Exercise is Not the Foundation of Weight Loss

doi:10.12114/j.issn.1007-9572.2023.0104

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (28): 3477-3481.DOI: 10.12114/j.issn.1007-9572.2023.0104

Special Issue: 运动相关研究最新文章合辑；肥胖/减重最新文章合辑

• Speculation and Controversy • Previous Articles Next Articles

Exercise is Not the Foundation of Weight Loss

1. Department of Clinical Medicine, Fujian Medical University, Fuzhou 350000, China
2. Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen 361000, China
3. School of Medicine, Xiamen University, Xiamen 361102, China

Received:2023-03-16 Revised:2023-05-05 Published:2023-10-05 Online:2023-05-08
Contact: LI Xuejun

运动不是减重之本

1．350000　福建省福州市，福建医科大学临床医学部
2．361000　福建省厦门市，厦门大学附属第一医院内分泌糖尿病科
3．361102　福建省厦门市，厦门大学医学院

通讯作者: 李学军

作者简介:

【通信作者简介】　李学军，医学博士，主任医师、教授、博士生导师。现任厦门大学附属第一医院内分泌糖尿病科主任、厦门市糖尿病研究所所长，兼任中华医学会糖尿病学分会委员、中华医学会糖尿病学分会糖尿病与肥胖学组委员、中华医学会糖尿病学分会糖尿病与相关内分泌疾病学组委员、中华中医药学会糖尿病分会副主任委员。从事医教研工作20余年，近年来的研究方向为表观遗传学在2型糖尿病及其慢性并发症发生发展中的作用、生活方式干预代谢性疾病的作用及机制研究、2型糖尿病的优化治疗研究等。

作者贡献：蒋秋惠负责文献资料的收集与整理、论文撰写；李学军负责论文的框架构思及最终版本修订，对文章负责。

基金资助:
国家自然科学基金资助项目(81870606)

Abstract

Abstract:

Obesity is an increasingly prevalent and costly public health problem. Many people regard exercise as an effective weight loss strategy, even superior to dieting. However, the effectiveness and safety of exercise for weight loss in obese individuals need to be carefully weighed. This paper briefly discusses the view that "Exercise is not the foundation of weight loss" in the combination of evidence-based medicine, from the aspects of mild effect of exercise on weight loss, poor adherence to long-term high-intensity exercise, safety of high-intensity exercise in obese individuals, and the mechanism of poor weight loss effect of exercise.

Key words: Obesity, Exercise, Weight loss, Treatment adherence and compliance, Dissent and disputes

摘要：

肥胖是日益普遍和代价高昂的公共卫生问题。不少人认为运动是一种有效的减重策略，甚至比控制饮食更有效。然而，肥胖个体运动减重的有效性和安全性需仔细权衡。本文结合循证医学证据，从运动的减重效果轻微、长期坚持高强度运动的依从性差、肥胖者从事高强度运动的安全性及运动减重效果不佳的机制探讨等方面简要阐述"运动不是减重之本"的观点。

关键词: 肥胖症, 运动, 减重, 治疗依从性, 异议和争论

JIANG Qiuhui,LI Xuejun. Exercise is Not the Foundation of Weight Loss[J]. Chinese General Practice, 2023, 26(28): 3477-3481. DOI: 10.12114/j.issn.1007-9572.2023.0104.
蒋秋惠,李学军. 运动不是减重之本[J]. 中国全科医学, 2023, 26(28): 3477-3481. DOI: 10.12114/j.issn.1007-9572.2023.0104.

References 42

[1]	PAN X F, WANG L M, PAN A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol，2021，9(6):373-392. DOI：10.1016/S2213-8587(21)00045-0.
[2]	中国营养学会肥胖防控分会，中国营养学会临床营养分会，中华预防医学会行为健康分会，等. 中国居民肥胖防治专家共识[J]. 中华流行病学杂志，2022，43(5):609-626. DOI：10.3760/cma.j.cn112338-20220402-00253.
[3]	THOMAS D M, KYLE T K, STANFORD F C. The gap between expectations and reality of exercise-induced weight loss is associated with discouragement[J]. Prev Med，2015，81:357-360. DOI：10.1016/j.ypmed.2015.10.001.
[4]	DEJESUS R S, BAUER K W, BRADLEY D P，et al. Experience and expectations of patients on weight loss：the Learning Health System Network Experience[J]. Obes Sci Pract，2019，5(5):479-486. DOI：10.1002/osp4.364.
[5]	MALINAUSKAS B M, RAEDEKE T D, AEBY V G，et al. Dieting practices，weight perceptions，and body composition：a comparison of normal weight，overweight，and obese college females[J]. Nutr J，2006，5:11. DOI：10.1186/1475-2891-5-11.
[6]	MARTIN C B, HERRICK K A, SARAFRAZI N，et al. Attempts to lose weight among adults in the United States，2013—2016[J]. NCHS Data Brief，2018(313):1-8.
[7]	WHARTON C M, ADAMS T, HAMPL J S. Weight loss practices and body weight perceptions among US college students[J]. J Am Coll Health，2008，56(5):579-584. DOI：10.3200/JACH.56.5.579-584.
[8]	KLEM M L, WING R R, MCGUIRE M T，et al. A descriptive study of individuals successful at long-term maintenance of substantial weight loss[J]. Am J Clin Nutr，1997，66(2):239-246. DOI：10.1093/ajcn/66.2.239.
[9]	SCHOELLER D A, SHAY K, KUSHNER R F. How much physical activity is needed to minimize weight gain in previously obese women？[J]. Am J Clin Nutr，1997，66(3):551-556. DOI：10.1093/ajcn/66.3.551.
[10]	JEFFERY R W, WING R R, THORSON C，et al. Use of personal trainers and financial incentives to increase exercise in a behavioral weight-loss program[J]. J Consult Clin Psychol，1998，66(5):777-783. DOI：10.1037//0022-006x.66.5.777.
[11]	JAKICIC J M, WINTERS C, LANG W，et al. Effects of intermittent exercise and use of home exercise equipment on adherence，weight loss，and fitness in overweight women：a randomized trial[J]. JAMA，1999，282(16):1554-1560. DOI：10.1001/jama.282.16.1554.
[12]	JAKICIC J M, MARCUS B H, GALLAGHER K I，et al. Effect of exercise duration and intensity on weight loss in overweight，sedentary women：a randomized trial[J]. JAMA，2003，290(10):1323-1330. DOI：10.1001/jama.290.10.1323.
[13]	BERGE J, HJELMESÆTH J, HERTEL J K，et al. Effect of aerobic exercise intensity on energy expenditure and weight loss in severe obesity—a randomized controlled trial[J]. Obesity，2021，29(2):359-369. DOI：10.1002/oby.23078.
[14]	TATE D F, JEFFERY R W, SHERWOOD N E，et al. Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain?[J]. Am J Clin Nutr，2007，85(4):954-959. DOI：10.1093/ajcn/85.4.954.
[15]	ZHANG H J, HE J, PAN L L，et al. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease：a randomized clinical trial[J]. JAMA Intern Med，2016，176(8):1074-1082. DOI：10.1001/jamainternmed.2016.3202.
[16]	BUTRYN M L, WEBB V, WADDEN T A. Behavioral treatment of obesity[J]. Psychiatr Clin North Am，2011，34(4):841-859. DOI：10.1016/j.psc.2011.08.006.
[17]	SARIS W H M, BLAIR S N, VAN BAAK M A，et al. How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement[J]. Obes Rev，2003，4(2):101-114. DOI：10.1046/j.1467-789X.2003.00101.x.
[18]	JAKICIC J M, MARCUS B H, LANG W，et al. Effect of exercise on 24-month weight loss maintenance in overweight women[J]. Arch Intern Med，2008，168(14):1550-1560. DOI：10.1001/archinte.168.14.1550.
[19]	DI PIETRO L, DZIURA J, BLAIR S N. Estimated change in physical activity level（PAL）and prediction of 5-year weight change in men：the Aerobics Center Longitudinal Study[J]. Int J Obes Relat Metab Disord，2004，28(12):1541-1547. DOI：10.1038/sj.ijo.0802821.
[20]	BORG P, KUKKONEN-HARJULA K, FOGELHOLM M，et al. Effects of walking or resistance training on weight loss maintenance in obese，middle-aged men：a randomized trial[J]. Int J Obes Relat Metab Disord，2002，26(5):676-683. DOI：10.1038/sj.ijo.0801962.
[21]	DUGAS L R, HARDERS R, MERRILL S，et al. Energy expenditure in adults living in developing compared with industrialized countries：a meta-analysis of doubly labeled water studies[J]. Am J Clin Nutr，2011，93(2):427-441. DOI：10.3945/ajcn.110.007278.
[22]	PONTZER H, DURAZO-ARVIZU R, DUGAS L R，et al. Constrained total energy expenditure and metabolic adaptation to physical activity in adult humans[J]. Curr Biol，2016，26(3):410-417. DOI：10.1016/j.cub.2015.12.046.
[23]	FOTHERGILL E, GUO J E, HOWARD L，et al. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition[J]. Obesity（Silver Spring），2016，24(8):1612-1619. DOI：10.1002/oby.21538.
[24]	CAREAU V, HALSEY L G, PONTZER H，et al. Energy compensation and adiposity in humans[J]. Curr Biol，2021，31(20):4659-4666.e2. DOI：10.1016/j.cub.2021.08.016.
[25]	BULLEN B A, REED R B, MAYER J. Physical activity of obese and nonobese adolescent girls appraised by motion picture sampling[J]. Am J Clin Nutr，1964，14(4):211-223. DOI：10.1093/ajcn/14.4.211.
[26]	PACY P J, WEBSTER J, GARROW J S. Exercise and obesity[J]. Sports Med，1986，3(2):89-113. DOI：10.2165/00007256-198603020-00002.
[27]	孟和，顾志华. 骨伤科生物力学[M]. 北京：人民卫生出版社，1991：306.
[28]	励建安. 康复医学[M]. 北京：科学出版社，2002：68.
[29]	尤培建，王旭东. 运动减肥安全性与不同运动形式的初步探讨[J]. 江西中医学院学报，2008，20(4):93-95. DOI：10.3969/j.issn.1005-9431.2008.04.036.
[30]	WILLIAMS P T. Effects of running and walking on osteoarthritis and hip replacement risk[J]. Med Sci Sports Exerc，2013，45(7):1292-1297. DOI：10.1249/MSS.0b013e3182885f26.
[31]	Centers for Disease Control and Prevention. Arthritis as a potential barrier to physical activity among adults with obesity—United States，2007 and 2009[J]. MMWR Morb Mortal Wkly Rep，2011，60(19):614-618.
[32]	STEWART J M, CUBILLAN L D P, JR CUNNINGHAM E T. Prevalence，clinical features，and causes of vision loss among patients with ocular toxocariasis[J]. Retina，2005，25(8):1005-1013. DOI：10.1097/00006982-200512000-00009.
[33]	PAULSEN G, MIKKELSEN U R, RAASTAD T，et al. Leucocytes，cytokines and satellite cells：what role do they play in muscle damage and regeneration following eccentric exercise?[J]. Exerc Immunol Rev，2012，18:42-97.
[34]	PEAKE J M, NEUBAUER O, DELLA GATTA P A，et al. Muscle damage and inflammation during recovery from exercise[J]. J Appl Physiol，2017，122(3):559-570. DOI：10.1152/japplphysiol.00971.2016.
[35]	HICKNER R C, MEHTA P M, DYCK D，et al. Relationship between fat-to-fat-free mass ratio and decrements in leg strength after downhill running[J]. J Appl Physiol（1985），2001，90(4):1334-1341. DOI：10.1152/jappl.2001.90.4.1334.
[36]	KIM J, SO W Y. High body mass index is associated with the extent of muscle damage after eccentric exercise[J]. Int J Environ Res Public Health，2018，15(7):1378. DOI：10.3390/ijerph15071378.
[37]	YOON E J, KIM J. Effect of body fat percentage on muscle damage induced by high-intensity eccentric exercise[J]. Int J Environ Res Public Health，2020，17(10):3476. DOI：10.3390/ijerph17103476.
[38]	MARGARITELIS N V, THEODOROU A A, KYPAROS A，et al. Effect of body composition on redox homeostasis at rest and in response to exercise：the case of underfat women[J]. J Sports Sci，2019，37(14):1630-1637. DOI：10.1080/02640414.2019.1578450.
[39]	中国医药卫生文化协会心血管健康与科学运动分会. 运动相关心血管事件风险的评估与监测中国专家共识[J]. 中国循环杂志，2022，37(7):659-668. DOI：10.3969/j.issn.1000-3614.2022.07.002.
[40]	FORIGHT R M, PRESBY D M, SHERK V D，et al. Is regular exercise an effective strategy for weight loss maintenance?[J]. Physiol Behav，2018，188:86-93. DOI：10.1016/j.physbeh.2018.01.025.
[41]	JONES F, HARRIS P, WALLER H，et al. Adherence to an exercise prescription scheme：the role of expectations，self-efficacy，stage of change and psychological well-being[J]. Br J Health Psychol，2005，10(3):359-378. DOI：10.1348/135910704X24798.
[42]	FOLK A L, HOOPER L, HAZZARD V M，et al. Does weight-motivation for exercise predict physical activity levels across the life course from adolescence to adulthood?[J]. J Adolesc Health，2022，71(1):112-118. DOI：10.1016/j.jadohealth.2022.02.002.

Exercise is Not the Foundation of Weight Loss

运动不是减重之本

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

References 42

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	China Sport Science Society. Guidelines for Exercise Prescription of Dyslipidemia [J]. Chinese General Practice, 2026, 29(32): 4673-4689.
[2]	TANG Bo, YANG Rui, ZHAO Qian, LIU Hong, LIU Lidi, ZHANG Ying, JIANG Lihua, WANG Xiaogang, YANG Rong, LIAO Xiaoyang. Interpretation of the 2024 U.S. Preventive Services Task Force Recommendation Statement on Fall Prevention in Community-dwelling Older Adults [J]. Chinese General Practice, 2026, 29(30): 4360-4365.
[3]	HE Qizhen, ZHONG Qingling, XU Jin, YU Yi, ZHAO Yuefei. Perceptions and Experiences of Zero-time Exercise among Community-dwelling Older Adults: a Qualitative Study [J]. Chinese General Practice, 2026, 29(30): 4480-4488.
[4]	LI Lan, LIU Lidi, ZHANG Peng, LI Dongze, YANG Ziyu, CHENG Yonglang, LIAO Xiaoyang, WAN Zhi. Lifestyle Intervention-based Weight Management: an Analysis of Key Highlights from the Partial Update of the 2025 NICE Guideline Overweight and Obesity Management (NG246) [J]. Chinese General Practice, 2026, 29(30): 4353-4359.
[5]	LI Xiling, ZHANG Fan, YANG Xinyue, YANG Heng. Application of Exercise Snacks in Chronic Disease Management: a Scoping Review [J]. Chinese General Practice, 2026, 29(30): 4472-4479.
[6]	FU Xiaoya, YANG Fei, GU Keyi, GU Handong, WANG Weiqiang. Correlation between Relative Fat Mass Index and Decreased Glomerular Filtration Rate in Patients with Cardiometabolic Comorbidities [J]. Chinese General Practice, 2026, 29(28): 4187-4192.
[7]	ZHANG Han, CAI Genshen, FENG Zhengwen, ZHANG Kaiyue, LIAN Dongbo, ZHANG Hua, ZHANG Jing. Evaluating the Availability of Health Services for Obesity Comorbidities under Hierarchical Diagnosis and Treatment in Beijing: a Healthcare Institution Survey Study [J]. Chinese General Practice, 2026, 29(28): 4117-4124.
[8]	ZHANG Ying, TANG Yijun, LIU Lidi, JIANG Lihua, JIA Yu, YANG Rong, YANG Ziyu, LIAO Xiaoyang. Management of Cardiovascular Metabolic Risks in Obese Children and Adolescents in China: Based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes Position Paper on Cardiometabolic Risk in Children and Adolescents with Obesity [J]. Chinese General Practice, 2026, 29(27): 3879-3887.
[9]	WANG Yi, CHEN Yujie, LI Yao, YANG Linglin, LI Yong, HE Qinze, YUAN Quan. Effect of Eszopiclone and Telemedicine Management on NPPV Adherence in Patients with Coexisting Insomnia and Obstructive Sleep Apnea [J]. Chinese General Practice, 2026, 29(25): 3686-3693.
[10]	QI Jing, CAI Qing, ZHANG Wanting, GU Yan. A WeChat Mini-program-based Telerehabilitation Program for Stable COPD: Multidimensional Efficacy and Adherence Study [J]. Chinese General Practice, 2026, 29(24): 3476-3485.
[11]	Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School, China Rehabilitation Science Institute, China Rehabilitation Research Center, Professional Committee on Integrative Nutrition Management, Jiangsu Integrative Medicine Research Society, Specialty Committee of Rehabilitation Engineering and Industry, China Association of Rehabilitation Medicine, Regenerative Repair and Anti-Aging Branch of Guangdong Association for the Development of Rehabilitation Medicine. Expert Consensus on Nutritional Rehabilitation Management of Adolescent Idiopathic Scoliosis [J]. Chinese General Practice, 2026, 29(24): 3393-3408.
[12]	XU Kun, CHENG Jingwei, WANG Congshuai, WANG Yinhao, HU Junpeng, LI Wanyue, LIU Yangqing, XI Yan. The Role of Exercise in the Management of Metabolic-associated Fatty Liver Disease: Interpretation of the International Expert Consensus of ACSM and ESSA [J]. Chinese General Practice, 2026, 29(23): 3253-3260.
[13]	Expert Group on Guidelines for the Assessment, Treatment, and Prevention of Childhood Obesity in China, Professional Committee on Obesity Control in Women and Children, China Maternal and Child Health Research Association. Guidelines for the Assessment, Treatment, and Prevention of Childhood Obesity in China (Second Edition) [J]. Chinese General Practice, 2026, 29(23): 3233-3252.
[14]	WANG Yang, ZHAO Shiting, CHEN Yingying, SUN Zilin, QIU Shanhu. Key Points of Exercise Intervention and Implementation for People with Complications of Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(21): 2989-2994.
[15]	HAN Congcong, QIU Xinyu, SHAN Chunfang, SONG Ning, CHEN Qingjie, MULADILI· Abudureheman, LI Xiaomei, YANG Yining, ZHAO Qian. Impact of Metabolic Obesity Phenotype on Long-term Prognosis after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome [J]. Chinese General Practice, 2026, 29(21): 2950-2958.