Cited by 515Obesity, Physical Activity, DietPhysical Activity and HealthPharmacology and Obesity Treatment

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Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis

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Wu, T., Gao, X., Chen, M., Van Dam, R. M.·2009·Obesity Reviews

DOI 10.1111/j.1467-789x.2008.00547.x

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Abstract

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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Effects of weight management by exercise modes on markers of subclinical atherosclerosis and cardiometabolic profile among women with abdominal obesity: a randomized controlled trial
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Decrease in serum chemerin through aerobic exercise plus dieting and its association with mitigation of cardio-metabolic risk in obese female adolescents
Liu, M., Lin, X., & Wang, X. (2018) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2017-0431 · Cited by 31
“Most aerobic exercise interventions consist of a long-term (over a 4–6-month or longer period) moderateintensity exercise, for about 30–40 min for 3–4 days per week [29].”
Background
S1‐Leitlinie Lipödem
Reich-Schupke, S., Schmeller, W., Brauer, W. J., Cornely, M. E., Faerber, G., Ludwig, M., Lulay, G. R., Miller, A., Rapprich, S., Richter, D. F., et al. (2017) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.13036_g · Cited by 30
Effects of Synbiotic Supplementation and Lifestyle Modifications on Women With Polycystic Ovary Syndrome
Chudzicka-Strugała, I., Kubiak, A., Banaszewska, B., Zwoździak, B., Siakowska, M., Pawelczyk, L. A., & Dulęba, A. J. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab369 · Cited by 32
A combined planning and telephone aftercare intervention for obese patients: Effects on physical activity and body weight after one year
Ströbl, V., Knisel, W., Landgraf, U., & Faller, H. (2013) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-1095 · Cited by 30
Effect of aerobic exercise on blood lipid and glucose in obese or overweight adults: A meta-analysis of randomised controlled trials
Cai, M., & Zou, Z. (2015) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2015.10.010 · Cited by 32
Dietary Micronutrient Supplementation for 12 Days in Obese Male Mice Restores Sperm Oxidative Stress
McPherson, N. O., Shehadeh, H., Fullston, T., Zander‐Fox, D., & Lane, M. (2019) · Nutrients · doi:10.3390/nu11092196 · Cited by 32
“However, issues with compliance and remission frequently render lifestyle interventions ineffective as clinical interventions [29].”
Background
Anthropometric, metabolic, psychosocial and dietary factors associated with dropout in overweight and obese postmenopausal women engaged in a 6-month weight loss programme: a MONET study
Messier, V., Hayek, J. E., Karelis, A. D., Messier, L., Doucet, É., Prud’homme, D., RABASA-LHORET, R. P. R., & Strychar, I. M. (2009) · British Journal Of Nutrition · doi:10.1017/s0007114509993023 · Cited by 34
“The addition of a physical activity component to a weight loss programme tended to reduce dropout((15)), but results are controversial((5)), possibly depending also on the type of exercise.”
BackgroundMethodInfluential
Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review
Barker, K., Holland, A. E., Skinner, E. H., & Lee, A. L. (2023) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v55.2551 · Cited by 29
“With the known benefits of exercise on exercise capacity, cardiometabolic parameters and depression (84), these findings support what has been previously demonstrated when comparing exercise rehabilitation with other interventions (85–87).”
Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management
Khattab, R. Y. (2024) · Current Nutrition Reports · doi:10.1007/s13668-024-00551-x · Cited by 36
“Despite various treatment methods offering significant weight loss potential, long-term weight maintenance proves challenging, often resulting in weight regain [139, 140].”
Psychological wellbeing and biochemical modulation in response to weight loss in obese type 2 diabetes patients
Osama, A., & Shehab, A. (2015) · African Health Sciences · doi:10.4314/ahs.v15i2.25 · Cited by 29
Robotic-Assisted Kidney Transplantation
Tzvetanov, I. G., Giulianotti, P. C., Bejarano‐Pineda, L., Jeon, H., Garcı́a-Roca, R., Bianco, F. M., Oberholzer, J., & Benedetti, E. (2013) · Surgical Clinics of North America · doi:10.1016/j.suc.2013.08.003 · Cited by 29
Mobile health architecture for obesity management using sensory and social data
Harous, S., El Menshawy, M., Serhani, M. A., & Benharref, A. (2018) · Informatics in Medicine Unlocked · doi:10.1016/j.imu.2017.12.005 · Cited by 28
Daily physical activity as determined by age, body mass and energy balance
Westerterp, K. R. (2015) · European Journal of Applied Physiology · doi:10.1007/s00421-015-3135-7 · Cited by 30
“1 kg greater than for diet only (Wu et al. 2009).”
BackgroundMethodInfluential
Metabolic syndrome severity and lifestyle factors among adolescents
Wang, L. X., Gurka, M. J., & DeBoer, M. D. (2018) · Minerva Pediatrics · doi:10.23736/s0026-4946.18.05290-8 · Cited by 31
“While this study did not follow beyond the 16 weeks of intervention, other studies have suggested difficulty in adherence to on-going dietary regimens [58].”
Result
Physical Activity for the Prevention of Cardiometabolic Disease
Bull, F., Goenka, S., Lambert, V., & Pratt, M. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0518-9_ch5 · Cited by 35
The Role of Gut Microbiota, Nutrition, and Physical Activity in Depression and Obesity—Interdependent Mechanisms/Co-Occurrence
Sochacka, K., Kotowska, A., & Lachowicz, S. (2024) · Nutrients · doi:10.3390/nu16071039 · Cited by 34
“The ﬁndings indicated that combined diet and exercise interventions led to greater long-term weight loss compared to diet-only interventions [132].”
Background
Process evaluation outcomes from a global child obesity prevention intervention
Pettigrew, S., Borys, J. M., du Plessis, H. R., Walter, L., Huang, T. T. ‐., Levi, J., & Vinck, J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-757 · Cited by 28
Facilitators and barriers to participation in lifestyle modification for men with prostate cancer: A scoping review
Yannitsos, D., Murphy, R. A., Pollock, P., & Sebastiano, K. M. D. (2019) · European Journal of Cancer Care · doi:10.1111/ecc.13193 · Cited by 27
Whole-body vibration training as complement to programs aimed at weight loss.
Cristi‐Montero, C., Cuevas, M. J., & Collado, P. S. (2013) · PubMed · doi:10.3305/nh.2013.28.5.6656 · Cited by 27
Does 8 weeks of strenuous bicycle exercise improve diabetes-related inflammatory cytokines and free fatty acids in type 2 diabetes patients and individuals at high-risk of metabolic syndrome?
Madsen, S. M., Thorup, A., Bjerre, M., & Jeppesen, P. (2015) · Archives of Physiology and Biochemistry · doi:10.3109/13813455.2015.1082600 · Cited by 32
“As opposed to moderate-intensity aerobic exercise, which typically offers negligible abdominal fat mass losses (Wu et al., 2009), high intensity interval training (HIIT) seems to be capable of inducing significant abdominal fat mass loss in adults with T2D (Boudou et al.”
Background
Effects of a preconception lifestyle intervention in obese infertile women on diet and physical activity; A secondary analysis of a randomized controlled trial
van Elten, T. M., Karsten, M. D. A., Geelen, A., van Oers, A. M., van Poppel, M. N. M., Groen, H., Gemke, R. J. B. J., Mol, B. W., Mutsaerts, M. A. Q., Roseboom, T. J., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206888 · Cited by 29
“The lack of maintenance in lifestyle changes at twelve months after randomization (six months after the intervention ended) are in line with studies examining long-term weight loss by diet, exercise or combined diet and exercise programs [30,31].”
Result
Hippocampal Leptin Resistance and Cognitive Decline: Mechanisms, Therapeutic Strategies and Clinical Implications
Valladolid‐Acebes, I. (2024) · Biomedicines · doi:10.3390/biomedicines12112422 · Cited by 28
What drives patients’ acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors
Carrera, A., Zoccarato, F., Mazzeo, M., Lettieri, E., Toletti, G., Bertoli, S., Castelnuovo, G., & Fresa, E. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09090-7 · Cited by 26
“These variables are gender [46, 47], age [48], marital status, Body-Mass Index (BMI), level of education [49], employment [50], difficulties in maintaining weight loss [51], ease of use of the digital solution [46], and willingness to change and to be supported [52].”
Background
A randomized clinical trial of home-based exercise combined with a slight caloric restriction on obesity prevention among women
Mediano, M. F. F., Barbosa, J. S. D. O., Moura, A. S., Willett, W. C., & Sichieri, R. (2010) · Preventive Medicine · doi:10.1016/j.ypmed.2010.07.012 · Cited by 26
“regarding the role of PA on prevention of weight regain are still considered controversial, its application has become a part of the strategies for weight maintenance following weight loss programs (Haskell et al., 2007; Saris et al., 2003; Wu et al., 2009), and officially endorsed by the American College of Sports Me…”
Do the Nutrition Qualifications and Professional Practices of Registered Exercise Professionals Align?
McKean, M. R., Slater, G., Oprescu, F., & Burkett, B. J. (2014) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2014-0051 · Cited by 26
Motivational characteristics of obese adolescents toward physical activity: Contribution of self-determination theory
Gourlan, M., Trouilloud, D. O., & Sarrazin, P. G. (2013) · European Review of Applied Psychology · doi:10.1016/j.erap.2013.02.001 · Cited by 32
PACES: A Physical Activity Campus Environmental Supports Audit on University Campuses
Horacek, T. M., White, A. A., Byrd‐Bredbenner, C., Reznar, M. M., Olfert, M. D., Morrell, J. S., Koenings, M., Brown, O. N., Shelnutt, K. P., Kattelmann, K. K., et al. (2013) · American Journal of Health Promotion · doi:10.4278/ajhp.121212-quan-604 · Cited by 26
Survey of perceptions and educational needs of primary care providers regarding management of patients with class II and III obesity in Ontario, Canada
Zevin, B., Martin, M. C., Dalgarno, N., Chan, L., Sivapalan, N., Houlden, R. L., Birtwhistle, R., Smith, K., & Barber, D. (2021) · BMC Family Practice · doi:10.1186/s12875-020-01356-x · Cited by 24
Barriers to a healthy diet and physical activity in Mexican adults: results from the Mexican Health and Nutrition Survey
Zavala, G. A., Ainscough, T., & Jimenez‐Moreno, C. (2022) · Nutrition Bulletin · doi:10.1111/nbu.12568 · Cited by 28
An assessment of patient information channels and knowledge of physical activity and nutrition during pregnancy
Ferraro, Z., Rutherford, J. A., Keely, E. J., Dubois, L., & Adamo, K. B. (2011) · Obstetric Medicine · doi:10.1258/om.2011.110006 · Cited by 25
Using nudging and social marketing techniques to create healthy worksite cafeterias in the Netherlands: intervention development and study design
Velema, E., Vyth, E. L., & Steenhuis, I. H. (2017) · BMC Public Health · doi:10.1186/s12889-016-3927-7 · Cited by 30
Racial/Ethnic Differences in Weight-Loss Strategies among US Adults: National Health and Nutrition Examination Survey 2007-2012
Marquez, B., & Murillo, R. (2017) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.01.025 · Cited by 25
“The simultaneous use of diet and exercise is more effective at producing longer-term weight loss than diet or exercise alone.(14,15) The American Heart Association/American College of Cardiology/The Obesity Society Obesity Guidelines also recommend use of professional help for weight loss.”
Background
Dietary Interventions and Physical Activity as Crucial Factors in the Prevention and Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease
Rajewski, P., Cieściński, J., Rajewski, P., Suwała, S., Rajewska, A., & Potasz, M. (2025) · Biomedicines · doi:10.3390/biomedicines13010217 · Cited by 29
Coaction Between Physical Activity and Fruit and Vegetable Intake in Racially Diverse, Obese Adults
Heredia, N. I., Fernández, M. E., van den Berg, A. E., Durand, C. P., Kohl, H. W., Reininger, B. M., Hwang, K. O., & McNeill, L. H. (2019) · American Journal of Health Promotion · doi:10.1177/0890117119884479 · Cited by 24
Twelve Weeks of Aerobic Exercise at the Lactate Threshold Improves Autonomic Nervous System Function, Body Composition, and Aerobic Performance in Women with Obesity
Park, H., Jung, W., Kim, J., Hwang, H., & Lim, K. (2020) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes19063 · Cited by 24
A comparison of the impact of exercise training with dietary intervention versus dietary intervention alone on insulin resistance and glucose regulation in individual with overweight or obesity: a systemic review and meta-analysis
Khalafi, M., Alamdari, K. A., Symonds, M. E., Rohani, H., & Sakhaei, M. H. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2064424 · Cited by 26
“Ex, DI or Ex + DI induced weight loss is associated with a reduced fat mass, particularly VAT (Verheggen et al. 2016; Wu et al. 2009; Hayashino et al. 2014), which play fundamental role in glucose metabolism and insulin signaling.”
BackgroundResult
Experiential or behavioral processes: Which one is prominent in physical activity? Examining the processes of change 1 year after an intervention of therapeutic education among adults with obesity
Romain, A. J., Attalin, V., Sultan, A., Boegner, C., Gernigon, C., & Avignon, A. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.08.004 · Cited by 24

Authors: Wu, T., Gao, X., Chen, M., & Van Dam, R. M.
Affiliations: Harvard University (US)
Corresponding author: Wu, T.
ORCID: Wu, T.
Gao, X.
Chen, M.
Venue: Obesity Reviews
Publisher: Wiley
Published: 2009-04-24
Volume: 10
Issue: 3
Pages: 313-323
ISSN: 1467-7881 (ISSN-L)
1467-789X
DOI: 10.1111/j.1467-789x.2008.00547.x
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Obesity Reviews (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Health Sciences › Medicine › Pharmacology (medical) › 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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Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis

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