Background: Obesity is the leading preventable cause of death worldwide. It is associated with significant increases in morbidity and mortality. Few studies have addressed, prospectively, the impact of life-style modification in weight-reduction in 1) morbidly obese patients with BMI > 35 kg/m 2 and 2) on its associated co-morbid risk factors for metabolic syndrome viz. high blood pressure, diabetes, hyperlipidemia and steatohepatitis as well as psychiatric disorders. Patients and Methods: We prospectively evaluated the role of 1) two meals daily with in between 12-hour fasting, 2) thrice weekly 45-minute active-walk, and 3) their combination, in management of ambulant obese patients, at BMI of 35 to 39.9 kg/m 2 who had such multiple acquired metabolic disorders. The study was conducted over 3 years with 45 patients in 3 matched groups with regards to gender, age, BMI, waist circumference, lipid profile (LDL and TG), fibroscan steatosis grade, psychiatric assessment, antidiabetic drugs and antihypertensive ones. Results: At 6 and 12 months, the 3 regimens were well tolerated and were effective in weight loss, improvement in anthropometric measures and management of metabolic syndrome yet the combined one was significantly better in all endpoints. Conclusion: Our protocols of exercise and dieting were effective measures in managing obesity and its associated co-morbidities and their combination is synergetic.