Research
Original Research
A Structured Diet and Exercise Program Promotes Favorable Changes in Weight Loss, Body Composition, and Weight Maintenance

https://doi.org/10.1016/j.jada.2011.03.013Get rights and content

Abstract

Background

A number of diet and exercise programs purport to help promote and maintain weight loss. However, few studies have compared the efficacy of different methods.

Objective

To determine whether adherence to a meal-replacement–based diet program (MRP) with encouragement to increase physical activity is as effective as following a more structured meal-plan–based diet and supervised exercise program (SDE) in sedentary obese women.

Design

Randomized comparative effectiveness trial.

Participants/setting

From July 2007 to October 2008, 90 obese and apparently healthy women completed a 10-week university-based weight loss trial while 77 women from this cohort also completed a 24-week weight maintenance phase.

Intervention

Participants were matched and randomized to participate in an MRP or SDE program.

Main outcome measures

Weight loss, health, and fitness-related data were assessed at 0 and 10 weeks on all subjects as well as at 14, 22, and 34 weeks on participants who completed the weight maintenance phase.

Statistical analyses performed

Data were analyzed by multivariate analysis of variance for repeated measures.

Results

During the 10-week weight loss phase, moderate and vigorous physical activity levels were significantly higher in the SDE group with no differences observed between groups in daily energy intake. The SDE group lost more weight (−3.1±3.7 vs −1.6±2.5 kg; P=0.03); fat mass (−2.3±3.5 vs −0.9±1.6 kg; P=0.02); centimeters from the hips (−4.6±7 vs −0.2±6 cm; P=0.002) and waist (−2.9±6 vs −0.6±5 cm; P=0.05); and, experienced a greater increase in peak aerobic capacity than participants in the MRP group. During the 24-week maintenance phase, participants in the SDE group maintained greater moderate and vigorous physical activity levels, weight loss, fat loss, and saw greater improvement in maximal aerobic capacity and strength.

Conclusions

In sedentary and obese women, an SDE-based program appears to be more efficacious in promoting and maintaining weight loss and improvements in markers of health and fitness compared to an MRP type program with encouragement to increase physical activity.

Section snippets

Experimental Approach

This study was conducted as a randomized comparative effectiveness trial in a university clinical research setting from July 2007 to October 2008. Participants were matched based on age and body mass index (BMI; calculated as kg/m2) and randomized into one of two diet and exercise interventions. Participants were tested at 0 and 10 weeks of an active weight loss phase as well as at 14, 22, and 34 weeks of a weight maintenance phase. Primary outcome measures included energy intake, physical

Physical Activity

Physical activity patterns were quantified by assessing responses to the 7-day version of the International Physical Activity Questionnaire (IPAQ) (46, 47, 48) obtained at each testing session. This assessment tool evaluates the frequency and intensity of job-related physical activity; transportation physical activity; housework, house maintenance, and caring for family-related activities; and, recreation, sport, and leisure-time physical activity based on established metabolic equivalent (MET)

Statistical Methods

Baseline demographic data were analyzed by one-way analysis of variance (ANOVA). Data were normally distributed and did not require any transformation before statistical analysis. Only participants completing the 10-week weight loss phase and 24-week weight maintenance phase were included in the analyses. Missing data, if any, were replaced using the last observed value method. Related variables were grouped together and analyzed by multivariate ANOVA with repeated measures (PASW Statistics,

Weight Loss Phase

Ninety apparently healthy but sedentary and obese women (age 41.4±11 years, height 163±7 cm; weight 89±13 kg; BMI 33.5±4.5, 44.3±4 % fat, 22.1±4 mL/kg/min peak oxygen uptake, 6.3±1.2 peak METs) completed the 10-week weight loss phase of the study (n=45 in each group). No significant differences were observed between groups in baseline age, height, weight, BMI, or percent body fat. Table 1 presents changes in energy intake and physical activity patterns. Complete food records were obtained on 75

Discussion

One of the challenges in promoting weight loss and preventing weight regain is the difficulty in adhering to diet, exercise, and/or behavioral interventions over time. Although individuals can typically follow a strict diet or exercise program in the short term, research has shown that it is difficult to maintain weight loss unless the diet and/or exercise intervention can be incorporated into the individual's lifestyle. Consequently, there has been interest in identifying dietary, exercise,

Conclusions

Results from our study indicate that within the limitations of the study both diet and exercise strategies were effective in promoting and maintaining a modest, yet significant, amount of weight loss in apparently healthy but obese sedentary women. The MRP program that involved replacing meals with RTE cereals and cereal bars along with additional diet and exercise recommendations resulted in a decrease in total energy intake, an increase in the amount of light physical activity, and a modest

R. B. Kreider is a professor and head, Thomas A. and Joan Read Endowed Chair for Disadvantaged Youth, and director and founder, Exercise and Sport Nutrition Lab, Department of Health and Kinesiology, Texas A&M University, College Station

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    R. B. Kreider is a professor and head, Thomas A. and Joan Read Endowed Chair for Disadvantaged Youth, and director and founder, Exercise and Sport Nutrition Lab, Department of Health and Kinesiology, Texas A&M University, College Station

    M. Serra is a postdoctoral fellow, University of Maryland School of Medicine and the Geriatric Research, Education, and Clinical Center of the Baltimore Veterans Affairs Medical Center, Baltimore, MD; at the time of the study, she was a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    K. M. Beavers is a postdoctoral fellow; Section on Gerontology, Wake Forest University, School of Medicine, Winston-Salem, NC; at the time of the study, she was a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    J. Moreillon is a doctoral student, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    J. Y. Kresta is a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    M. Byrd is a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    J. M. Oliver is a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    C. Rasmussen is a research coordinator, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    J. Gutierrez is a visiting assistant professor, Department of Exercise Science, School of Public Health and Health Services, The George Washington University; Washington, DC; at the time of the study, he was a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    G. Hudson is an assistant professor, School of Human Performance and Recreation, University of Southern Mississippi, Hattiesburg; at the time of the study, he was a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    E. Deike is an assistant professor, Department of Exercise and Sport Science, Wayland Baptist University, Plainview, TX; at the time of the study, she was a doctoral research assistant; Exercise & Sport Nutrition Lab, Baylor University, Waco, TX

    B. Shelmadine is a postdoctoral fellow, Baylor University, Waco, TX; at the time of the study, he was a doctoral research assistant, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    P. Leeke is a medical student, Texas A&M Health Science Center College of Medicine, Temple; at the time of the study, she was an undergraduate student worker, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    M. Greenwwod is a research associate, Exercise and Sport Nutrition Lab, Texas A&M University, College Station; at the time of the study, he was a professor, Exercise and Sport Nutrition Lab, Baylor University, Waco, TX

    M. B. Cooke is a lecturer, School of Biomedical and Health Sciences, Faculty of Health, Engineering & Science, Victoria University, Melbourne, Australia; at the time of the study, he was an assistant professor, Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX

    C. Kerksick is an assistant professor, Health and Exercise Science Department, University of Oklahoma, Norman, and an adjunct assistant professor, Endocrinology and Diabetes Section, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City

    J. K. Campbell is a senior scientist, General Mills Bell Institute of Health & Nutrition, North Golden Valley, MN

    J. Beiseigel is a senior scientist, General Mills Bell Institute of Health & Nutrition, North Golden Valley, MN

    S. S. Jonnalagadda is a principal scientist, General Mills Bell Institute of Health & Nutrition, North Golden Valley, MN

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