Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Comparison of 2-year weight loss trends in behavioral treatments of obesity: diet, exercise, and combination interventions. Group cognitive behavioural therapy and weight regain after diet in type 2 diabetes: results from the randomised controlled POWER trial Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial Diet and Exercise Interventions among Overweight and Obese Lactating Women: Randomized Trial of Effects on Cardiovascular Risk Factors Quality of Life after Diet or Exercise-Induced Weight Loss in Overweight to Obese Postmenopausal Women: The SHAPE-2 Randomised Controlled Trial Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. ALIFE@Work: a randomised controlled trial of a distance counselling lifestyle programme for weight control among an overweight working population [ISRCTN04265725] The effect of the addition of resistance training to a dietary education intervention on apolipoproteins and diet quality in overweight and obese older adults Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes Home‐exercise Childhood Obesity Intervention: A Randomized Clinical Trial Comparing Print Versus Web‐based (Move It) Platforms Two-Year Results of Translating the Diabetes Prevention Program Into an Urban, Underserved Community Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: A randomized controlled trial Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials Effects of an Intervention and Maintenance Weight Loss Diet with and without Exercise on Anthropometric Indices in Overweight and Obese Healthy Women Physiological and behavioural outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes.
PURPOSE The purpose of this paper is to review the evidence on the role of physical activity in the treatment of adult overweight and obesity . Three specific questions are addressed : ( 1 ) Does exercise alone produce weight loss ? ( 2 ) Does exercise in combination with diet produce greater weight loss than diet only ? and ( 3 ) Does exercise in combination with diet produce better maintenance of weight loss than diet alone ? METHODS The literature initially identified by the Expert Panel on Clinical Guidelines for the Treatment of Obesity , three key meta analyses , and additional literature search es were used to identify r and omized trials related to the three aforementioned topics . These articles were review ed and tabulated . RESULTS Six of 10 r and omized studies found significantly greater weight loss in exercise alone versus no treatment controls . The magnitude of the effect averaged 1 - 2 kg . Only 2 of 13 studies found significant differences in initial weight loss for diet plus exercise versus diet only , although almost all studies pointed in this direction . Six studies were identified with maintenance periods of at least 1 yr . In two of the six there were significant long term differences favoring diet plus exercise , but in every study considered the direction of the difference favored diet plus exercise . Other strong evidence showing benefits of exercise for long-term weight loss comes from correlational analyses which consistently find that those individuals who report the greatest exercise have the best maintenance of weight loss . CONCLUSIONS R and omized trials consistently show benefits of exercise for weight loss , but the effects are often modest . This may result from small sample sizes , short study duration , and poor adherence to the exercise prescriptions . To better define the doses and types of exercise that will promote long-term weight loss , it is necessary to develop better ways to measure exercise and promote adherence to exercise OBJECTIVE The effects of three cognitive-behavioral weight control interventions for adults were compared : diet only , exercise only , and a combination of diet and exercise . This article reports 2-year follow-up data . DESIGN The three interventions were compared in a r and omized , experimental design . SUBJECTS A total of 127 men and women who were at least 14 kg overweight ( according to height-weight tables ) were recruited from an urban community and assigned r and omly to the experimental conditions . INTERVENTION The dietary intervention was a low-energy eating plan adjusted to produce a 1 kg/week loss of weight . The exercise component involved training in walking and a home-based program of up to five exercise periods per week . There were 12 weekly instructional sessions , followed by 3 biweekly and 8 monthly meetings . All sessions were led by registered dietitians . OUTCOME MEASURES Changes in body weight . STATISTICAL ANALYSES Analysis of variance for weight changes and repeated measures analysis of variance for weight change trends . RESULTS At 1 year , no significant differences were noted among the three groups . The diet-only group lost 6.8 kg , the exercise-only group lost 2.9 kg , and the combination group lost 8.9 kg ( P=.09 ) . During the second year , the diet-only group regained weight -- reaching 0.9 kg above baseline ; the combination group regained to 2.2 kg below baseline ; and the exercise-only group regained slightly to 2.7 kg below baseline ( P=.36 ) . Repeated measures analysis of variance showed a group-by-time interaction ( P=.001 ) ; data for the dieting groups best fit a U-shaped regain curve ( P=.001 ) . APPLICATIONS The results suggest that dieting is associated with weight loss followed by regain after treatment ends , whereas exercise alone produced smaller weight losses but better maintenance . The large outcome variability and unequal difficulty of the regimens across groups limit the generalizability of the findings Aims /hypothesisWeight-loss programmes for adults with type 2 diabetes are less effective in the long term owing to regain of weight . Our aim was to determine the 2 year effectiveness of a cognitive behavioural group therapy ( group-CBT ) programme in weight maintenance after diet-induced weight loss in overweight and obese adults with type 2 diabetes , using a r and omised , parallel , non-blinded , pragmatic study design . Methods We included 158 obese adults ( median BMI 36.3 [ IQR 32.5–40.0 ] kg/m2 ) with type 2 diabetes from the outpatient diabetes clinic of Erasmus MC , the Netherl and s , who achieved ≥5 % weight loss on an 8 week very low calorie diet .  Participants were r and omised ( stratified by weight loss ) to usual care or usual care plus group-CBT ( 17 group sessions ) . The primary outcomes were the between-group differences after 2 years in : ( 1 ) body weight ; and ( 2 ) weight regain . Secondary outcomes were HbA1c levels , insulin dose , plasma lipid levels , depression , anxiety , self-esteem , quality of life , fatigue , physical activity , eating disorders and related cognitions . Data were analysed using linear mixed modelling . Results During the initial 8 week dieting phase , the control group ( n = 75 ) lost a mean of 10.0 ( 95 % CI 9.1 , 10.9 ) kg and the intervention group ( n = 83 ) lost 9.2 ( 95 % CI 8.4 , 10.0 ) kg ( p = 0.206 for the between-group difference ) . During 2 years of follow-up , mean weight regain was 4.7 ( 95 % CI 3.0 , 6.3 ) kg for the control group and 4.0 ( 95 % CI 2.3 , 5.6 ) kg for the intervention group , with a between-group difference of −0.7 ( 95 % CI −3.1 , 1.6 ) kg ( p = 0.6 ) . The mean difference in body weight at 2 years was −1.2 ( 95 % CI −7.7 , 5.3 ) kg ( p = 0.7 ) . None of the secondary outcomes differed between the two groups . Conclusions /interpretationDespite increased treatment contact , a group-CBT programme for long-term weight maintenance after an initial ≥5 % weight loss from dieting in obese individuals with type 2 diabetes was not superior to usual care alone . Trial registration Trialregister.nl NTR2264 Funding The study was funded by the Erasmus MC funding programme ‘ Zorgonderzoek ’ ( grant 2008 - 8303 ) OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown . We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus , a trial design ed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention . RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years ( n = 626 ) were r and omized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet , physical activity promotion , and behavioral support ( IG ) or a control group ( CG ) . The primary and secondary outcomes were changes in weight and cardiovascular risk markers , respectively . RESULTS Diet and physical activity changes were in the expected direction , with significant improvements in IG versus CG . After 12 months , IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG ( P < 0.001 ) , a mean difference of −2.5 kg ( 95 % CI −3.1 to −1.9 ) . Weight loss ≥5 % occurred in 33.7 % of IG participants compared with 11.9 % in the CG ( P < 0.001 ) . Compared with the CG , cardiovascular risk factors , including waist circumference , fasting glucose , triglycerides , and HDL cholesterol , significantly improved in IG participants ( P < 0.002 ) . Reductions in insulin resistance , HbA1c , and circulating levels of leptin , interleukin-18 , and MCP-1 were greater in IG than CG participants ( P < 0.05 ) . IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity , along with triglycerides and HDL cholesterol levels compared with their CG counterparts . CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome , as well as in individuals with or at risk for diabetes Objective To examine the effects of Diet ( D ) and Exercise ( E ) interventions on cardiovascular fitness , waist circumference , blood lipids , glucose metabolism , inflammation markers , insulin-like growth factor 1 ( IGF-1 ) and blood pressure in overweight and obese lactating women . Methods At 10–14 wk postpartum , 68 Swedish women with a self-reported pre-pregnancy BMI of 25–35 kg/m2 were r and omized to a 12-wk behavior modification treatment with D , E , both or control using a 2 × 2 factorial design . The goal of D treatment was to reduce body weight by 0.5 kg/wk , accomplished by decreasing energy intake by 500 kcal/d and monitoring weight loss through self-weighing . The goal of E treatment was to perform 4 45-min walks per wk at 60–70 % of max heart-rate using a heart-rate monitor . Effects were measured 12 wk and 1 y after r and omization . General Linear Modeling was used to study main and interaction effects adjusted for baseline values of dependent variable . Results There was a significant main effect of the D treatment , decreasing waist circumference ( P = 0.001 ) , total cholesterol ( P = 0.007 ) , LDL-cholesterol ( P = 0.003 ) and fasting insulin ( P = 0.042 ) , at the end of the 12-wk treatment . The decreased waist circumference ( P<0.001 ) and insulin ( P = 0.024 ) was sustained and HDL-cholesterol increased ( P = 0.005 ) at the 1-y follow-up . No effects from the E treatment or any interaction effects were observed . Conclusions Dietary behavior modification that produced sustained weight loss among overweight and obese lactating women also improved risk factors for cardiovascular disease and type 2 diabetes . This intervention may not only reduce weight-related risks with future pregnancies but also long-term risk for metabolic disease . Trial registration Clinical Trials.gov Introduction This study investigates the effect of a modest weight loss either by a calorie restricted diet or mainly by increased physical exercise on health related quality of life ( HRQoL ) in overweight-to-obese and inactive postmenopausal women . We hypothesize that HRQoL improves with weight loss , and that exercise-induced weight loss is more effective for this than diet-induced weight loss . Methods The SHAPE-2 trial was primarily design ed to evaluate any additional effect of weight loss by exercise compared with a comparable amount of weight loss by diet on biomarkers relevant for breast cancer risk . In the present analysis we focus on HRQoL. We r and omly assigned 243 eligible women to a diet ( n = 97 ) , exercise ( n = 98 ) , or control group ( n = 48 ) . Both interventions aim ed for 5–6 kg weight loss . HRQoL was measured at baseline and after 16 weeks by the SF-36 question naire . Results Data of 214 women were available for analysis . Weight loss was 4.9 kg ( 6.1 % ) and 5.5 kg ( 6.9 % ) with diet and exercise , respectively . Scores of the SF-36 domain ‘ health change ’ increased significantly by 8.8 points ( 95 % CI 1.6;16.1 ) with diet , and by 20.5 points ( 95 % CI 13.2;27.7 ) with exercise when compared with control . Direct comparison of diet and exercise showed a statistically significantly stronger improvement with exercise . Both intervention groups showed a tendency towards improvements in most other domains , which were more pronounced in the exercise group , but not statistically different from control or each other . Conclusion In a r and omized trial in overweight-to-obese and inactive postmenopausal women a comparable 6%-7 % weight loss was achieved by diet-only or mainly by exercise and showed improvements in physical and mental HRQoL domains , but results were not statistically significant in either the diet or exercise group . However , a modest weight loss does lead to a positive change in self-perceived health status . This effect was significantly larger with exercise-induced weight loss than with comparable diet-induced weight loss . Trial Registration Clinical Trials.gov Lifestyle interventions for weight loss are the cornerstone of obesity therapy , yet their optimal design is debated . This is particularly true for postmenopausal women ; a population with a high prevalence of obesity yet toward whom fewer studies are targeted . We conducted a year-long , 4-arm r and omized trial among 439 overweight-to-obese postmenopausal sedentary women to determine the effects of a calorie-reduced , low-fat diet ( D ) , a moderate-intensity , facility-based aerobic exercise program ( E ) , or the combination of both interventions ( D+E ) , vs. a no-lifestyle-change control ( C ) on change in body weight and composition . The group-based dietary intervention had a weight-reduction goal of ≥10 % , and the exercise intervention consisted of a gradual escalation to 45-min aerobic exercise 5 day/week . Participants were predominantly non-Hispanic whites ( 85 % ) with a mean age of 58.0 ± 5.0 years , a mean BMI of 30.9 ± 4.0 kg/m(2 ) and an average of 47.8 ± 4.4 % body fat .  Baseline and 12-month weight and adiposity measures were obtained by staff blinded to participants ' intervention assignment . Three hundred and ninety nine women completed the trial ( 91 % retention ) . Using an intention-to-treat analysis , average weight loss at 12 months was -8.5 % for the D group ( P < 0.0001 vs. C ) , -2.4 % for the E group ( P = 0.03 vs. C ) , and -10.8 % for the D+E group ( P < 0.0001 vs. C ) , whereas the C group experienced a nonsignificant -0.8 % decrease . BMI , waist circumference , and % body fat were also similarly reduced . Among postmenopausal women , lifestyle-change involving diet , exercise , or both combined over 1 year improves body weight and adiposity , with the greatest change arising from the combined intervention Background The prevalence of overweight is increasing and its consequences will cause a major public health burden in the near future . Cost-effective interventions for weight control among the general population are therefore needed . The ALIFE@Work study is investigating a novel lifestyle intervention , aim ed at the working population , with individual counselling through either phone or e-mail . This article describes the design of the study and the participant flow up to and including r and omisation . Methods / Design ALIFE@Work is a controlled trial , with r and omisation to three arms : a control group , a phone based intervention group and an internet based intervention group . The intervention takes six months and is based on a cognitive behavioural approach , addressing physical activity and diet . It consists of 10 lessons with feedback from a personal counsellor , either by phone or e-mail , between each lesson . Lessons contain educational content combined with behaviour change strategies . Assignments in each lesson teach the participant to apply these strategies to every day life . The study population consists of employees from seven Dutch companies . The most important inclusion criteria are having a body mass index ( BMI ) ≥ 25 kg/m2 and being an employed adult . Primary outcomes of the study are body weight and BMI , diet and physical activity . Other outcomes are : perceived health ; empowerment ; stage of change and self-efficacy concerning weight control , physical activity and eating habits ; work performance/productivity ; waist circumference , sum of skin folds , blood pressure , total blood cholesterol level and aerobic fitness . A cost-utility- and a cost-effectiveness analysis will be performed as well . Physiological outcomes are measured at baseline and after six and 24 months . Other outcomes are measured by question naire at baseline and after six , 12 , 18 and 24 months . Statistical analyses for short term ( six month ) results are performed with multiple linear regression . Analyses for long term ( two year ) results are performed with multiple longitudinal regression . Analyses for cost-effectiveness and cost-utility are done at one and two years , using bootstrapping techniques . Discussion ALIFE@Work will make a substantial contribution to the development of cost-effective weight control- and lifestyle interventions that are applicable to and attractive for the large population at risk Objectives The aim of the study was to examine the additive effect of resistance training ( RT ) to a dietary education ( DE ) intervention on emerging coronary heart disease ( CHD ) risk factors , concentration of apolipoproteins B ( apoB ) and A-I ( apoA-I ) , and Dietary Approaches to Stop Hypertension ( DASH ) Diet Index scores in overweight and obese older adults . Patients and methods This was an ancillary study of a r and omized clinical trial held in the Fall of 2008 at the University of Rhode Isl and . Participants were overweight or obese subjects ( mean body mass index [ BMI ] of 31.7 kg/m2 ) r and omized into two groups , one participating in DE only ( n = 12 ) and the other participating in DE plus RT ( DERT ) ( n = 15 ) . The intervention involved all subjects participating in 30 minutes of DE per week for 10 weeks . Subjects in the DERT group participated in an additional 40 minutes of RT three times per week for 10 weeks . Measurements taken were anthropometric ( height , weight , waist circumference , and body composition using the BOD POD ® [ Body Composition System , v 2.14 ; Life Measurement Instruments , Concord , CA ] ) , clinical ( blood pressure ) , and biochemical ( lipid profile and apoB and apoA-I concentrations ) , and the DASH Diet Index was used to measure diet quality . Results 27 subjects ( 11 males , 16 females ) , with a mean age of 66.6 ± 4.3 years , were included in analyses . The DERT subjects had significantly better triacylglycerol and apoB concentrations and DASH Diet Index scores than the DE subjects post-intervention . Improvements were seen within the DE group in energy intake , fat-free mass , and systolic blood pressure and within the DERT group in body weight , percentage of body fat , BMI , diastolic blood pressure , and oxidized low-density lipoprotein ( all P < 0.05 ) . Conclusion The addition of RT effectively reduced CHD risk factors , body composition , and diet quality in overweight and obese older adults ; DERT was more effective than DE alone in improving DASH Diet Index scores and lowering apoB concentrations but was not more effective in increasing apoA-I concentrations . Future research is needed to determine if apolipoproteins are superior to lipoprotein cholesterol concentrations in predicting CHD risk Summary Two studies were conducted to determine whether adding exercise to a diet programme promotes weight loss or glycaemic control in Type 2 ( non-insulin-dependent ) diabetic subjects . In Study 1 , 25 subjects were r and omly assigned to diet plus moderate exercise or diet plus placebo exercise .  All subjects exercised twice a week as a group and once a week on their own ; the diet plus moderate exercise group walked a 3-mile route at each session while the diet plus placebo exercise group did very low intensity exercises such as stretching and light calisthenics . All subjects followed a calorie-counting diet and were taught behaviour modification strategies . Weight losses and improvements in glycaemic control did not differ significantly between the two treatment groups at the end of the 10-week treatment or at 1-year follow-up . In Study 2 , more extreme conditions were compared : a diet only group and a diet plus exercise group . The diet plus exercise group walked a 3-mile route with the group 3 times/week and once a week on their own , while the diet only group was instructed to maintain their current low level of activity . Both groups received comparable diet and behaviour modification instruction and therapist contacts . The diet plus exercise group had significantly ( p<0.01 ) better weight losses than the diet only condition at the end of the 10 week programme ( −9.3 kg vs −5.6 kg ) and at 1 year follow-up ( −7.9 kg vs −3.8 kg ) . Both groups had similar improvements in glycosylated haemoglobin , but reductions in medication were more frequent and greater in magnitude in the diet plus exercise group . Finally , analyses were conducted collapsing across studies and across treatment groups and comparing subjects who reported low , medium , or high levels of exercise at 1 year . Self-reported exercise was related to weight loss and to improvements in glycosylated haemoglobin , even after adjusting for weight loss . These data suggest that the combination of diet and exercise  improves weight loss and glycaemic control compared to diet only in Type 2 diabetic patients Purpose : To compare the impact of adhering to a Mediterranean diet plus mixed physical exercise program ( Move‐It ) implemented by means of printed instructions or via a web‐platform ( with or without e‐mail support ) on body composition , physical fitness , and blood pressure . Design and Methods : R and omized clinical trial . Fifty‐two overweight or obese Spanish children and adolescents were r and omly assigned to the print‐based ( n = 18 ) , Move‐It ( n = 18 ) , or Move‐It plus support ( n = 16 ) intervention groups . Two‐way mixed ANOVA tests were used to compare any changes between the groups in terms of percentage body fat , physical fitness ( VO2peak ) , h and grip strength , and systolic and diastolic blood pressure . The measurements were taken before and after a three‐month mixed‐exercise ( aerobic and resistance ) and Mediterranean‐diet program which was either implemented by means of printed instructions or via a web‐platform ( with or without e‐mail support ) . Results : No statistical differences were found between groups . However , the results highlighted significant improvements in body fat percentage metrics over time for all three groups ( print‐based : −1.8 % , 95%CI −3.3 % to −0.3 % ; Move‐It : −1.8 % , 95%CI −3.3 % to −0.3 % ; Move‐It plus support : −2.0 % , 95%CI −3.7 % to −0.4 % , P < 0.05 ) . We also observed a tendency towards improvement in the VO2peak , h and grip strength , and blood pressure variable values 10 min after the exercise‐stress test in these three groups . Conclusions : The program improved the body composition , regardless of the way it is implemented . Practice Implication s : A mixed physical exercise program lasting for three months , combined with a Mediterranean diet , improves the body composition of children and adolescents with overweight/obesity . Highlights : Move‐It improves the body composition in three months . Move‐It improves the body composition , regardless of the way it is implemented . Move‐It shows a tendency towards improvement in physical fitness and blood pressure Purpose The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance ( GLB ) program on weight , impaired fasting glucose , hypertension , and hyperlipidemia in an urban , medically underserved community . Methods This study was a single-arm prospect i ve intervention study that was design ed to test the effectiveness of a community-based GLB intervention . In sum , 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m2 and metabolic syndrome . Eligible individuals took part in a 12-week GLB intervention ( n = 105 ) that addressed weight loss and physical activity . Subjects were followed for 24 months . Results The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7 % over the long-term follow-up . Of the participants who lost at least 5 % of their body weight following the intervention , 52.6 % maintained the 5 % weight loss at their last follow-up time , weighing about 20 lb less than they did at baseline . Conclusion Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact Background Overweight ( Body Mass Index [ BMI ] ≥ 25 kg/m2 ) and obesity ( BMI ≥ 30 kg/m2 ) are associated with increased cardiovascular risk , posing a considerable burden to public health . The main aim of this study was to investigate lifestyle intervention effects on cardiovascular risk factors in healthy overweight employees . Methods Participants were 276 healthy overweight employees ( 69.2 % male ; mean age 44.0 years [ SD 9.2 ] ; mean BMI 29.7 kg/m2 [ SD 3.1 ] ) . They were r and omized to one of two intervention groups receiving a six month lifestyle intervention with behavior counseling by phone ( phone group ) or e-mail ( Internet group ) , or to a control group receiving usual care .  Body weight , height , waist circumference , sum of skinfolds , blood pressure , total cholesterol level and predicted aerobic fitness were measured at baseline , at 6 and at 24 months . Regression analyses included the 141 participants with complete data . Results At 6 months a significant favorable effect on total cholesterol level ( -0.2 mmol/l , 95%CI -0.5 to -0.0 ) was observed in the phone group and a trend for improved aerobic fitness ( 1.9 ml/kg/min , 95%CI -0.2 to 3.9 ) in the Internet group . At two years , favorable trends for body weight ( -2.1 kg , 95%CI -4.4 to 0.2 ) and aerobic fitness ( 2.3 ml/kg/min , 95%CI -0.2 to 4.8 ) were observed in the Internet group . Conclusions The intervention effects were independent of the used communication mode . However short-term results were in favor of the phone group and long-term results in favor of the internet group . Thus , we found limited evidence for our lifestyle intervention to be effective in reducing cardiovascular risk in a group of apparently healthy overweight workers . Trial registration IS RCT Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content Background and Aims : There is growing evidence that excess body weight and body fat levels may lead to various diseases . A low-calorie diet has been found to reduce body weight and fat ; however , 95 % of patients regain the weight within a short period of time . The aim of this study was to investigate the effects of a reduced-calorie diet with and without exercise on body composition profile as well as to evaluate maintenance of weight loss 18 weeks after the intervention had concluded . Methods : Two hundred and six overweight and /or obese women were r and omized by a computer to either diet only ( DO ) or diet and exercise ( DE ) for an 18-week intervention period and 18 weeks of maintenance . Statistical significance was set at p < 0.05 . Results : Body mass index ( BMI ) was reduced by 5.1 in the DE group compared to 3.2 in the DO group 18 weeks after the intervention period had ended ; waist circumference ( WC ) was 14.2 cm lower in the exercise group and 8 cm lower in the diet alone group , and body fat was reduced by 15.5 % in the DE group , while no changes were observed in the DO group . Conclusion : A combination of a reduced-calorie diet with exercise may successfully reduce weight , BMI , WC and body fat levels AIM This study evaluates the efficacy of the Choose Health program , a family-based cognitive behavioural lifestyle program targeting improved eating and activity habits , in improving body composition , cardiovascular fitness , eating and activity behaviours in overweight and obese adolescents . METHOD The sample comprised 29 male and 34 female overweight ( n = 15 ) or obese ( n = 48 ) adolescents aged 11.5 - 18.9 years ( M = 14.3 , SD = 1.9 ) . Participants were r and omly allocated to treatment or waitlist control conditions ; waitlist condition participants were offered treatment after 6 months .  DEXA-derived and anthropometric measures of body composition ; laboratory-based cycle ergometer and field-assessed cardiovascular fitness data ; objective and self-report physical activity measures ; and self-report measures of eating habits and 7-day weighed food diaries  were used to assess treatment outcome . Adherence to treatment protocol s was high . RESULTS Treatment result ed in significant ( p < .05 ) and sustained improvements in a range of body composition ( body fat , percent body fat , lean mass ) and anthropometric measures ( weight , BMI , BMI -for-age z-score and percentiles ) . Minimal improvements were seen in cardiovascular fitness . Similar results were obtained in completer and intention-to-treat analysis . Poor adherence to assessment protocol s limits conclusions that can be drawn from physical activity and dietary data . CONCLUSIONS Participation in the Choose Health program result ed in significant improvement in body composition . Longer-term follow up is required to determine the durability of intervention effects . Alternative approaches to the measurement of diet and physical activity may be required for adolescents Overweight and obesity are major contributors to both type 2 diabetes and cardiovascular disease ( CVD ) . Moreover , individuals with type 2 diabetes who are overweight or obese are at particularly high risk for CVD morbidity and mortality . Although short-term weight loss has been shown to ameliorate obesity-related metabolic abnormalities and CVD risk factors , the long-term consequences of intentional weight loss in overweight or obese individuals with type 2 diabetes have not been adequately examined . The primary objective of the Look AHEAD clinical trial is to assess the long-term effects ( up to 11.5 years ) of an intensive weight loss program delivered over 4 years in overweight and obese individuals with type 2 diabetes . Approximately 5000 male and female participants who have type 2 diabetes , are 45 - 74 years of age , and have a body mass index > or=25 kg/m(2 ) will be r and omized to one of the two groups . The intensive lifestyle intervention is design ed to achieve and maintain weight loss through decreased caloric intake and increased physical activity . This program is compared to a control condition given diabetes support and education . The primary study outcome is time to incidence of a major CVD event . The study is design ed to provide a 0.90 probability of detecting an 18 % difference in major CVD event rates between the two groups . Other outcomes include components of CVD risk , cost and cost-effectiveness , diabetes control and complications , hospitalizations , intervention processes , and quality of life
Results from the network meta-analyses confirmed these findings .
Conclusions Moderate- quality evidence from the present network meta- analysis suggests that D + E can be highly recommended for long-term obesity management .
Furthermore , the evidence suggests a moderate superiority of D over E with respect to anthropometric outcomes .
Background The aim of this meta- analysis was to compare the long-term efficacy of diet plus exercise ( D + E ) vs. diet ( D ) , D + E vs. exercise ( E ) and D vs. E on anthropometric outcomes and cardiovascular risk factors in overweight and obese participants .