Severe vs moderate energy restriction with and without exercise in the treatment of obesity: efficiency of weight loss

Background: Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear. Objective: To determine the efficacy of exercise alone for treating overweight in children/adolescents. Design: A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N ¼ 481 overweight boys and girls, aged B12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD). Results: Few studies were of robust design. The pooled SMD was À0.4 (À0.7, À0.1, P ¼ 0.006) for percent body fat, and À0.2 (À0.6, 0.1, P ¼ 0.07) for central obesity outcomes, whereas the pooled WMD was À2.7 kg (À6.1 kg, 0.8 kg, P ¼ 0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155-180 min/weeks vs 120-150 min/ weeks). Conclusions: Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155-180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.

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“…90,93 Theoretically, a similar rationale for preserving fat-free mass would apply when selecting an optimal treatment for overweight in youth.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

2006

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“…40 Besides these considerations, the use of this type of diet seems to promote, in the course of time, adaptation mechanisms that allow the body greater conservation of energy, making it necessary to decrease the energy ingestion in order to maintain weight. 41 On the other hand, Amador et al 42 demonstrated that growing children can substantially improve their body composition without actual weight loss, with the use of the normocaloric diet associated with physical activity. In the present study, both groups of girls and boys gained weight from the beginning of treatment, but the majority were able to reduce their body size.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of obese children and adolescents enrolled in a multidisciplinary health program

et al. 1998

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OBJECTIVE: The study was designed to evaluate the impact of a multidisciplinary program on children and adolescents' weight control. DESIGN: Retrospective study regarding changes in relative weight of all patients treated regularly in an out-patient care public service between January 1992 and December 1993. SUBJECTS: 198 children and adolescents (108 girls and 90 boys; mean age: 9.25 y; mean body mass index (BMI): 24.26 kg/m 2 , range 19.1 ± 40.31). MEASUREMENTS: Anthropometric data collected at the visits were obtained until June 30 1994. BMI compared to reference data was used. Dual Photon X-ray Absorptiometry (DEXA) was used for 64 patients, to determine percent body fat. RESULTS: Relative weight at the last visit was signi®cantly lower when compared with initial relative weight for the whole sample. Signi®cantly better outcome of relative weight was obtained when six or more visits occurred for the whole sample, and for girls when the days' interval between visits was shorter than 52 d. Variables such as percent body fat, body shape at the ®rst visit, family obesity pattern, length of obesity and pubertal stage, did not signi®cantly in¯uence the outcome of relative weight for the subjects during the treatment. CONCLUSION: Results obtained indicated that good outcomes can be obtained in a program using nutrition education focused on small modi®cations of eating habits in order to avoid excess energy intake. The best predictors of weight improvement for children and adolescents participating in the program were the higher frequency of visits and shorter intervals between them.

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“…(76) A moderately energy-restricted diet (MER) was defined as a diet providing greater or equal to 5.0 MJ per day. (78) BMD in all studies was reported as grams per square centimeter (g/cm 2 ). Data for lumbar spine BMD measured between L 1 and L 4 were pooled with data measured between L 2 and L 4 .…”

Section: Methodsmentioning

confidence: 99%

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials

Zibellini

Seimon

Lee

et al. 2015

Journal of Bone and Mineral Research

116

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Diet-induced weight loss has been suggested to be harmful to bone health. We conducted a systematic review and meta-analysis (using a random-effects model) to quantify the effect of diet-induced weight loss on bone. We included 41 publications involving overweight or obese but otherwise healthy adults who followed a dietary weight-loss intervention. The primary outcomes examined were changes from baseline in total hip, lumbar spine, and total body bone mineral density (BMD), as assessed by dual-energy X-ray absorptiometry (DXA). Secondary outcomes were markers of bone turnover. Diet-induced weight loss was associated with significant decreases of 0.010 to 0.015 g/cm 2 in total hip BMD for interventions of 6, 12, or 24 (but not 3) months' duration (95% confidence intervals [CIs], -0.014 to -0.005, -0.021 to -0.008, and -0.024 to -0.000 g/cm 2 , at 6, 12, and 24 months, respectively). There was, however, no statistically significant effect of diet-induced weight loss on lumbar spine or whole-body BMD for interventions of 3 to 24 months' duration, except for a significant decrease in total body BMD (-0.011 g/cm 2 ; 95% CI, -0.018 to -0.003 g/cm 2 ) after 6 months. Although no statistically significant changes occurred in serum concentrations of N-terminal propeptide of type I procollagen (P1NP), interventions of 2 or 3 months in duration (but not of 6, 12, or 24 months' duration) induced significant increases in serum concentrations of osteocalcin (0.26 nmol/L; 95% CI, 0.13 to 0.39 nmol/L), C-terminal telopeptide of type I collagen (CTX) (4.72 nmol/L; 95% CI, 2.12 to 7.30 nmol/L) or N-terminal telopeptide of type I collagen (NTX) (3.70 nmol/L; 95% CI, 0.90 to 6.50 nmol/L bone collagen equivalents [BCEs]), indicating an early effect of diet-induced weight loss to promote bone breakdown. These data show that in overweight and obese individuals, a single diet-induced weight-loss intervention induces a small decrease in total hip BMD, but not lumbar spine BMD. This decrease is small in comparison to known metabolic benefits of losing excess weight.

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Severe vs moderate energy restriction with and without exercise in the treatment of obesity: efficiency of weight loss

Cited by 77 publications

References 22 publications

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

Outcomes of obese children and adolescents enrolled in a multidisciplinary health program

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials

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