John M Jakicic PhD Senior Investigator Director Population Science AdventHealth Translational Research Institute Orlando FL Disclosures Past 12 Months Scientific Advisory Board WW International Inc formerly Weight Watchers ID: 1036260
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1. Weight Gain Prevention: Opportunities for Physical Activity to Impact ObesityJohn M. Jakicic, PhDSenior InvestigatorDirector, Population ScienceAdventHealth – Translational Research InstituteOrlando, FL
2. Disclosures(Past 12 Months)Scientific Advisory Board: WW International, Inc. (formerly Weight Watchers)Scientific Advisory Board: Wondr Health (formerly Naturally Slim)Research Funding: UPMC EnterprisesResearch Funding: National Institutes of Health
3. Periods of OpportunityPrimary Prevention of Weight GainPrevention of Weight Regain
4. Periods of OpportunityPrimary Prevention of Weight GainPrevention of Weight Regain
5. Trends in obesity prevalence among adults aged 20 and over (age-adjusted) and youth aged 2-19 years: United States, 1999-2000 through 2013-2014Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;219(November).
6. What is the relationship between physical activity and prevention of weight gain?
7. Literature Search
8. Evidence of an Overall Relationship26 of 33 studies demonstrate a significant relationship between greater amounts of physical activity and attenuated weight gain in adults. Inconsistent evidence for a specific volume threshold of physical activity that is associated with prevention of weight gain in adults. At least 1 hour per week of moderate intensity reduces the risk of developing obesity Normal weight women (incidence rate ratio (IRR)=0.81; 95% confidence interval (CI): 0.71-0.93) Overweight women (IRR=0.88; 95% CI: 0.81-0.95).A similar result may be observed with less than 1 hour per week if the activity is of vigorous intensity, rather than moderate intensity. Williams and Wood [2006] have reported that running equivalent to 4.4 km per week (~2.8 miles per week (~28 minutes per week at a 10-minute per mile pace) in men and 6.2 km per week (~3.8 miles per week (~38 minutes per week at a 10-minute per mile pace) in women may be sufficient to prevent weight gain associated with aging.
9. Evidence of an Overall RelationshipSome evidence also supports the need to achieve at least 150 minutes per week of moderate intensity physical activity to minimize weight gain or to prevent increases in BMI. Studies also support greater amounts of physical activity to prevent or minimize weight gain, with some studies reporting this effect with greater than 150 minutes per week at a moderate intensity500 or more MET-minutes per week (>167 minutes per week at a 3-MET intensity)more than 300 minutes per week.
10. Dose-Response RelationshipSims et al. [2012] reported a trend (P<0.08) for minimized weight gain in womenEngaging in more than 8.3–20 MET-hours per week (>167-400 minutes per week at a 3-MET intensity) or more than 20 MET-hours per week (>400 minutes per week at a 3-MET intensity) of physical activity minimized weight gain compared to those engaged in less than 1.7 MET-hours per week (<33 minutes per week at a 3-MET intensity). A physical activity volume of 1.7-8.3 MET-hours per week was not protective against weight gain.
11. Dose-Response RelationshipBlanck et al. [2007] reported on the odds of gaining 10 or more pounds (>4.5 kg) in women with normal weight0 MET-hours per week (1.01; 95% CI: 0.82-1.01)>0 and <4 MET-hours per week (1.0)4 to less than 10 MET-hours per week (0.93; 95% CI: 0.80-1.08)10 to <18 MET-hours per week (0.99; 95% CI: 0.87-1.14)18+ MET-hours per week (0.88; 95% CI: 0.77-0.99)
12. Odds of Maintaining a Healthy Weight by Level of Physical Activity Source: Adapted from data found in Brown et al., 2016.
13. Incidence Rate Ratio of Developing Obesity at Various Levels of Vigorous Physical ActivitySource: Adapted from data found in Rosenberg et al., 2013.
14. 2009 ACSM Position Stand on Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for AdultsPhysical Activity of 150 to 250 min/wk with an energy equivalent of 1200 to 2000 kcal/wk will prevent weight gain greater than 3% in most adults.
15. Intensity and Type of Physical ActivityTotal leisure-time physical activity was consistently inversely associated with weight change.Studies reporting on moderate intensity and moderate-to-vigorous intensity physical activity showed consistent patterns of inverse associations with weight gain. Light-intensity physical activity was either not associated with weight change or was associated with weight gain.Walking was not consistently associated with change in weight or BMI or with the incidence of developing obesity. However, achieving 10,000 steps or more per day attenuated weight gain compared with not achieving 10,000 steps per day.Occupational activity was inversely associated with weight gain.This association was observed with moderate- and vigorous intensity occupational activity.This association was not observed with light-intensity occupational activity.Household activity did not appear to minimize weight gain.
16. Intensity and Type of Physical ActivityTotal leisure-time physical activity was consistently inversely associated with weight change.Studies reporting on moderate intensity and moderate-to-vigorous intensity physical activity showed consistent patterns of inverse associations with weight gain. Light-intensity physical activity was either not associated with weight change or was associated with weight gain.Walking was not consistently associated with change in weight or BMI or with the incidence of developing obesity. However, achieving 10,000 steps or more per day attenuated weight gain compared with not achieving 10,000 steps per day.Occupational activity was inversely associated with weight gain.This association was observed with moderate- and vigorous intensity occupational activity.This association was not observed with light-intensity occupational activity.Household activity did not appear to minimize weight gain.
17. Research NeedsConduct longitudinal research on lower exposure levels of physical activity to allow for an enhanced understanding of the dose-response associations between physical activity and weight gain across a wider spectrum of exposure.Conduct large research trials with ample sample sizes to allow for stratum-specific analyses to determine whether the influence of physical activity on the prevention of weight gain varies by age, sex, race/ethnicity, socioeconomic status, or initial weight status. Conduct experimental research on varying intensities (light, moderate, and vigorous) of physical activity, while holding energy expenditure constant, to determine the independent effects of physical activity intensity on weight gain. Conduct observational and experimental research that quantifies energy intake and eating behavior to determine whether these factors influence the association between physical activity and weight gain. Studies are needed to examine “mode” of physical activity (e.g., “exercise”, recreational, occupational, activity for transportation, household) on prevention of weight gain and the development of obesity.
18. Research NeedsConduct longitudinal research on lower exposure levels of physical activity to allow for an enhanced understanding of the dose-response associations between physical activity and weight gain across a wider spectrum of exposure.Conduct large research trials with ample sample sizes to allow for stratum-specific analyses to determine whether the influence of physical activity on the prevention of weight gain varies by age, sex, race/ethnicity, socioeconomic status, or initial weight status. Conduct experimental research on varying intensities (light, moderate, and vigorous) of physical activity, while holding energy expenditure constant, to determine the independent effects of physical activity intensity on weight gain. Conduct observational and experimental research that quantifies energy intake and eating behavior to determine whether these factors influence the association between physical activity and weight gain. Studies are needed to examine “mode” of physical activity (e.g., “exercise”, recreational, occupational, activity for transportation, household) on prevention of weight gain and the development of obesity.
19. Periods of OpportunityPrimary Prevention of Weight GainPrevention of Weight Regain
20. Weight Change in Response to Lifestyle Behavior Interventions
21. Weight Change in Response to Lifestyle Behavior Interventions
22. YearsWeight Change – Diabetes Prevention StudyN Eng J Med. 2002; 346(6): 393-403
23. Weight Change – Look AHEAD StudyArch Intern Med. 2010; 170(17): 1566-1575
24. What is the Long-Term Impact of Physical Activity in the Management of Body Weight?OBJECTIVELY MEASURED PHYSICAL ACTIVITY
25. Subjects Grouped based on Weight Loss Achieved and Maintained>10% Weight Loss at 6 Months>10% Weight Loss at 18 MonthsNon-Loss(n=107, 41%)NoNoLate-Loss(n=19, 7%)NoYesNon-Maintain(n=45, 17%)YesNoMaintain(n=87, 34%)YesYesJakicic et al. Obesity. 2014
26. P-ValuesWeight Change Group: <0.0001Time: <0.0001Weight Change Group X Time: <0.0001% Change in Body Weight by GroupJakicic et al. Obesity. 2014
27. Change in Moderate-to-Vigorous Intensity Physical Activity (bouts >10 minute in duration) by Weight Loss PatternP-ValuesWeight Change Group: <0.0001Time: <0.0001Weight Change Group X Time: <0.0001Jakicic et al. Obesity. 2014
28. Change in Light Intensity Physical Activity by Weight Loss PatternP-ValuesWeight Change Group: 0.0002Time: 0.0326Weight Change Group X Time: 0.0075Jakicic et al. Obesity. 2014
29. Dependent VariableVariableUnadjusted AnalysisAdjusted AnalysisBetaS.E.p-valueModel r2BetaS.E.p-valueModel r2Baseline Percent Body FatIntercept46.8932.6625<.001.089936.10842.6230<.001.4957Baseline LPA (MET-minutes per week)-.0013.0002<.001 -.0002.0002.337 *Age (years)--------------- .0149.0267.576 *Sex (female)--------------- 7.7404.5692<.001 *Race (white)--------------- 1.2332.4730.010 *Ethnicity (non-Hispanic)--------------- 1.07921.1258.338 *$Baseline MVPA (MET-minutes per week)--------------- -1.1755.2578.001 Change in Percent Body Fat from Baseline to 12 monthsIntercept-4.9399.2755<.001.1036-1.43472.1708.509.2684Change in LPA (MET-minutes per week)-.0014.0002<.001 -.0013.0003<.001 *Age (years)--------------- -.0370.0312.236 *Sex (female)--------------- .8524.6082.162 *Race (white)--------------- -1.6102.5706.005 *Ethnicity (non-Hispanic)--------------- -2.05161.4042.145 *Treatment Group 1 .6780.5905.252 *Treatment Group 2 .5526.5825.344 *Change in MVPA (MET-minutes per week)--------------- -.0008.0002<.001 *Baseline LPA (MET-minutes per week)--------------- -.0007.0002.005 Light Intensity Physical Activity as a predictor of percent body fat at baseline and change in percent body fat at 12 months.Jackson RE. Doctoral Dissertation. University of Pittsburgh. 2021*Indicates these variables were forced in the model as covariates for the adjusted analysis.$Indicates that the data were log transformed.
30. 2009 ACSM Position Stand on Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for AdultsSome studies support the value of ~200- to 300-min/wk of physical activity during weight maintenance to reduce weight regain after weight loss.
31. Research NeedsConduct longitudinal research on lower exposure levels of physical activity to allow for an enhanced understanding of the dose-response associations between physical activity and weight regain across a wider spectrum of exposure.Conduct large research trials with ample sample sizes to allow for stratum-specific analyses to determine whether the influence of physical activity on the prevention of weight regain varies by age, sex, race/ethnicity, socioeconomic status, or initial weight status. Conduct experimental research on varying intensities (light, moderate, and vigorous) of physical activity, while holding energy expenditure constant, to determine the independent effects of physical activity intensity on weight regain. Conduct observational and experimental research that quantifies energy intake and eating behavior to determine whether these factors influence the association between physical activity and weight regain. Studies are needed to examine “mode” of physical activity (e.g., “exercise”, recreational, occupational, activity for transportation, household) on prevention of weight regain.
32. Periods of OpportunityPrimary Prevention of Weight GainPrevention of Weight Regain
33. Additional ConsiderationsBehavior/LifestyleAre intervention strategies designed to effectively modify physical activity behavior?Initial adoption?Maintenance?Effective for what level of physical activity?Physiology/BiologyPhysiology compensates to body weight regulation?Combination Lifestyle/Behavior → Physiology/Biology → Weight RegulationPhysiology/Biology → Lifestyle/Behavior → Weight Regulation
34. Moderate-to-Vigorous Physical ActivityPhysiological / Metabolic FactorsOrexigenic biomarkersAnorexigenic biomarkersEating Behavior / Energy IntakeChange in Body Weight and Body FatnessPsychosocial FactorsDepressive symptomsDietary RestraintDietary DisinhibitionMood/affectStressTotal Energy ExpenditureLight Intensity Physical ActivitySedentary BehaviorLean Body MassTheoretical Pathway by which Physical Activity Influences Body Weight and Body Fatness Total Energy Expenditure
35. Public Health ImpactWeight gain (regain) that results in overweight or obesity is associated with increased risk for numerous chronic conditions. This is a significant health concern in the United States due to the high prevalence of both overweight and obesity. While it is important to focus on effective treatments for overweight and obesity, there is also a need to implement effective public health strategies to prevent weight gain and the onset of both overweight and obesity. The scientific evidence supports that physical activity can be an effective lifestyle behavior to prevent or minimize weight gain (regain) in adults. Public health initiatives to prevent weight gain (regain), overweight, and obesity should include physical activity as an important lifestyle behavior.