BACKGROUND: Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain. OBJECTIVE: To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors. DATA SOURCES: PubMed and Embase were searched (January 1990 to October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review. STUDY ELIGIBILITY CRITERIA: Primary source, peer reviewed randomized trials published in English with an active weight loss period of > 6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (eg, diet versus aerobic exercise, diet versus diet plus aerobic exercise etc) and study design (long-term or weight loss/follow-up). RESULTS: Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet plus aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (about 55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise.

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