How effective are traditional dietary and exercise interventions for weight loss?

Health care professionals have used restrictive dieting and exercise intervention strategies in an effort to combat the rising prevalence of obesity in affluent countries. In spite of these efforts, the prevalence of obesity continues to rise. This apparent ineffectiveness of diet and exercise programming to reduce obesity has caused many health care providers, obesity researchers, and lay persons to challenge the further use of diet and exercise for the sole purpose of reducing body weight in the obese. The purposes of this paper were to examine the history and effectiveness of diet and exercise in obesity therapy and to determine the best future approach for health promotion in the obese population. A brief survey of the most popular dieting techniques used over the past 40 yr shows that most techniques cycle in and out of popularity and that many of these techniques may be hazardous to health. Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr. The paucity of data provided by the weight-loss industry has been inadequate or inconclusive. Those who challenge the use of diet and exercise solely for weight control purposes base their position on the absence of weight-loss effectiveness data and on the presence of harmful effects of restrictive dieting. Any intervention strategy for the obese should be one that would promote the development of a healthy lifestyle. The outcome parameters used to evaluate the success of such an intervention should be specific to chronic disease risk and symptomatologies and not limited to medically ambiguous variables like body weight or body composition.