 · Cited by 64 · see citing works
Improving psychological treatment for obesity. Which eating behaviours should we target?
Carter, F. A., & Jansen, A. T. M. (2012) · Appetite · doi:10.1016/j.appet.2012.01.016 · Cited by 60 · see citing works
Hoedjes, M., van Stralen, M. M., Joe, S. T. A., Rookus, M. A., van Leeuwen, F. E., Michie, S., Seidell, J. C., & Kampman, E. (2017) · Journal of Cancer Survivorship · doi:10.1007/s11764-016-0594-8 · Cited by 58 · see citing works
“In addition, longer interventions have been associated with greater weight loss in obese or overweight adults [90].”
BackgroundMascaró, C. M., Bouzas, C., Montemayor, S., Casares, M., Llompart, I., Ugarriza, L., Borràs, P. A., Martínez, J. A., & Tur, J. A. (2022) · Nutrients · doi:10.3390/nu14091813 · Cited by 62 · see citing works
“A combination of PA and diet resulted in higher weight loss than diet alone [16], but also in higher improvement in risk factors for NAFLD than PA or diet alone [17].”
BackgroundOh, M., Kim, S., An, K.-Y., Min, J., Yang, H. I., Lee, J., Lee, M. K., Kim, D.-I., Lee, J., Lee, J., et al. (2018) · BMC Public Health · doi:10.1186/s12889-018-6009-1 · Cited by 56 · see citing works
Michalopoulou, E., Thymis, J., Lampsas, S., Pavlidis, G., Katogiannis, K., Vlachomitros, D., Katsanaki, E., Kostelli, G., Pililis, S., Pliouta, L., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14020428 · Cited by 63 · see citing works
“Although the effects of exercise on weight reduction and hepatic fat loss are not entirely clear, it has been demonstrated that exercise can improve liver enzyme levels and insulin resistance in all diabetic patients with MASLD and MASH [66].”
- Authors
- Wu, T., Gao, X., Chen, M., & Van Dam, R. M.
- Affiliations
- Harvard University (US)
- Corresponding author
- Wu, T.
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2009-04-24
- Volume
- 10
- Issue
- 3
- Pages
- 313-323
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W2160779142
- Semantic Scholar
- 2e2c800320db9017115a2ee36508002f2df52542
- Cited by
- 515
- References
- 40
- Citations by year
- 2026: 8 · 2025: 29 · 2024: 24 · 2023: 23 · 2022: 26 · 2021: 31 · 2020: 42 · 2019: 35 · 2018: 40 · 2017: 47 · 2016: 35 · 2015: 37 · 2014: 33 · 2013: 37 · 2012: 25
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- weight loss, obesity, overweight adults, long-term weight loss, body mass index, weight regain, combined diet and exercise
- MeSH terms
- Diet, Humans, Time Factors, Weight Loss, Exercise, Randomized Controlled Trials as Topic
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