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February 9, 2011

Diet and Physical Activity Interventions in Severely Obese Adults

JAMA. 2011;305(6):563-564. doi:10.1001/jama.2011.83

To the Editor: The lack of well-designed clinical trials on lifestyle interventions for weight loss in severe obesity has probably contributed to skepticism for such interventions1 and may indirectly have added to the surge in bariatric surgery, for which the evidence is more convincing.2 Unfortunately, the randomized trial by Dr Goodpaster and colleagues3 does not provide persuasive support for lifestyle interventions for weight loss in severe obesity. The study examined whether physical activity would promote greater weight loss when added to a dietary intervention. One group included physical activity initially and another added it after 6 months. The effects of adding physical activity to diet in weight loss have been covered extensively,4 albeit not in the severely obese. Nevertheless, increased physical activity has been part of standard care in obesity for many years, and the findings are unlikely to change clinical practice. Indeed, after 12 months, weight loss was similar between groups.