Review

International Journal of Obesity (2005) 29, 1168–1174. doi:10.1038/sj.ijo.0803015; published online 31 May 2005

Long-term weight loss after diet and exercise: a systematic review

C C Curioni1 and P M Lourenço1

1Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Brazil

Correspondence: CC Curioni, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524, pavilhão João Lyra Filho, 7° andar, blocos D e E, Maracanã Rio de Janeiro-RJ-CEP. 20559-900, Brasil. E-mail: c_curioni@uol.com.br

Received 22 September 2004; Revised 13 April 2005; Accepted 27 April 2005; Published online 31 May 2005.

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Abstract

OBJECTIVE:

 

To assess the effectiveness of dietary interventions and exercise in long-term weight loss in overweight and obese people.

DESIGN:

 

A systematic review with meta-analysis.

SUBJECTS:

 

Overweight and obese adults—18 years old or older with body mass index (calculated as weight divided by the square of height in meters)>25.

DATA SOURCE:

 

Medline, Cochrane Library and Lilacs databases up to March 2003. Also, published reviews and all relevant studies and their reference lists were reviewed in search for other pertinent publications. No language restrictions were imposed.

STUDY SELECTION:

 

Randomised clinical trials comparing diet and exercise interventions vs diet alone. All trials included a follow-up of 1 y after intervention.

DATA EXTRACTION:

 

Two reviewers independently abstracted data and evaluated the studies' quality with criteria adapted from the Jadad Scale and the Delphi list.

DATA SYNTHESIS:

 

The estimate of the intervention's effect size was based on the differences between the comparison groups, and then the overall effect was calculated. A chi-squared test was used to assess statistical heterogeneity.

RESULTS:

 

A total of 33 trials evaluating diet, exercise or diet and exercise were found. Only 6 studies directly comparing diet and exercise vs diet alone were included (3 additional studies reporting repeated observations were excluded). The active intervention period ranged between 10 and 52 weeks across studies. Diet associated with exercise produced a 20% greater initial weight loss. (13 kg vs 9.9 kg; z=1.86—p=0.063, 95%CI). The combined intervention also resulted in a 20% greater sustained weight loss after 1 y (6.7 kg vs 4.5 kg; z=1.89—p=0.058, 95%CI) than diet alone. In both groups, almost half of the initial weight loss was regained after 1 y.

CONCLUSION:

 

Diet associated with exercise results in significant and clinically meaningful initial weight loss. This is partially sustained after 1 y.

Keywords:

diet, exercise, systematic review, meta-analysis

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