Review: diet interventions, with or without exercise, promote weight loss more than advice alone

April 2008
Evidence Based Medicine;Apr2008, Vol. 13 Issue 2, p41
Academic Journal
METHODS Question: in overweight and obese adults, which interventions are most effective for weight loss? Search methods: PubMed (1997 to September 2004) and reference lists. Study selection and assessment: English-language, randomised controlled trials (RCTs) that evaluated weight loss interventions in overweight or obese adults and had ⩾1 year follow-up. 80 RCTs (n = 26 455, mean age 23-69 y, 0- 100% men) met the selection criteria. At baseline, mean weight was 77-131 kg and mean body mass index was 29-43 kg/m². The interventions included advice only (28 RCTs), exercise (6 RCTs), diet (51 RCTs), diet plus exercise (17 RCTs), meal replacements (7 RCTs), very-low-energy diet (11 RCTs), orlistat (13 RCTs), and sibutramine (7 RCTs). No RCT on bariatric surgery was found. Study duration ranged from 12 to 60 months. Overall patient follow-up at study end was 69%. Outcomes: weight loss. MAIN RESULTS For most interventions, maximum weight loss occurred early in the study (pooled mean weight loss at 6 mo was 0.7 kg for advice only, 2.4 kg for exercise, 4.9 kg for diet, 7.9 kg for diet plus exercise, 8.2 kg for sibutramine, 8.3 kg for orlistat, 8.6 kg for meal replacements, and 17.9 kg for very-low-energy diet), with some regain over time. Except for the advice-only group, mean weight did not completely regress to baseline level by end of study. By meta-analysis, reduced-energy diet interventions, with or without exercise programmes, resulted in more weight loss than advice alone (table). Meal replacements and weight-management drugs resulted in more weight loss than diet (table). Data from RCTs of very-low-energy diets were insufficient to do meta-analysis for this intervention. CONCLUSIONS Interventions involving a reduced-energy diet, with or without an exercise programme, promote weight loss more than advice alone. Meal replacement products and weight-management drugs promote weight loss more than diet alone. Regardless of the type of intervention, most weight loss occurs in the first 6 months, with some weight regain thereafter.


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