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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 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]
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“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]
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“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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van Elten, T. V., van Poppel, M. V., Gemke, R., Groen, H., Hoek, A., Mol, B., & Roseboom, T. (2018) · Nutrients · doi:10.3390/nu10121953 · Cited by 9
“Randomized controlled trials (RCTs) showed that improving lifestyle and reducing body weight improved cardiometabolic health [4,5].”
MethodWilliams, A. J., Lee, H., Kamper, S. J., O’Brien, K. M., Wiggers, J., Wolfenden, L., Yoong, S. L., Hodder, R. K., Robson, E. K., Haskins, R., et al. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519831419 · Cited by 14
“33(6) 1088 –1097 © The Author(s) 2019 Article reuse guidelines: sagepub.”
Park, H., Jung, W., Kim, J., Hwang, H., & Lim, K. (2020) · Iranian Journal of Public Health · doi:10.18502/ijph.v48i8.2978 · Cited by 11
“Effectiveness of hypoxic therapy for treating obesity Exercise modalities such as MICT, HIIT, and WBVT usually require at least 12 weeks of exercise intervention for prevention and treatment of obesity, but they have the disadvantage of increasing appetite and dietary intake due to sustained exercise (1, 48).”
Methodvan Dammen, L., Bush, N. R., de Rooij, S. R., Mol, B. W., Mutsaerts, M. A. Q., van Oers, A. M., Groen, H., Hoek, A., & Roseboom, T. J. (2020) · Stress and Health · doi:10.1002/smi.2976 · Cited by 14
O’Gorman, P., Monaghan, A., McGrath, M., Naimimohasses, S., Gormley, J., & Norris, S. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa195 · Cited by 12
Robust Reductions of Body Weight and Food Intake by an Oxytocin Analog in Rats
Elfers, C., Blevins, J. E., Lawson, E. A., Pittner, R. A., Silva, D., Kiselyov, A. S., & Roth, C. L. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.726411 · Cited by 11
“, 2016) over the short-term but results in subpar long-term weight loss (Wu et al., 2009; Barte et al., 2010; Dombrowski et al., 2014).”
BackgroundGába, A., Hartwig, T. B., Jašková, P., Sanders, T., Dygrýn, J., Vencálek, O., Antczak, D., Conigrave, J. H., Parker, P. D., Cruz, B. D. P., et al. (2024) · Sports Medicine · doi:10.1007/s40279-024-02148-4 · Cited by 10
“Regular physical activity is considered an essential component of lifestyle change, complementing the benefits of dietary change [7] and improving the efficacy of modern pharmacological therapy [8].”
Emiloju, O. C., & Chinedu, S. N. (2016) · World Journal of Nutrition and Health · doi:10.12691/jnh-4-1-1 · Cited by 10
Alomari, M., Rashid, M. U., Chadalavada, P. N., Ragheb, J. G., Zafar, H., Suarez, Z. K., Khazaaleh, S., Gonzalez, A. J., & Castro, F. (2023) · World Journal of Hepatology · doi:10.4254/wjh.v15.i4.477 · Cited by 11
Kanke, S., Kawai, T., Takasawa, N., Mashiyama, Y., Ishii, A., & Kassai, R. (2015) · Asia Pacific Family Medicine · doi:10.1186/s12930-015-0022-7 · Cited by 14
“Previous studies have shown that intervention methods involving multiple approaches for weight reduction are more effective than those with a single approach [14, 38, 39].”
BackgroundShin, J. H., Gadde, K. M., Østbye, T., & Bray, G. A. (2014) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12275 · Cited by 10
“As suggested by the sibutramine discontinuation study and the this study of zonisamide, weight regain after drug discontinuation appears to be faster than after discontinuation of lifestyle interventions [4,5].”
Tometich, D. B., Mosher, C. E., Winger, J. G., Badr, H., Snyder, D. C., Sloane, R. J., & Demark‐Wahnefried, W. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3665-0 · Cited by 10
“Based on prior diet and exercise research with breast cancer survivors [6, 10–13, 29] and non-cancer samples [7, 9, 14, 15, 30], we hypothesized that improved diet quality and decreased daily caloric intake after the year-long intervention would be associated with better weight-related outcomes (i.”
Why Do Lifestyle Recommendations Fail in Most Patients with Nonalcoholic Fatty Liver Disease?
Roman, J. H., & Patel, S. S. (2019) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2019.10.001 · Cited by 10
Gorny, A. W., Low, M. C., Sayampanathan, A. A., Shiraz, F., & Müller‐Riemenschneider, F. (2021) · BMC Public Health · doi:10.1186/s12889-021-10373-z · Cited by 11
Cantor, A. G., Nelson, H. D., Pappas, M., & Atchison, C. (2022) · Annals of Internal Medicine · doi:10.7326/m22-0160 · Cited by 10
“health conditions (20, 21), preventing obesity is an important approach that is missing from existing recommendations.”
BackgroundWilkinson, A. V., Barrera, S. L., McBride, C. M., Snyder, D. C., Sloane, R. J., Meneses, K., Pekmezi, D., Kraus, W. E., & Demark‐Wahnefried, W. (2010) · Psycho-Oncology · doi:10.1002/pon.1870 · Cited by 11
“These findings parallel previous studies, which also found higher levels of depressive symptoms in similar populations [17], and associations between fatalism and older age and lower socioeconomic status [18].”
Geng, L., Jiang, G., Yu, L., Xu, Y., Huang, W., Chen, Z., Qi, X., Zhang, T., & Zhao, M. (2023) · JMIR mhealth and uhealth · doi:10.2196/50226 · Cited by 9
“However, combining a healthy diet with PA is more beneficial for weight loss [41].”
BackgroundO’Donnell, C., Ryan, O. K., Hogan, A. E., Killick, D., Crilly, S., Dodd, J. D., Murphy, D. J., Ryan, S., & O'Shea, D. B. (2024) · Obesity · doi:10.1002/oby.24126 · Cited by 9
“Historically, the focus of weight management has been on the reduction of energy intake via changes in diet; however, this approach is limited in its efficacy for the majority of patients [9, 10].”
Effective Diet and Exercise Interventions to Improve Body Composition in Obese Individuals
Rankin, J. W. (2013) · American Journal of Lifestyle Medicine · doi:10.1177/1559827613507879 · Cited by 11
Implementation of psychiatric‐focused lifestyle medicine programs in A sia
Sarris, J. J., Nishi, D., Xiang, Y., Su, K., Bannatyne, A. J., Oliver, G., Kua, E. H., & Ng, C. H. (2015) · Asia-Pacific Psychiatry · doi:10.1111/appy.12212 · Cited by 9
“For example, numerous meta-analyses (Franz et al., 2007; Wu et al., 2009; Schaar et al., 2010) have indicated that interventions combining diet and exercise strategies produce significantly better long-term outcomes than interventions consisting of diet or exercise-only strategies.”
BackgroundPsychological interventions for adults who are overweight or obese
Brennan, L., Murphy, K. D., Garcia, X. D. L. P., Ellis, M. E., Metzendorf, M., & McKenzie, J. E. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012114 · Cited by 9
RetractedFerriby, M., Pratt, K. J., Noria, S. F., & NEEDLEMAN, B. J. (2018) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12357 · Cited by 10
Park, H., Kim, S., Kim, Y., Park, S., & Nam, S.-S. (2019) · Physical Activity and Nutrition · doi:10.20463/jenb.2019.0019 · Cited by 9
Poraj‐Weder, M., Wąsowicz, G., & Pasternak, A. (2021) · Health Psychology Open · doi:10.1177/20551029211024406 · Cited by 11
“…weight are often ineffective and unaccompanied by the internalization of the principles that can support dietary change (Anderson et al., 2001; De Ridder et al., 2014; Hall and Kahan, 2018; Loveman et al., 2011; Meule et al., 2012; Williams et al., 1996; Wing and Phelan, 2005; Wu et al., 2009).”
BackgroundWhy Some Women Eat Too Much: A Qualitative Study of Food-Dependent Women
Ostrand, G. V. (2015) · ScholarWorks (Walden University) · Cited by 9
Obesity and Metabolic Syndrome Hypertension
Hall, M. E., Wang, Z., do Carmo, J. M., Kamimura, D., & Hall, J. E. (2018) · Updates in hypertension and cardiovascular protection · doi:10.1007/978-3-319-59918-2_42 · Cited by 8
IC-Behavior: An interdisciplinary taxonomy of behaviors
Larsen, K. R. T., Ramsay, L. J., Godinho, C. I. A., Gershuny, V., & Hovorka, D. S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0252003 · Cited by 10
“, eating junk food) are detrimental to their running progress [17].”
BackgroundØverby, N. C., Medin, A. C., Valen, E. N., Salvesen, L., Wills, A. K., Engeset, D., Vik, F. N., & Hillesund, E. R. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-055116 · Cited by 8
Pradhan, I. D., & De, B. (2020) · The Journal of Horticultural Science and Biotechnology · doi:10.1080/14620316.2020.1754925 · Cited by 8
Turner, R. T., Wong, C. P., Fosse, K. M., Branscum, A. J., & Iwaniec, U. T. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22136789 · Cited by 8
Metadata
- 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 › 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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