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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.”
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]
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“No significant effect of exercise was found on weight maintenance (1 SR‐MA).”
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“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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“7,27 These results were extracted from five SR-MAs of which four were rated as good or fair quality and three included only RCTs, and therefore provide a reasonably high degree of confidence in this overview's conclusions.”
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Metadata
- 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
- 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 (medical) › 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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