While exercise is not typically the primary driver of weight loss, it plays a critical role in weight maintenance. For those following a dietary plan geared toward weight loss, the incorporation of physical activity into that plan aids in the preservation of muscle mass.

In the Look AHEAD study published in Obesity, over 5,000 individuals with overweight and obesity and type 2 diabetes were randomized to dietary changes and exercise compared with diabetes education and support. The study tracked changes in body composition measured by DXA over 8 years for more than 1,000 participants. Fat mass was lower in the intervention group that included exercise, while the proportion of lean mass loss was more significant in the control group throughout the study.

Exercise favorably impacts fat distribution by reducing abdominal and visceral fat. In a 2022 meta-analysis in Obesity Reviews that included 25 randomized controlled trials, regular aerobic exercise resulted in an average reduction in waist circumference of 3.2 cm (about 1.26 inches), plus an associated reduction in visceral adipose tissue, compared with controls. A more significant reduction was seen with vigorous-intensity compared with moderate-intensity activity. Visceral adiposity is an important cardiometabolic risk factor and a predisposing factor to several malignancies and decreased overall life expectancy.

Benefits for Mental Health & Beyond

Physical activity can also have a favorable effect on mental health, which in turn influences obesity. By modulating the release of multiple neurotransmitters such as dopamine, serotonin, and norepinephrine, regular exercise can improve mood, reduce stress, and improve self-image. We know that these factors have a direct impact on weight management.

Physical activity has many health benefits beyond those related to obesity. Regular exercise decreases the risk for cardiovascular disease, type 2 diabetes, dementia, pregnancy complications, and some cancers, including bladder, breast, colon, endometrial, renal, lung, and esophageal. Physical activity has been shown to improve sleep, cognition, and QOL.

Physical Activity in Patients With Obesity

An essential first step when discussing physical activity with patients with obesity is to assess the patient’s current level of physical activity and any limitations they may have in their ability to exercise. You want to set goals and design a stepwise plan that does not feel out of reach for your patients. Clinicians should understand and acknowledge comorbidities that may limit types of physical activity. This should be accomplished by understanding your patient’s complete medical history and directly eliciting information about their perceived barriers to physical activity. Your physical activity plan, or exercise prescription, should include a type of exercise, duration, and frequency. The plan should be designed with input from patients regarding what would be an attainable goal and what kinds of exercise they enjoy. This patient input increases the chance of long-term commitment to this plan. Revisiting this plan and the patient’s progress at regularly scheduled follow-up visits improves adherence.

Physical activity is generally divided into two broad categories: aerobic activity and strengthening. Aerobic exercise can be further stratified into low, moderate, and high intensity. For those patients with obesity who are limited by joint pain, low-impact activity such as biking or water-based exercise is preferable. Aside from dedicated exercise sessions, there are simple ways to incorporate more physical activity into a patient’s lifestyle. Some examples are taking the stairs instead of an elevator, parking further away from an entrance in a parking lot, and walking to work or nearby errands.

It is important not to make a certain level of physical activity a prerequisite before offering patients obesity treatment. Lifestyle changes are the backbone of weight management but can seem insurmountable and discouraging for patients. The key is to set small, gradual goals.

For clinicians looking for more information about physical activity and guidance in creating personalized plans for patients, the Obesity Medicine Association has several recorded webinars on the topic, including “Improving Physical Activity in People with Obesity and Physical Limitations,” “Physical Activity Case Studies,” and “Creating a Physical Activity Plan for Patients with Limited Mobility.” The OMA Obesity Algorithm also provides a guide for delivering an exercise prescription to patients and general guidance for activity based on the mobility level of a particular patient.