Measuring Outcomes in Adult Weight Loss Studies That Include Diet and Physical Activity: A Systematic Review

Millstein, Rachel A.

doi:10.1155/2014/421423

Cited by 54Obesity, Physical Activity, DietBody Composition Measurement TechniquesObesity and Health Practices

Measuring Outcomes in Adult Weight Loss Studies That Include Diet and Physical Activity: A Systematic Review

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Millstein, Rachel A.·2014·Journal of Nutrition and Metabolism

DOI 10.1155/2014/421423PMC PMC4262752

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Abstract

Background. Measuring success of obesity interventions is critical. Several methods measure weight loss outcomes but there is no consensus on best practices. This systematic review evaluates relevant outcomes (weight loss, BMI, % body fat, and fat mass) to determine which might be the best indicator(s) of success.Methods. Eligible articles described adult weight loss interventions that included diet and physical activity and a measure of weight or BMI change and body composition change.Results. 28 full-text articles met inclusion criteria. Subjects, settings, intervention lengths, and intensities varied. All studies measured body weight (−2.9 to −17.3 kg), 9 studies measured BMI (−1.1 to −5.1 kg/m 2), 20 studies measured % body fat (−0.7 to −10.2%), and 22 studies measured fat mass (−0.9 to −14.9 kg). All studies found agreement between weight or BMI and body fat mass or body fat % decreases, though there were discrepancies in degree of significance between measures.Conclusions. Nearly all weight or BMI and body composition measures agreed. Since body fat is the most metabolically harmful tissue type, it may be a more meaningful measure of health change. Future studies should consider primarily measuring % body fat, rather than or in addition to weight or BMI.

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Several studies have reported percentage body fat to be more responsive to exercise than body weight.
“Several studies have reported %BF to be more responsive to exercise than BW”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [81]
Body fat is the most metabolically harmful tissue type, and it may be a more meaningful measure of health change for evaluating exercise interventions.
“because body fat is the most metabolically harmful tissue type, it may be a more meaningful measure of health change for evaluating exercise interventions.”
From What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis (2021) · cites this paper as [81]

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Result
A gender- and culturally-sensitive weight loss intervention for Hispanic males: The ANIMO randomized controlled trial pilot study protocol and recruitment methods
Garcia, D. O., Valdez, L. A., Bell, M. L., Humphrey, K., Hingle, M. D., McEwen, M. M., & Hooker, S. P. (2018) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2018.01.010 · Cited by 17 · see citing works
“It is recommended that body fat percentage be measured as an additional outcome in weight loss interventions due to limitations of body weight and BMI informing only on total change, not the types of tissue mass lost [35].”
Background
Are long‐term FAD diets restricting micronutrient intake? A randomized controlled trial
Malik, N., Tonstad, S., Paalani, M., Santos, H. D., & do Prado, W. L. (2020) · Food Science & Nutrition · doi:10.1002/fsn3.1895 · Cited by 14 · see citing works
“A meta-analysis revealed attrition rates for prospective weight loss studies range from 2.5% to 48.8% (Millstein, 2014).”
BackgroundInfluential
Body weight of individuals with obesity decreases after a 6-month high pasta or low pasta Mediterranean diet weight-loss intervention
Rosi, A., Tesan, M., Cremonini, A., Biasini, B., Bicchieri, L., Cossu, M., Brighenti, F., Dall’Aglio, E., & Scazzina, F. (2020) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2020.02.013 · Cited by 13 · see citing works
Changes in Body Composition and Physical Performance in Children with Excessive Body Weight Participating in an Integrated Weight-Loss Programme
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“Researchers agree that since adipose tissue is the most metabolically harmful type of tissue, effective evaluation of the effectiveness of reduction programs should primarily take into account the measurement of % adipose tissue and not only BMI or body weight [31].”
Background
Effect of personal activity trackers on weight loss in families enrolled in a comprehensive behavioral family-lifestyle intervention program in the federally qualified health center setting: A randomized controlled trial
Espinoza, J., Chen, A., Orozco, J., Deavenport‐Saman, A., & Yin, L. (2017) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2017.06.004 · Cited by 12 · see citing works
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“Other studies showed that sixmonth interventions decreased both the BMI and the body fat percentage, the latter decreasing more quickly [9].”
Result
Economic Evaluation of a Personalized Nutrition Plan Based on Omic Sciences Versus a General Nutrition Plan in Adults with Overweight and Obesity: A Modeling Study Based on Trial Data in Denmark
Galekop, M. M. J., Groot, C. U.-D., & Redekop, K. (2023) · PharmacoEconomics - Open · doi:10.1007/s41669-023-00461-8 · Cited by 8 · see citing works
“For example, body fat might be a better measure for ‘weight loss’ since it is the most metabolically harmful tissue type [1, 96].”
Fat, muscle, and anti-obesity medications in cardiovascular disease prevention
Khan, M. S., Dawood, M. H., Handelsman, Y., Anker, S. D., Coats, A. J. S., Green, J. B., & Butler, J. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag201 · Cited by 9 · see citing works
INDICATORS OF SUCCESS IN THE DIETARY MANAGEMENT OF OVERWEIGHT AND OBESITY: WEIGHT, BODY FAT LOSS AND QUALITY.
García-Galbis, M. R., Baeza, M. R., & Cortés‐Castell, E. (2015) · PubMed · doi:10.3305/nh.2015.32.3.9248 · Cited by 7 · see citing works
Measuring What Matters: Beyond Quality Performance Measures in Caring for Adults with Obesity
Ciemins, E. L., Joshi, V., Horn, D. B., Nadglowski, J. F., Ramasamy, A., & Cuddeback, J. K. (2020) · Population Health Management · doi:10.1089/pop.2020.0109 · Cited by 7 · see citing works
“Weight and BMI are easily measurable and widely used to gauge the success of interventions addressing obesity.(12) Other potential measures include documentation of a diagnosis of obesity; prescription for, or referral to, an evidencebased treatment or program; and change in quality of life (QOL) as assessed by patien…”
Background
Body composition outcomes of Healthy Fit and the role of acculturation among low-income Hispanics on the US-Mexico border
Lopez, D. I., Chacon, L., Vasquez, D., & Brown, L. D. (2021) · BMC Public Health · doi:10.1186/s12889-021-11015-0 · Cited by 7 · see citing works
“Furthermore, BFP is a stronger indicator for overweight/ obesity and disease risk since it can differentiate between lean mass and fat mass [36, 37].”
Background
Obesity among postmenopausal women: what is the best anthropometric index to assess adiposity and success of weight-loss intervention?
Ghachem, A., Marcotte‐Chénard, A., Tremblay, D., Prud’homme, D., RABASA-LHORET, R. P. R., Riesco, É., Brochu, M., & Dionne, I. J. (2021) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000001754 · Cited by 6 · see citing works
“identify individuals at higher risk of developing obesityrelated disorders(5,8) and second, to assess the success of weight-loss interventions.(9)”
Background
Influence of co-morbidity on body composition changes after weight loss intervention among overweight housewives: a follow-up study of the MyBFF@home
Aziz, N. S. A., Shahar, S., Ambak, R., Nor, N. S. M., Jamil, A. T., & Aris, T. (2018) · BMC Women s Health · doi:10.1186/s12905-018-0600-6 · Cited by 5 · see citing works
“A multidisciplinary approach has identified a combination of balanced dietary intake, regular exercise and psychological intervention as potentially effective weight loss strategies in overweight and obese adults [9].”
Background
Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative
Ranjan, P., Vikram, N. K., Kumari, A., Chopra, S., Choranur, A., Pradeep, Y., Puri, M., Malhotra, A., Ahuja, M., Meeta, et al. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_51_22 · Cited by 5 · see citing works
“Midlife women measure successful weight loss outcomes mainly in terms of achieving clinically significant weight loss.[253] Women should be sensitised regarding the role of weight loss in managing cardiometabolic, musculoskeletal, menopausal and mental health.”
Background
Cost‐Effectiveness of Personalised Nutrition in Adults With Overweight and Obesity: PREVENTOMICS Studies in Poland and the UK
Galekop, M. M. J., Calder, P. C., Baker, E. J., Góralska, J., Raźny, U., Malczewska-Malec, M., Groot, C. A. U., & Redekop, K. (2025) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70071 · Cited by 4 · see citing works
Dreaming of effective diet change? Motivation, emotions, and dietician presence can all matter
Wąsowicz, G., Poraj-Weder, M., & Matthys, C. (2022) · Journal of Health Psychology · doi:10.1177/13591053211042064 · Cited by 4 · see citing works
“They include, for example, changes in weight, BMI (Millstein, 2014), consumed food, and ability to manage emotional distress (Johnson et al.”
BackgroundInfluential
Branched-Chain and Aromatic Amino Acids in Relation to Fat Mass and Fat-Free Mass Changes among Adolescents: A School-Based Intervention
Pana, M. P., Ayotte, P., Anassour-Laouan-Sidi, E., Suhas, E., Gatti, C. M. I., & Lucas, M. (2022) · Metabolites · doi:10.3390/metabo12070589 · Cited by 4 · see citing works
“Although changes in body mass index (BMI) and overall body weight can be used to estimate the impact of an obesityrelated intervention, studies suggest that body fat percentage is a more physiologically significant measure [12].”
BackgroundMethod
Effects of blood flow restriction training on cardiometabolic health and body composition in adults with overweight and obesity: a meta-analysis
Kong, H., Zhang, Y., Yin, M., Xu, K., Sun, Q., Xie, Y., & Girard, O. (2025) · Frontiers in Physiology · doi:10.3389/fphys.2024.1521995 · Cited by 4 · see citing works
[THE MANAGEMENT OF QUALITATIVE AND QUANTITATIVE DIETARY TREATMENT FOR OVERWEIGHT AND OBESITY: METHODOLOGY AND A NEW PERSPECTIVE ON INDIVIDUALISED ASSESSMENT].
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The IMAGINE Intervention: Impacting Physical Activity, Body Fat, Body Mass Index, and Dietary Inflammatory Index
Bernhart, J., Turner-McGrievy, G. M., Wirth, M., Shivappa, N., & Hébert, J. (2021) · Translational Journal of The American College of Sports Medicine · doi:10.1249/tjx.0000000000000181 · Cited by 2 · see citing works
[PREDICTORS OF WEIGHT LOSS AND FAT IN THE DIETARY MANAGEMENT: SEX, AGE, BMI AND CONSULTING ASSISTANCE].
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The evaluation of clinical outcomes assessments and digital health technologies in clinical trials for obesity
GOETZ, I. A., Sutter, C., Abraham, T. H., Kanu, C., Boye, K. S., & Symonds, T. L. (2025) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-025-00841-0 · Cited by 2 · see citing works
“Often, because of its reliable and quantifiable nature, the reduction of body weight is used as a standard in therapies [40], and a focus is placed on the resolution of comorbidities.”
A health technology assessment of personalized nutrition interventions using the EUnetHTA HTA Core Model
Galekop, M. M. J., Bas-Prior, J. M. D., Calder, P. C., Groot, C. A. U., & Redekop, K. (2024) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462324000060 · Cited by 2 · see citing works
“Third, this HTA primarily focused on BMI as (short-term) outcome measures, but other health outcomes such as waist circumference, blood glucose, systolic blood pressure, or LDL cholesterol might even be more important (67;68).”
Background
IDEAL REDUCTION OF CALORIES FOR GREATEST REDUCTION OF BODY FAT AND MAINTENANCE OF LEAN BODY MASS
Lombardo, M., Magarotto, R., Marinelli, F., Padua, E., Caprio, M., Annino, G., Bellia, A., & Iellamo, F. (2017) · Journal of Aging Research and Lifestyle · doi:10.14283/jarcp.2017.1 · Cited by 2 · see citing works
Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial
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“The primary outcome measure will be a reduction or stabilization in the child BMI z score (index participant) and a reduction in parent BMI (coparticipant) [88].”
Obesity and Health Care: Identifying Measures, Indicators and Tools
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Original / Obesidad Indicators of success in the dietary management of overweight and obesity: weight, body fat loss and quality
García-Galbis, M. R., Baeza, M. R., & Cortés‐Castell, E. (2015)
Original / Obesidad Gestión del tratamiento dietético cuali-cuantitativo en el sobrepeso y la obesidad: metodología y una nueva perspectiva de asesoramiento individualizado
García-Galbis, M. R. (2015)
Prevention of Type II diabetes mellitus through lifestyle intervention in predisposed obese adults
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Effectiveness of interventions to support weight loss in adults taking antipsychotics: a review
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La actividad física y el estado nutricional en médicos
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Authors: Millstein, R. A.
Affiliations: San Diego State University (US)
Corresponding author: Millstein, Rachel A.
ORCID: Millstein, Rachel A.
Venue: Journal of Nutrition and Metabolism
Publisher: Hindawi Limited
Published: 2014
Volume: 2014
Pages: 1-13
ISSN: 2090-0724 (ISSN-L)
2090-0732
DOI: 10.1155/2014/421423
PMC: PMC4262752
OpenAlex: W2105897397
Cited by: 54
References: 53
Citations by year: 2026: 2 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 8 · 2020: 8 · 2019: 3 · 2018: 9 · 2017: 3 · 2016: 1 · 2015: 7
FWCI: 0.57
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/3.0/ (unspecified)
Locations: Journal of Nutrition and Metabolism (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: University of California, San Diego
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords: weight loss outcomes, obesity intervention, body composition, body fat percentage, fat mass, body mass index, diet and physical activity

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Measuring Outcomes in Adult Weight Loss Studies That Include Diet and Physical Activity: A Systematic Review

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