Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18–65 years old) who are overfat, or obese; systematic review and meta-analysis

The effectiveness for establishing hypocaloric imbalance does not equate with the effectiveness for body compositional changes or biomarkers associated with metabolic issues.

“First, hypocaloric balance is necessary for changing body composition, but the effectiveness for establishing imbalance does not equate with the effectiveness for body compositional changes, or any biomarkers associated with metabolic issues.”

Endurance training (ET) performed at high intensity (≥70% VO2max or HRmax for 30 minutes 3-4 times/week) or in an interval training style is more effective than low-to-moderate steady-state ET (50-70% VO2max or HRmax for at least equal time) at altering body mass, fat mass, and fat-free mass, with ES of 0.35, 0.39, and 0.13 respectively.

“Even though generally lower ES than RT, the inclusion of ET was more effective when performed at high intensity (e.g. ≥70% VO2max or HRmax for 30-minutes 3-4x’s/wk), or in an interval training style than when utilizing the relatively common prescribed method of low-to-moderate (e.g., 50-70% VO2max or HRmax for at least equal time) steady state method, ES of 0.35, 0.39, and 0.13 for BM, FM, and FFM”

Resistance training (RT) is more effective at reducing fasting insulin levels (ES = 3.5) than endurance training (ET) or ET and RT.

“Additionally RT was more effective at reducing fasting insulin levels (ES = 3.5) than ET or ET and RT.”

There is a difference favoring the combination of diet with endurance training versus diet alone for alterations in body mass (χ2 = 3.09, p = 0.055).

“Interestingly, there were differences noted between effects favoring the combination of diet with ET versus diet alone for alterations in body mass (χ2 = 3.09, p = 0.055).”

Endurance training alone is less effective for retention of fat-free mass than dieting alone or diet combined with exercise (χ2 = 7.458, p < 0.01).

“When examining the effect of ET, when separated from the aspect of additional diet intervention, ET alone appears to less effective to allow for the retention of FFM than dieting alone, or in a combination with use of diet (χ2 = 7.458, p < 0.01).”

There were very few differences in the pooled effect size versus the diet-only intervention for adipokines/cytokines.

“Furthermore, there were very few differences in the pooled effect size versus the diet only intervention, with difference in ES for changes of adiponectin and leptin being elicited by the use of RT, either with or without diet, trending toward significant difference, χ2 = 3.085 (p = 0.07) and χ2 = 3.45 (p = 0.06), respectively.”

Males have greater effectiveness than females for loss of fat mass following an intervention of diet with combination of both endurance and resistance training (χ2 = 3.64, p < 0.05).

“Along with males indicated has having a greater level of effectiveness relative to females for loss of FM and retention of FFM following an intervention of diet with combination of both ET and RT (χ2 = 3.64, p < 0.05).”

The combination of diet with resistance training is more effective than diet alone for reduction in fat mass (χ2 = 3.8, p < 0.05).

“And differences indicate an effectiveness favoring for the combination of diet with RT versus diet along for reduction in FM (χ2 = 3.8, p < 0.05) and retention of FFM (χ2 = 6.7, p < 0.0001).”

There were no differences between any of the pooled effect sizes for assumed differences in energetic balance across the various treatment interventions.

“Lastly, as related to changes in caloric (energetic) balance there were no differences noted between any of the pooled ES for the assumed differences in energetic balance across the various treatment interventions.”

• AssumptionThe authors state this as an assumption: There are differences in energetic balance across the various treatment interventions.

Males have greater effectiveness than females for retention of fat-free mass following an intervention of diet with combination of both endurance and resistance training (χ2 = 3.64, p < 0.05).

“Along with males indicated has having a greater level of effectiveness relative to females for loss of FM and retention of FFM following an intervention of diet with combination of both ET and RT (χ2 = 3.64, p < 0.05).”

Males tend to have a larger pooled effect size than females for retention of fat-free mass following diet with resistance training (χ2 = 3.94, p < 0.05).

“Where males tend to have a larger pooled ES for responses to diet with RT retention of FFM and reduction in FM relative to female groups (χ2 = 3.94, and 3.64, p < 0.05, respectively).”

Endurance training trended toward favoring effectiveness in changes seen in HDL (χ2 = 2.842, p = 0.089).

“Yet trended toward favoring ET for effectiveness in changes seen in HDL (χ2 = 2.842, p = 0.089).”

The use of resistance training, either with or without diet, trended toward significant difference for changes in leptin (χ2 = 3.45, p = 0.06).

“Furthermore, there were very few differences in the pooled effect size versus the diet only intervention, with difference in ES for changes of adiponectin and leptin being elicited by the use of RT, either with or without diet, trending toward significant difference, χ2 = 3.085 (p = 0.07) and χ2 = 3.45 (p = 0.06), respectively.”

Resistance training is more effective than endurance training for fat-free mass retention (χ2 = 10.15, p < 0.01).

“With no significant difference noted between the effectiveness for diet with ET or diet with RT for alterations to BM, but a difference for effectiveness that favors RT over ET for FFM retention (χ2 = 10.15, p < 0.01).”

There was no trend for females to have a larger pooled effect size than males for fat-free mass following diet with endurance training.

“While females trended toward having a larger pooled ES for responses to diet alone, χ2 = 2.09 (p = 0.11), and in combination to ET for reduction in total body mass, χ2 = 1.94 (p = 0.12), and FM, χ2 = 3.1 (p = 0.09), but not FFM.”

Females trended toward having a larger pooled effect size than males for reduction in fat mass following diet with endurance training (χ2 = 3.1, p = 0.09).

“While females trended toward having a larger pooled ES for responses to diet alone, χ2 = 2.09 (p = 0.11), and in combination to ET for reduction in total body mass, χ2 = 1.94 (p = 0.12), and FM, χ2 = 3.1 (p = 0.09), but not FFM.”

There were no differences noted on the pooled effect for treatment based on the gender of the participant groups for any of the treatment intervention options.

“Additionally, there were no differences noted on the pooled effect for treatment based on the gender of the participant groups for any of the treatment intervention options.”

Resistance training, both alone and in combination with diet, provides greater stimulus for retention of fat-free mass (χ2 = 3.5, p < 0.05).

“While the use of RT, both alone as well as in combination with diet provides greater stimulus for retention of FFM (χ2 = 3.5, p < 0.05).”

There were no differences noted between the therapeutic effectiveness for treatment in the responses to either CRP or TNF-α between any of the combinations for interventions.

“While there were no differences noted between the therapeutic effectiveness for treatment in the responses to either CRP or TNF-α between any of the combinations for interventions.”

There is no significant difference between diet with endurance training and diet with resistance training for alterations in body mass.

“With no significant difference noted between the effectiveness for diet with ET or diet with RT for alterations to BM, but a difference for effectiveness that favors RT over ET for FFM retention (χ2 = 10.15, p < 0.01).”

Males tend to have a larger pooled effect size than females for reduction in fat mass following diet with resistance training (χ2 = 3.64, p < 0.05).

“Where males tend to have a larger pooled ES for responses to diet with RT retention of FFM and reduction in FM relative to female groups (χ2 = 3.94, and 3.64, p < 0.05, respectively).”

Resistance training, whether alone or in combination with diet, showed greater effectiveness for eliciting changes in LDL relative to diet-only options (χ2 = 4.95).

“The responses invoked by RT, whether alone or in combination with diet, showed a greater effectiveness for eliciting changes in TC and LDL relative to the diet only options (χ2 = 7.18, 4.95, respectively) and trends toward significance for HDL (χ2 = 3.38, p = 0.068).”

The use of resistance training, either with or without diet, trended toward significant difference for changes in adiponectin (χ2 = 3.085, p = 0.07).

“Furthermore, there were very few differences in the pooled effect size versus the diet only intervention, with difference in ES for changes of adiponectin and leptin being elicited by the use of RT, either with or without diet, trending toward significant difference, χ2 = 3.085 (p = 0.07) and χ2 = 3.45 (p = 0.06), respectively.”

There was a trend for women utilizing endurance training in combination with diet for having a greater effect in changes in HDL levels versus men (χ2 = 2.0, p = 0.12).

“However there was a trend for women utilizing ET in combination with diet for having a great effect in the changes in HDL levels versus those seen in men (χ2 = 2.0, p = 0.12).”

The combination of diet with resistance training is more effective than diet alone for retention of fat-free mass (χ2 = 6.7, p < 0.0001).

“And differences indicate an effectiveness favoring for the combination of diet with RT versus diet along for reduction in FM (χ2 = 3.8, p < 0.05) and retention of FFM (χ2 = 6.7, p < 0.0001).”

Resistance training showed no difference to the responses invoked by endurance training, either with or without the combination of diet, for blood lipid changes.

“But showed no difference to the responses invoked by ET, either with or without the combination of diet.”

Effectiveness for eliciting positive changes to adipokines (adiponectin and leptin) or cytokines (CRP, TNF-α) of interest were noted occurring from all treatment interventions.

“Similar to the changes seen with blood lipids, effectiveness for eliciting positive changes to adipokines (adiponectin and leptin) or cytokines (c-reactive protein (CRP), TNF-α) of interest were noted occurring from all treatment interventions.”

Females trended toward having a larger pooled effect size than males for responses to diet alone (χ2 = 2.09, p = 0.11).

“While females trended toward having a larger pooled ES for responses to diet alone, χ2 = 2.09 (p = 0.11), and in combination to ET for reduction in total body mass, χ2 = 1.94 (p = 0.12), and FM, χ2 = 3.1 (p = 0.09), but not FFM.”

Females trended toward having a larger pooled effect size than males for reduction in total body mass following diet with endurance training (χ2 = 1.94, p = 0.12).

“While females trended toward having a larger pooled ES for responses to diet alone, χ2 = 2.09 (p = 0.11), and in combination to ET for reduction in total body mass, χ2 = 1.94 (p = 0.12), and FM, χ2 = 3.1 (p = 0.09), but not FFM.”

Resistance training, whether alone or in combination with diet, showed a trend toward greater effectiveness for eliciting changes in HDL relative to diet-only options (χ2 = 3.38, p = 0.068).

“The responses invoked by RT, whether alone or in combination with diet, showed a greater effectiveness for eliciting changes in TC and LDL relative to the diet only options (χ2 = 7.18, 4.95, respectively) and trends toward significance for HDL (χ2 = 3.38, p = 0.068).”

Resistance training, whether alone or in combination with diet, showed greater effectiveness for eliciting changes in total cholesterol relative to diet-only options (χ2 = 7.18).

“The responses invoked by RT, whether alone or in combination with diet, showed a greater effectiveness for eliciting changes in TC and LDL relative to the diet only options (χ2 = 7.18, 4.95, respectively) and trends toward significance for HDL (χ2 = 3.38, p = 0.068).”

Endurance training, either alone or in combination with diet, shows no difference for effectiveness at eliciting changes in blood lipids (TC, LDL, and TG) versus diet-only intervention.

“While the use of ET either alone, or in combination with diet, show no difference for effectiveness at eliciting changes blood lipids (TC, LDL and TG) versus the changes elicited by a diet only intervention.”

Diet-only intervention had a positive impact on TC and HDL levels.

“While the diet only intervention did have a positive impact on TC and HDL levels”

ET-only cannot establish changes in lipid profiles for all measures.

“there appears to be a pattern where the induction for changes in lipid profiles cannot be established through the use of ET only for all measures.”

Therapeutic interventions may induce elevations in certain lipids.

“there is also a very interesting finding that therapeutic interventions may actually induce elevations in certain lipids.”

For TG changes, diet+RT is least effective relative to diet-only or diet+ET.

“As far as changes in TG, diet with combination of RT appears be the least effective for inducing changes relative to either the diet only or the diet with combination of ET”

Diet+ET induced a larger ES for TC and LDL than diet-only.

“the treatment interventions that combined diet with ET induced a much larger ES, Figure 4, for measures TC and LDL.”

The combination of diet and resistance training appears to be able to induce favorable adaptations in measurements of fat-free mass (χ2 = 8.02, p < 0.01).

“With respect to the combination of diet and RT, this intervention appears to be able to induce favorable adaptions in, measurements of both FM and FFM (χ2 = 9.24 and χ2 = 8.02, p < 0.01, respectively).”

A trend toward gender difference for effectiveness of treatment was noted in the change in fat-free mass for the utilization of diet with resistance training only in male groups versus female counterparts (χ2 = 3.3, p = 0.06).

“In continuation with what was noted in the pooled therapeutic effect size, a trend toward gender difference for effectiveness of treatment was noted in the change in FFM for the utilization of diet with RT only in male groups versus female counterparts (χ2 = 3.3, p = 0.06).”

Diet alone was not more effective than other treatments at inducing changes in fat mass.

“While a diet alone treatment did induce a beneficial treatment effect following intervention. It was not more effective than other treatments at inducing changes in FM, see Figure 2.”

Diet-only intervention had minimal impact on LDL or TG levels.

“it has only minimal impact on either LDL or TG levels”

Diet+RT produced a larger ES for TC, HDL, LDL, and TG than diet+ET.

“diet with combination of RT was able to produce a much lager ES for these measures in comparison to those induced by diet with combination of ET, for each of these measures”

The combination of diet and resistance training produces equivalent effect sizes for body mass changes as either diet alone or diet in combination with endurance training.

“While producing equivalent ES for body mass changes as either diet alone, or diet in combination with ET, see Figure 2.”

The combination of diet and resistance training appears to be able to induce favorable adaptations in measurements of fat mass (χ2 = 9.24, p < 0.01).

“With respect to the combination of diet and RT, this intervention appears to be able to induce favorable adaptions in, measurements of both FM and FFM (χ2 = 9.24 and χ2 = 8.02, p < 0.01, respectively).”

There were no differences noted showing a favor toward the combination of diet with both endurance and resistance training versus the other intervention methods.

“Interestingly, there were no differences noted showing a favor toward the combination of diet with both ET and RT versus the other intervention methods.”

RT-only is slightly more effective than diet alone or diet+ET for changes in HDL and TG.

“RT is the only intervention that appears to be slightly more effective than diet alone or diet in combination of ET for changes in HDL and TG”

In comparison of body compositional changes based on method of intervention, there are effect size differences in treatment responses that favor the combination of intervention methods.

“In comparison of body compositional changes based on the method of intervention, as would be expected, there are effect size differences in treatment responses that favor the combination of intervention methods.”

For energetic imbalance, there were no gender differences in treatment effectiveness.

“Additionally, there were no differences between gender groups that would indicate a greater effectiveness of a treatment methodology for a specific gender grouping.”

For changes in energetic imbalance, combined diet+exercise interventions are more favorable than diet alone or exercise alone.

“Eliciting energetic imbalance indicates a pattern that favors an intervention that is a combination of diet with any type of exercise versus that of either diet, or exercise, alone, Figure 3.”

Endurance training appears to be effective at inducing a larger loss of fat-free mass relative to diet with combination of resistance training (χ2 = 6.531, p = 0.01).

“ET appears to be effective at inducing a larger loss of FFM relative to diet with combination of RT (χ2 = 6.531, p = 0.01).”

The combination of diet and endurance training was not as effective as any of the other treatments with respect to changing body composition.

“While the combination of diet and ET was not as effective as any of the other treatments with respect to changing of body composition.”

Diet+RT induces a larger ES in TC, HDL, LDL, and TG changes relative to diet-only.

“diet in combination with RT induces a larger ES in TC, HDL, LDL and TG changes relative to those changes seen in diet only treatments”

For energetic imbalance, diet+ET had more favorable treatment ES than any other treatment combination.

“Furthermore, the treatment ES for energetic imbalance for the combination of diet and ET were more favorable than any other treatment intervention combinations.”

Responses for changes in adiponectin, leptin, TNF-α, CRP were highly variable across treatment methods.

“There were highly variable responses for effectiveness for each treatment method to induce changes to circulating levels of adiponectin, leptin, TNF-α, or CRP”

Higher intensity training is better than diet-only for adiponectin, leptin, TNF-α, CRP, IL-6 with ES.

“And is better than the diet only option for treatment (ES of 0.26, 0.59, 0.29, 0.86, 0.33 for adiponectin, leptin, TNF-α, CRP and IL-6 respectively).”

No indication that diet+ET+RT is more effective for changing cytokine or adipokine levels.

“there were no indication for a more effective means to change cytokine or adipokine levels with the utilization of diet in combination with both ET and RT.”

Diet+exercise more effective than exercise alone or diet alone for body compositional changes.

“When combined with diet, exercise interventions were more effective at inducing responses in body compositional changes than either an exercise, or diet, alone option for intervention.”

High protein hypocaloric diet (>1.5 g/kg, >25% kcal) induces larger effect for body compositional changes than any other diet methods, with ES 0.60, 0.54, 0.38 for BM loss, FM loss, FFM retention.

“With the use of a high protein diet, indicated here as a diet with >1.5 g protein*kg−1body mass (>25% of total kcal/d), in a hypocaloric model inducing a larger effect for body compositional changes relative to any of the other diet methods, ES of 0.60, 0.54, 0.38 for loss of body mass, FM and retention of FFM respectively.”

Higher intensity RT favored over ET protocols, ET+RT combination, or lower intensity RT for BM, FM, FFM with ES 0.47, 0.30, 0.40.

“there is an indication for favoring higher intensity RT at an ES of 0.47 for BM, of 0.30 for FM and 0.40 for FFM, respectively to any of the ET protocols, ET and RT combination or lower intensity RT.”

RT is more effective than ET at eliciting beneficial changes.

“analysis of effectiveness showed preference of favor toward RT rather than the classically recommended ET at being more effective to elicit beneficial changes.”

For CRP and TNF-α changes, effectiveness differences between diet alone and diet+exercise were nearly identical (ES crosses 0).

“the changes induced in CRP and TNF-α, Figures 8, 9 and 10, were nearly identical, i.e. ES that crosses 0, for differences in effectiveness for changes between diet alone, or diet in combination with exercise”

Higher intensity exercise is more effective regardless of methodology.

“The effectiveness for exercise becomes more pronounced with higher levels of intensity of exercise regardless of the methodology employed”

The most prominently reported hormones and cytokines were insulin, followed by adiponectin, leptin, IL-6, CRP, and TNF-α.

“The most prominently reported hormones and cytokine signal throughout the studies was insulin, followed by adiponectin, leptin, IL-6, CRP, and TNF-α.”

For insulin changes, ET+diet or ET alone induces a lower effect than diet alone.

“ES for eliciting changes in insulin, Figure 7, indicates that ET in combination with diet (or as a stand-alone intervention) induces a lower effect than diet alone.”

Lower carbohydrate/higher protein diet leads to greater effect in changes to TC, HDL, adiponectin, leptin with ES 0.60, 2.14, 0.59, 0.77.

“the lower carbohydrate and higher protein model lead to a greater effect in changes to blood lipids and cytokines (adiponectin and leptin) with an ES of 0.60, 2.14, 0.59, and 0.77, for TC, HDL, adiponectin and leptin respectively.”

Higher intensity training elicited greater effect than lower intensities for adiponectin, leptin, TNF-α, CRP, IL-6 with ES.

“higher intensity training once again elicited a greater effect in the responses than lower intensities (ES of 0.66, 0.3, 0.42, 1.15, 0.92 for adiponectin, leptin, TNF-α, CRP and IL-6 respectively).”

Addition of exercise provides responses at least as effective as any diet-only method for altering body composition.

“the addition of exercise provided stimulus for responses that are at least as effective as any diet-only method for altering body composition”

For CRP and TNF-α changes, diet alone and diet+exercise were more effective than exercise alone.

“And all were more effective than the exercise alone treatments.”

For insulin changes, treatments more effective in males than females.

“There was a gender difference to response and effectiveness indicated within the analysis for insulin changes, with treatments appearing to be more effective in male groupings than in female groups.”

RT induced greater ES for IL-6 and CRP than ET at higher and lower intensities, with ES.

“RT induced a greater ES for changes in IL-6 and CRP relative to ET, at higher (ES of 0.27 and 1.34, respectively) and lower intensities (ES of 0.36 and 0.76, respectively).”

High training intensity induces greater effect on energetic imbalance than lower intensity.

“the combination of a high level of training intensity (regardless of method of exercise, ET or RT or ET and RT, or in combination with diet or not) induced a greater effect on the level of energetic imbalance than a lower level of training intensity.”

For adiponectin and leptin changes, diet alone and diet+ET were more effective than RT incorporation.

“diet alone and in combination with ET, were more effective than what was seen with changes induced by the incorporation of RT for changes to adiponectin and leptin”

No gender differences in treatment effectiveness for any cytokine or adipokine changes.

“there were no gender differences indicated throughout the analysis of ES for any of the changes to the level of cytokines or adipokines following treatments, regardless of the methodology employed.”

High intensity exercise elicits greater effectiveness for changes in body composition, insulin, blood lipids, cytokines, with specific ES.

“elicited greater effectiveness at inducing changes to body composition, insulin levels, blood lipids, and cytokines (adiponectin, CRP, IL-6), with an ES of 0.49, 0.66, 0.37, 0.50, 0.75, 0.78, 0.75, 0.66, 1.15, and 0.92 for BM, FM, FFM, Insulin, TC, LDL, TG, adiponectin, CRP, and IL-6 respectively.”

High-protein diet more effective than hypocaloric or low fat diet for insulin changes, ES 0.49.

“the high-protein (regardless of carbohydrate modification) diet was more effective than the simply having a hypocaloric, or the traditional low fat, diet within the spectrum of diet options examined, ES of 0.49.”

Diet+RT was more effective at altering BM (reducing FM, retaining FFM) than any other exercise method categorization, regardless of training level.

“diet with RT was not only more effective at altering BM in the most beneficial pattern (i.e. reduction of FM with retention of FFM), without regard to level of training, versus any of the other categorization of the methods for exercise.”

Effectiveness for inducing changes in caloric imbalance does not match effectiveness to induce body compositional changes.

“the effectiveness for inducing changes in caloric imbalance does not match the effectiveness to induce body compositional changes for the adult that is overfat.”

Only a few studies indicated changes in resting metabolic rate related to diet, exercise, or combination.

“With only a few indicated changes in resting metabolic rate related to either the hypocaloric diet or exercise or combination therein.”

There is a spectrum of effectiveness across methods.

“there are patterns of responses indicating a spectrum of effectiveness, within and across the various methods of diet, exercise or combination of diet with exercise.”

High-protein diet combined with exercise is even more effective, ES 0.77.

“And is seen even more so when combined with an exercise programs, ES of 0.77.”

Higher-level RT is more effective at reducing BM and FM while retaining/increasing FFM.

“becomes more effective at higher levels of stimulation RT (e.g., >75-80% 1RM for at least 3 sets with repetition ranges of 5-to-10 with 60-to-90 second rest intervals) at inducing changes in body composition that leads to the reduction of BM and FM, while retaining (and in some cases increases of) FFM for the individual who is overfat.”

Dieting alone is less effective than any exercise or diet+exercise for fasting insulin changes.

“dieting alone is shown to be overall less effective than any of the exercise or diet in combination with exercise modalities.”

Lower-level RT provides responses mimicking ET or ET+RT.

“And when employed at even lower levels of stimulation (e.g., <70% 1RM, single set for at least 12 repetitions, use of pneumatic or selectorized machines, and performance of circuit resistance training) RT provides responses that mimic the ES from ET, or the combination to ET and RT.”

With high protein/low carbohydrate diet + exercise, RT is more effective than ET for insulin changes, regardless of intensity, ES 3.5.

“This difference in treatment effectiveness is reversed with incorporation of the high protein/low carbohydrate diet with combination of exercise where RT is more effective than ET, regardless of intensity (ES of 3.5).”

Difference in effectiveness more pronounced for higher intensity exercise.

“this difference in effectiveness becomes even more pronounced in favor of the higher intensity exercise protocols (regardless of using ET or RT).”

Diet+exercise (especially RT) more effective than diet or diet+ET for reducing BM and FM while retaining FFM.

“the combination of diet with exercise (especially RT) being more effective than diet or diet with ET in reduction of body mass and fat mass while retaining of FFM following treatment.”

RT favored for reducing TC, LDL, TG relative to diet alone or diet+ET.

“there is a favor toward use of RT is seen with eliciting reductions of blood lipids levels, TC, LDL and TG, relative to either dieting alone, or in combination of diet with ET.”

Increases in testosterone and growth hormone seem related to changes in FM following treatment, not intervention used.

“the relative changes in absolute values note an increase in testosterone and growth hormone that seem to not be related to the intervention used, but instead changes in FM following treatment.”

Too few studies examined changes in anabolic hormones in relation to treatments without pharmaceutical intervention.

“There were too few studies that looked at these changes in relation to the treatments that were used, that did not involve a pharmaceutical intervention.”

Exercise more effective than diet for fasting insulin changes.

“exercise was more effective at inducing changes in fasting insulin levels than diet.”

No relationship between treatment effectiveness for inducing acute changes in energetic balance and effectiveness for body composition or biomarkers of health.

“there appears to be no relationship between any treatments effectiveness for inducing acute changes in energetic balance with the effectiveness for induced responses to body composition or biomarkers of health from said treatment program.”

Exercise protocols more effective than hypocaloric diet alone.

“protocols utilizing exercise were more effective than those that employed just a hypocaloric diet.”

Diet+exercise at least as effective for changing hormonal levels and blood lipid profiles.

“And are at least as effective for changing hormonal levels and blood lipid profiles.”

ET (alone or with diet/RT) more effective than RT (alone or with diet) for insulin changes.

“the use of ET (both alone and in combination with diet or in conjunction of diet and RT) was more effective than RT (either when used alone or in combination with diet) for eliciting changes in insulin.”

Higher-intensity exercise more effective than lower-intensity regardless of diet.

“the use of higher-intensity exercise was more effective than lower-intensity exercise without regard to diet selection.”

Differences in effectiveness between RT and ET regardless of diet or intensity.

“there are differences in effectiveness noted between RT and ET. This is seen regardless of being utilized alone or with modification to diet, or based on the intensities of training.”

There is a continuum of effectiveness across treatment modalities and submodalities.

“Analysis of effectiveness of responses both within and between interventions differences for treatment options modalities (e.g., diet, exercise, or combination therein) along with submodality of treatment (e.g., high intensity versus low intensity, high protein/low carbohydrate diets) indicate a continuum of effectiveness.”

Diet+RT was the only intervention with pooled therapeutic ES that did not cross ES=0 relative to control.

“the combination of diet with RT was only intervention that provided a pooled therapeutic ES that did not elicit the possibility of no response (i.e. crosses a point of ES = 0) from treatment relative to the control.”

Diet alone can be effective if hypocaloric and high protein, with at least 55% expected beneficial response.

“if utilized as a stand alone intervention, diets can be effective if hypocaloric and comprised of a higher percentage of total caloric intake from protein, with an expectation for at least 55% of the population showing a beneficial response from the intervention.”

RT produces greater effectiveness for altering these measures, especially with specific protocol.

“With RT producing a greater level of effectiveness for altering these measures, especially when RT is progressive and periodized with a training volume of 2-to-3 sets at 6-to-10 reps with an intensity of ≥75% 1RM and a rest interval of 60–90 seconds, and utilizes whole body (and free-weight) exercises.”

Hypocaloric balance is necessary for changing body composition in adults who are overfat.

“First, hypocaloric balance is necessary for changing body composition, but the effectiveness for establishing imbalance does not equate with the effectiveness for body compositional changes, or any biomarkers associated with metabolic issues.”

Exercise must be included in combination with diet to effectively elicit changes in body composition and biomarkers of metabolic issues.

“With analysis showing that there is a necessity to include exercise in combination with diet effectively elicit changes in body composition and biomarkers of metabolic issues.”

The greatest impact of these endocrinological changes appears related to alterations in sex hormones (testosterone and androgens), growth hormone, and adipokines.

“The greatest impact of these changes appears to be related to alterations in sex hormone (i.e. testosterone and androgens), growth hormone, and a host of adipokines [29,34-46].”

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• cites [40] Guay AT. The emerging link between hypogonadism and metabolic syndrome. J Androl. 2009;30:370–6. sourceNot checked yet

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• cites [41] Mammi C, Calanchini M, Antelmi A, Cinti F, Rosano GMC, Lenzi A, et al. Androgens and adipose tissue in males: a complex and reciprocal interplay. Int J Endocrinol. 2012;2012:789653. sourceNot checked yet

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• cites [42] Maya-Monteiro CM, Bozza PT. Leptin and mTOR: partners in metabolism and inflammation. Cell Cycle. 2008;7:1713–7. sourceNot checked yet

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Improvements from altering health behaviors appear to stem from endocrinological changes that occur with overfatness and following exposure to exercise.

“Where these improvements appear to stem from a number of endocrinological changes that occur with both expression of overfatness and following exposure to exercise that ultimately alters the health status for the individual who is overfat [18,19,26,28,30,32-34].”

• cites [18] Bruunsgaard H. Physical activity and modulation of systemic low-level inflammation. J Leukoc Biol. 2005;78:819–35. sourceNot checked yet

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• cites [19] Clark JE. An overview of the contribution of fatness and fitness factors, and the role of exercise, in the formation of health status for individuals who are overweight. J Diab Metab Disord. 2012;11:19. sourceNot checked yet

  Not checked in the free run.

• cites [26] Booth FW, Gordon SE, Carlson CJ, Hamilton MT. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol (Bethesda, Md : 1985). 2000;88:774–87. sourceNot checked yet

  Not checked in the free run.

• cites [28] Clark JE, Goon DT. The roles of resistance training for treatment of obesity related health issue and for changing health status of the individual who is overfat or obese: A review. J Sports Med Phys Fit. 2015;55(3):205–22.Not checked yet

  Not checked in the free run.

• cites [30] Hood DA, Irrcher I, Ljubicic V, Joseph A-M. Coordination of metabolic plasticity in skeletal muscle. J Exp Biol. 2006;209:2265–75. sourceNot checked yet

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• cites [32] Mathur N, Pedersen BK. Exercise as a mean to control low-grade systemic inflammation. Mediators Inflamm. 2008;2008:109502. sourceNot checked yet

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• cites [33] Müssig K, Remer T, Maser-Gluth C. Brief review: Glucocorticoid excretion in obesity. J Steroid Biochem Mol Biol. 2010;121(3–5):589–93. sourceNot checked yet

  Not checked in the free run.

• cites [34] Bastard J-P, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17:4–12.Not checked yet

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There is evidence for greater change in body composition from utilization of resistance exercise, both with and without conjunction with hypocaloric diet.

“and evidence for greater change in body composition from utilization of resistance exercise, both with and without conjunction with hypocaloric diet [51].”

• cites [51] Bouchard DR, Soucy L, Sénéchal M, Dionne IJ, Brochu M. Impact of resistance training with or without caloric restriction on physical capacity in obese older women. Menopause. 2009;16:66–72. sourceNot checked yet

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Metabolic issues associated with low healthy behaviors are reversed with exposure to physical activity (e.g., exercise).

“And are reversed with exposure to physical activity (e.g., exercise) with speculation that resistance exercise may provide the greatest impact on reversing such issues [28,47-50]”

• cites [28] Clark JE, Goon DT. The roles of resistance training for treatment of obesity related health issue and for changing health status of the individual who is overfat or obese: A review. J Sports Med Phys Fit. 2015;55(3):205–22.Not checked yet

  Not checked in the free run.

• cites [47] Balducci S, Zanuso S, Nicolucci A, Fernando F, Cavallo S, Cardelli P, et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis. 2009;20(8):608–17. sourceNot checked yet

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• cites [48] Pedersen BK, Febbraio MA. Muscles, exercise and obesity: skeletal muscle as a secretory organ. Nat Rev Endocrinol. 2012;8:457–65. sourceNot checked yet

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• cites [49] Shaibi GQ, Roberts CK, Goran MI. Exercise and insulin resistance in youth. Exerc Sport Sci Rev. 2008;36:5–11. sourceNot checked yet

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• cites [50] Tresierras MA, Balady GJ. Resistance training in the treatment of diabetes and obesity: mechanisms and outcomes. J Cardiopulm Rehabil Prev. 2009;29:67–75. sourceNot checked yet

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All treatments provide an effective means to elicit change relative to status at start of treatment or to the control treatment.

“Such findings indicate that all treatments provide an effective means to elicit change relative to status at start of treatment or to the control treatment.”

All treatment options provided an effective means for change in blood lipid profiles relative to pre-intervention status or control condition.

“In comparison of blood lipid profiles, e.g., total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides (TG), all treatment options once again provided an effective means for change relative to either the pre-intervention status or in comparison to the control conditon.”

Hypocaloric high-protein/low carbohydrate diet appears to generate the greatest ES for change relative to all hypocaloric and low fat diets.

“a hypocaloric high-protein/low carbohydrate diet appears to generate the greatest ES for change relative to all hypocaloric, and low fat, diets.”

• cites [61] Mettler S, Mitchell N, Tipton KD. Increased protein intake reduces lean body mass loss during weight loss in athletes. Med Sci Sports Exerc. 2010;42:326–37. sourceNot checked yet

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• cites [62] Volek JS, Westman EC. Very-low-carbohydrate weight-loss diets revisited. Cleve Clin J Med. 2002;69:849–53. 856–848 passim. sourceNot checked yet

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• cites [63] Volek JS, Sharman MJ, Forsythe CE. Modification of lipoproteins by very low-carbohydrate diets. J Nutr. 2005;135:1339–42. sourceNot checked yet

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• cites [64] Phinney SD. Ketogenic diets and physical performance. Nutri Metabol. 2004;1:2. sourceNot checked yet

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The classically recommended treatment for overfatness may not actually be the most effective.

“the analysis of ES pooled across studies in aggregate indicate here is that what has been the general classically recommend treatment for overfatness, and associated diseases, may not actually be the most effective.”

Overfatness is highly complex with interconnected factors beyond caloric balance.

“the issue of overfatness is one that is highly complex. Where there a variety of interconnected factors at play beyond the simplistic caloric balance issue”

High circulating insulin is a key indicator for metabolic health issues in overfat adults.

“one of the key indicators for metabolic health issues for adults that are overfat is high levels of circulating insulin”

• cites [19] Clark JE. An overview of the contribution of fatness and fitness factors, and the role of exercise, in the formation of health status for individuals who are overweight. J Diab Metab Disord. 2012;11:19. sourceNot checked yet

  Not checked in the free run.

• cites [26] Booth FW, Gordon SE, Carlson CJ, Hamilton MT. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol (Bethesda, Md : 1985). 2000;88:774–87. sourceNot checked yet

  Not checked in the free run.

• cites [28] Clark JE, Goon DT. The roles of resistance training for treatment of obesity related health issue and for changing health status of the individual who is overfat or obese: A review. J Sports Med Phys Fit. 2015;55(3):205–22.Not checked yet

  Not checked in the free run.

• cites [31] Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med. 2012;25:9–15. sourceNot checked yet

  Not checked in the free run.

• cites [32] Mathur N, Pedersen BK. Exercise as a mean to control low-grade systemic inflammation. Mediators Inflamm. 2008;2008:109502. sourceNot checked yet

  Not checked in the free run.

• cites [33] Müssig K, Remer T, Maser-Gluth C. Brief review: Glucocorticoid excretion in obesity. J Steroid Biochem Mol Biol. 2010;121(3–5):589–93. sourceNot checked yet

  Not checked in the free run.

• cites [34] Bastard J-P, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17:4–12.Not checked yet

  Not checked in the free run.

• cites [42] Maya-Monteiro CM, Bozza PT. Leptin and mTOR: partners in metabolism and inflammation. Cell Cycle. 2008;7:1713–7. sourceNot checked yet

  Not checked in the free run.

RT can be a more effective treatment for reversing insulin resistance.

“utilizing RT can be a more effective treatment for reversing insulin resistance”

RT + high protein/low carb diet is significantly more effective than standard ET recommendations.

“when combined with the combination of a high protein/low carbohydrate diet, RT exercise (regardless of level of intensity) can be significantly more effective than the standard ET recommendations.”

Better means for prescription of exercise is at higher levels of training intensities.

“it appears that the better means for prescription of exercise is at the higher levels of training intensities.”

RT is a viable option for overfat adults who do not self-select ET.

“there is an indication that RT is a viable option for the adult who is overfat and does not self-select towards an ET mode of exercise”