Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials
Open accessAbstract
Background: Weight-loss maintenance remains a major challenge in obesity treatment. Objective: The objective was to evaluate the effects of anti-obesity drugs, diet, or exercise on weight-loss maintenance after an initial very-low-calorie diet (VLCD)/low-calorie diet (LCD) period (<1000 kcal/d). Design: We conducted a systematic review by using MEDLINE, the Cochrane Controlled Trial Register, and EMBASE from January 1981 to February 2013. We included randomized controlled trials that evaluated weight-loss maintenance strategies after a VLCD/LCD period. Two authors performed independent data extraction by using a predefined data template. All pooled analyses were based on random-effects models. Results: Twenty studies with a total of 27 intervention arms and 3017 participants were included with the following treatment categories: anti-obesity drugs (3 arms; n = 658), meal replacements (4 arms; n = 322), high-protein diets (6 arms; n = 865), dietary supplements (6 arms; n = 261), other diets (3 arms; n = 564), and exercise (5 arms; n = 347). During the VLCD/LCD period, the pooled mean weight change was −12.3 kg (median duration: 8 wk; range 3–16 wk). Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg [95% CI: 1.5, 5.5 kg; median duration: 18 mo (12–36 mo)], meal replacements by 3.9 kg [95% CI: 2.8, 5.0 kg; median duration: 12 mo (10–26 mo)], and high-protein diets by 1.5 kg [95% CI: 0.8, 2.1 kg; median duration: 5 mo (3–12 mo)]. Exercise [0.8 kg; 95% CI: −1.2, 2.8 kg; median duration: 10 mo (6–12 mo)] and dietary supplements [0.0 kg; 95% CI: −1.4, 1.4 kg; median duration: 3 mo (3–14 mo)] did not significantly improve weight-loss maintenance compared with control. Conclusion: Anti-obesity drugs, meal replacements, and high-protein diets were associated with improved weight-loss maintenance after a VLCD/LCD period, whereas no significant improvements were seen for dietary supplements and exercise.
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These studies reported no evidence of a beneficial effect of exercise on weight maintenance.
“These studies reported no evidence of a beneficial effect of exercise on weight maintenance.”
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 [17]
The Exercise section reports no significant benefit when all exercise trials were pooled, supporting the overall conclusion. But it also reports significantly improved short-term maintenance in the two trials focused solely on exercise; the unqualified statement that there was no evidence of benefit overlooks that finding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNo significant effect of exercise on weight maintenance was found in one SR-MA.
“No significant effect of exercise was found on weight maintenance (1 SR‐MA).”
The literature search identified only one SR-MA including three RCTs and one additional RCT published in 2018 on exercise after weight loss for preventing weight regain.
“Contrary to our expectations, our literature search identified only one SR‐MA including three RCTs17 and one additional RCT published in 2018.”
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- Authors
- Johansson, K., Neovius, M., & Hemmingsson, E.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Johansson, Kari
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 99
- Issue
- 1
- Pages
- 14-23
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC3862452
- OpenAlex
- W2155231441
- Semantic Scholar
- 3c5db8e0c32c0f2f1fc771ec71ad517c918034ae
- Cited by
- 243
- References
- 47
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 6 · 2023: 19 · 2022: 18 · 2021: 28 · 2020: 18 · 2019: 17 · 2018: 20 · 2017: 27 · 2016: 21 · 2015: 27 · 2014: 24 · 2013: 1
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- weight loss maintenance, very low calorie diet, hypocaloric diet, anti-obesity drugs, meal replacement, high-protein diet, dietary supplements, physical activity, obesity treatment, weight regain
- MeSH terms
- Energy Intake, Feeding Behavior, Humans, Obesity, Weight Loss, Exercise, Randomized Controlled Trials as Topic, Databases, Factual, Treatment Outcome, Anti-Obesity Agents, Caloric Restriction, Meals
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