Effects of Lifestyle Interventions That Include a Physical Activity Component in Class II and III Obese Individuals: A Systematic Review and Meta-Analysis

Background In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals. Methods An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran’s chi-square test and quantified through an estimation of the I ². Results Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2–7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4–2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose. Conclusions Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.

[1]  T. Mellman,et al.  In Psychiatric Clinics of North America. , 2020, Sleep medicine clinics.

[2]  M. Bondi,et al.  Interdisciplinary rehabilitation in morbidly obese subjects: an observational pilot study. , 2016, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[3]  L. Valiquette,et al.  Impact of physical activity and fitness in class II and III obese individuals: a systematic review , 2014, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[4]  G. Davis,et al.  Exercise, energy expenditure, and body composition in people with spinal cord injury. , 2014, Journal of physical activity & health.

[5]  J. Oppert,et al.  An EASO Position Statement on Multidisciplinary Obesity Management in Adults , 2014, Obesity Facts.

[6]  M. Langlois,et al.  Weight management in Canada: an environmental scan of health services for adults with obesity , 2014, BMC Health Services Research.

[7]  B. Burguera,et al.  One year weight loss in the TRAMOMTANA study. A randomized controlled trial , 2013, Clinical endocrinology.

[8]  Janusz Wnek,et al.  2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults , 2013, Circulation.

[9]  J. Hjelmesæth,et al.  Predictors of weight loss after an intensive lifestyle intervention program in obese patients: a 1-year prospective cohort study , 2013, Health and Quality of Life Outcomes.

[10]  J. Annesi.  Association of Multimodal Treatment-Induced Improvements in Stress, Exercise Volume, Nutrition, and Weight with Improved Blood Pressure in Severely Obese Women , 2013, International Journal of Behavioral Medicine.

[11]  R. Sturm,et al.  Morbid obesity rates continue to rise rapidly in the United States , 2013, International Journal of Obesity.

[12]  L. Sjöström.  Review of the key results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery , 2013, Journal of internal medicine.

[13]  H. Buchwald,et al.  Metabolic/Bariatric Surgery Worldwide 2011 , 2013, Obesity Surgery.

[14]  M. McHugh.  Interrater reliability: the kappa statistic , 2012, Biochemia medica.

[15]  K. Jones,et al.  Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. , 2012, JAMA.

[16]  V. Moyer,et al.  Screening for and Management of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement , 2012, Annals of Internal Medicine.

[17]  M. Malone,et al.  Use of Orlistat 60 mg in the Management of Weight Loss before Bariatric Surgery , 2012, The Annals of pharmacotherapy.

[18]  E. Aadland,et al.  Physical Activity Is Associated with Weight Loss and Increased Cardiorespiratory Fitness in Severely Obese Men and Women Undergoing Lifestyle Treatment , 2012, Journal of obesity.

[19]  L. Reis,et al.  Bariatric Surgery Does not Interfere With Sperm Quality—A Preliminary Long-Term Study , 2012, Reproductive Sciences.

[20]  J. Annesi.  Comparative Effects of Improved Cardiorespiratory Fitness, Stress, and Weight on Blood Pressure in a Community-Based Treatment: Implications for Physician Referral , 2012 .

[21]  G. Ogedegbe,et al.  Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study , 2012, Surgical Endoscopy.

[22]  S. Maestrini,et al.  The nicotinic acetylcholine receptor α7 in subcutaneous mature adipocytes: downregulation in human obesity and modulation by diet-induced weight loss , 2012, International Journal of Obesity.

[23]  John M. Jakicic,et al.  Obesity and physical activity. , 2011, The Psychiatric clinics of North America.

[24]  N. Ahmadi,et al.  Effects of intense exercise and moderate caloric restriction on cardiovascular risk factors and inflammation. , 2011, The American journal of medicine.

[25]  T. Wadden,et al.  Effectiveness of Lifestyle Interventions for Individuals With Severe Obesity and Type 2 Diabetes , 2011, Diabetes Care.

[26]  D. Sarwer,et al.  Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. , 2011, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[27]  P. Sarrazin,et al.  Interventions promoting physical activity among obese populations: a meta‐analysis considering global effect, long‐term maintenance, physical activity indicators and dose characteristics , 2011, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[28]  J. Annesi.  Self-Regulatory Skills Usage Strengthens the Relations of Self-Efficacy for Improved Eating, Exercise, and Weight in the Severely Obese: Toward an Explanatory Model , 2011, Behavioral medicine.

[29]  R. Mårvik,et al.  Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year , 2011, Obesity surgery.

[30]  Mark Hopkins,et al.  Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss , 2011, British Journal of Sports Medicine.

[31]  D. Roffey,et al.  Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults. , 2011, The spine journal : official journal of the North American Spine Society.

[32]  C. Ogden,et al.  Adult obesity prevalence in Canada and the United States. , 2011, NCHS data brief.

[33]  J. Helge,et al.  Improved glucose tolerance after intensive life style intervention occurs without changes in muscle ceramide or triacylglycerol in morbidly obese subjects , 2011, Acta physiologica.

[34]  M. Stumvoll,et al.  Beta cell function after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention , 2011, European journal of endocrinology.

[35]  D. Withrow,et al.  The economic burden of obesity worldwide: a systematic review of the direct costs of obesity , 2011, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[36]  J. Annesi,et al.  Relationship of Exercise Program Participation with Weight Loss in Adults with Severe Obesity: Assessing Psychologically Based Mediators , 2010, Southern medical journal.

[37]  T. Jenssen,et al.  Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention , 2010, European journal of endocrinology.

[38]  J. DeLany,et al.  Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. , 2010, JAMA.

[39]  J. Annesi,et al.  Psychological Factors Associated With Weight Loss in Obese and Severely Obese Women in a Behavioral Physical Activity Intervention , 2010, Health education & behavior : the official publication of the Society for Public Health Education.

[40]  J. Annesi,et al.  Changes in Theory-Based Psychological Factors Predict Weight Loss in Women with Class III Obesity Initiating Supported Exercise , 2010, Journal of obesity.

[41]  S. Mæhlum,et al.  The Hjelp24 NIMI Ringerike obesity clinic: an inpatient programme to address morbid obesity in adults , 2010, British Journal of Sports Medicine.

[42]  M. Fogelholm.  Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review , 2010, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[43]  S. Aldana,et al.  Employee weight management through health coaching , 2010, Eating and weight disorders : EWD.

[44]  Zhaoping Li,et al.  Feasibility of a Supervised Inpatient Low-Calorie Diet Program for Massive Weight Loss Prior to RYGB in Superobese Patients , 2010, Obesity surgery.

[45]  R. Mårvik,et al.  Bariatric surgery or lifestyle intervention? An exploratory study of severely obese patients' motivation for two different treatments. , 2009, Obesity research & clinical practice.

[46]  J. Colquitt,et al.  The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. , 2009, Health technology assessment.

[47]  A. Vingerhoets,et al.  Effects of Aquajogging in Obese Adults: A Pilot Study , 2009, Journal of obesity.

[48]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[49]  G. Heath,et al.  Recommended levels of physical activity and health-related quality of life among overweight and obese adults in the United States, 2005. , 2009, Journal of physical activity & health.

[50]  J. Hebebrand,et al.  [Obesity and overweight]. , 2009, Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie.

[51]  R. V. van Dam,et al.  Long‐term effectiveness of diet‐plus‐exercise interventions vs. diet‐only interventions for weight loss: a meta‐analysis , 2009, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[52]  A. Dabrowski,et al.  The effect of intragastric balloon on plasma ghrelin, leptin, and adiponectin levels in patients with morbid obesity. , 2009, The Journal of clinical endocrinology and metabolism.

[53]  M. Jensen,et al.  Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. , 2009, The American journal of medicine.

[54]  R. Ramanathan,et al.  Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure , 2008, Clinical cardiology.

[55]  A. Carlin,et al.  Preoperative weight loss is not a predictor of postoperative weight loss after laparoscopic Roux-en-Y gastric bypass. , 2008, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[56]  U. Ekelund,et al.  Impact of Social Support Intensity on Walking in the Severely Obese: A Randomized Clinical Trial , 2008, Obesity.

[57]  Nick Finer,et al.  Management of Obesity in Adults: European Clinical Practice Guidelines , 2008, Obesity Facts.

[58]  J. Annesi.  Relations of Mood with Body Mass Index Changes in Severely Obese Women Enrolled in a Supported Physical Activity Treatment , 2008, Obesity Facts.

[59]  L. Aucott.  Influences of weight loss on long-term diabetes outcomes , 2008, Proceedings of the Nutrition Society.

[60]  M. Crowell,et al.  Behavioral Intervention for the Treatment of Obesity: Strategies and Effectiveness Data , 2007, The American Journal of Gastroenterology.

[61]  David Brumley.  FitBlue: A Multidimensional Weight Management Initiative , 2007 .

[62]  R. Dalle Grave,et al.  The Effect of Obesity Management on Body Image in Patients Seeking Treatment at Medical Centers , 2007, Obesity.

[63]  J. Douketis,et al.  2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary] , 2007, Canadian Medical Association Journal.

[64]  Y. Lacasse,et al.  Health-Related Quality of Life in Morbid Obesity , 2006, Obesity surgery.

[65]  H. Sesso,et al.  Joint Effects of Physical Activity and Body Weight on Diabetes and Cardiovascular Disease , 2006, Exercise and sport sciences reviews.

[66]  J. Douketis,et al.  Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice , 2005, International Journal of Obesity.

[67]  C. Lafortuna,et al.  Gender-related changes in body composition, muscle strength and power output after a short-term multidisciplinary weight loss intervention in morbid obesity , 2005, Journal of endocrinological investigation.

[68]  A. Avenell,et al.  Effects of Weight Loss in Overweight/Obese Individuals and Long-Term Hypertension Outcomes: A Systematic Review , 2005, Hypertension.

[69]  C. Lafortuna,et al.  Changes in body composition, physical performance and cardiovascular risk factors after a 3-week integrated body weight reduction program and after 1-y follow-up in severely obese men and women , 2005, European Journal of Clinical Nutrition.

[70]  B. H. Thomas,et al.  A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. , 2004, Worldviews on evidence-based nursing.

[71]  Jane B Shofer,et al.  Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. , 2004, Diabetes.

[72]  G. Bray,et al.  0021-972X/04/$15.00/0 The Journal of Clinical Endocrinology & Metabolism 89(6):2583–2589 Printed in U.S.A. Copyright © 2004 by The Endocrine Society doi: 10.1210/jc.2004-0535 Medical Consequences of Obesity , 2022 .

[73]  C. Lafortuna,et al.  Body mass reduction markedly improves muscle performance and body composition in obese females aged 61-75 years: comparison between the effects exerted by energy-restricted diet plus moderate aerobic-strength training alone or associated with rGH or nandrolone undecanoate. , 2004, European journal of endocrinology.

[74]  C. Pichard,et al.  New interdisciplinary cognitive-behavioural-nutritional approach to obesity treatment: A 5-year follow-up study , 2004, Eating and weight disorders : EWD.

[75]  Diederick E. Grobbee,et al.  Influence of Weight Reduction on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials , 2003, Hypertension.

[76]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[77]  M. Tagliaferri,et al.  Effect of chronic treatment with beta-blockers on resting energy expenditure in obese hypertensive patients during a low-calorie and physical training program. , 2003, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[78]  F. Agosti,et al.  Ghrelin secretion in severely obese subjects before and after a 3-week integrated body mass reduction program , 2003, Journal of endocrinological investigation.

[79]  C. Lafortuna,et al.  Three-week integrated body weight reduction programme markedly improves performance and work capacity in severely obese patients , 2003, Eating and weight disorders : EWD.

[80]  J. Marrugat,et al.  Función cardiopulmonar y capacidad de ejercicio en pacientes con obesidad mórbida , 2003 .

[81]  C. Lafortuna,et al.  Short-term changes of fatigability and muscle performance in severe obese patients after an integrated body mass reduction program. , 2003, Diabetes, nutrition & metabolism.

[82]  A. Claessens,et al.  Predictors of 6‐minute walk test results in lean, obese and morbidly obese women , 2003, Scandinavian journal of medicine & science in sports.

[83]  C. Galvani,et al.  Effects of non-specific vs individualized exercise training protocols on aerobic, anaerobic and strength performance in severely obese subjects during a short-term body mass reduction program , 2003, Journal of endocrinological investigation.

[84]  C. Lafortuna,et al.  Effects of a 3-week integrated body weight reduction program on leptin levels and body composition in severe obese subjects , 2003, Journal of endocrinological investigation.

[85]  C. Galvani,et al.  Effects of different training protocols on exercise performance during a short-term body weight reduction programme in severely obese patients , 2003, Eating and weight disorders : EWD.

[86]  G. Malfatto,et al.  Changes of autonomic cardiac profile after a 3-week integrated body weight reduction program in severely obese patients , 2003, Journal of endocrinological investigation.

[87]  G. Bedogni,et al.  Short-term effects of exercise on body water distribution of severely obese subjects as determined by bioelectrical impedance analysis. , 2002, Diabetes, nutrition & metabolism.

[88]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[89]  M. Sullivan,et al.  Impact of overweight and obesity on health-related quality of life—a Swedish population study , 2002, International Journal of Obesity.

[90]  G. Balady,et al.  Clinical profile and outcomes of obese patients in cardiac rehabilitation stratified according to National Heart, Lung, and Blood Institute criteria. , 2001, Journal of cardiopulmonary rehabilitation.

[91]  R. Leibbrand,et al.  Predictors of post-treatment weight reduction after in-patient behavioral therapy , 2001, International Journal of Obesity.

[92]  M. Narici,et al.  Aerobic and anaerobic performance before and after a short-term body mass reduction program in obese subjects. , 2001, Diabetes, nutrition & metabolism.

[93]  X. Bigard,et al.  Muscle plasticity and metabolism: effects of exercise and chronic diseases. , 1999, Molecular aspects of medicine.

[94]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[95]  Ae Hardman,et al.  Physical activity, obesity and blood lipids , 1999, International Journal of Obesity.

[96]  L. Peltonen,et al.  Polymorphism of the beta 3-adrenergic receptor gene in morbid obesity. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[97]  C. Bouchard,et al.  A single threshold value of waist girth identifies normal-weight and overweight subjects with excess visceral adipose tissue. , 1996, The American journal of clinical nutrition.

[98]  J. Anderson,et al.  Relationship of weight loss to cardiovascular risk factors in morbidly obese individuals. , 1994, Journal of the American College of Nutrition.

[99]  K. Steinbeck,et al.  Severe obesity: the use of very low energy diets or standard kilojoule restriction diets , 1992, The Medical journal of Australia.

[100]  A. Ortega,et al.  Anthropometric changes and nitrogen balance in patients with morbid obesity treated with very low calorie diet , 1991 .

[101]  Arthur M. Nezu,et al.  Effect of length of treatment on weight loss. , 1989, Journal of consulting and clinical psychology.

[102]  Mahesh S. Patel.  An introduction to meta-analysis. , 1989, Health policy.

[103]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[104]  H. Björvell,et al.  Long term treatment of severe obesity: four year follow up of results of combined behavioural modification programme. , 1985, British medical journal.

[105]  L. Mccargar,et al.  Healthy strategies for successful weight loss and weight maintenance: a systematic review. , 2014, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[106]  J. Annesi.  Supported exercise improves controlled eating and weight through its effects on psychosocial factors: extending a systematic research program toward treatment development. , 2012, The Permanente journal.

[107]  N. Pronk,et al.  TELEPHONE-BASED SUPPORT FOR WEIGHT LOSS SURGERY: A Practice-Based Program Evaluation , 2011 .

[108]  K. Behrns.  Medical and Surgical Treatments for Obesity Have Opposite Effects on Peptide YY and Appetite: A Prospective Study Controlled for Weight Loss , 2011 .

[109]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[110]  Byron C. Wallace,et al.  Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data , 2009, BMC medical research methodology.

[111]  D. Classen.  Outcomes: A Systematic Review Systems on Physician Performance and Patient Effects of Computer-Based Clinical Decision Support , 2009 .

[112]  Heinz Schneider,et al.  Prevention and treatment of obesity with lifestyle interventions: review and meta-analysis , 2007, International Journal of Public Health.

[113]  K. Fontaine,et al.  Weight loss and health-related quality of life: results at 1-year follow-up. , 2004, Eating behaviors.

[114]  J. Marrugat,et al.  [Cardiopulmonary function and exercise capacity in patients with morbid obesity]. , 2003, Revista espanola de cardiologia.

[115]  N. Sakane,et al.  Usefulness of mazindol in combined diet therapy consisting of a low-calorie diet and Optifast in severely obese women. , 1994, International journal of clinical pharmacology research.

[116]  J. D. Fachnie,et al.  Effects of weight reduction, exercise, and diet modification on lipids and apolipoproteins A-1 and B in severely obese persons. , 1987, Henry Ford Hospital medical journal.

[117]  Fachnie Jd,et al.  Effects of weight reduction, exercise, and diet modification on lipids and apolipoproteins A-1 and B in severely obese persons. , 1987 .