• R Ross, D Dagnone, P J Jones, H Smith, A Paddags, R Hudson, and I Janssen.
• School of Physical and Health Education, Queen's University, Kingston, Ontario, Canada. rossr@post.queensu.ca
• Ann. Intern. Med. 2000 Jul 18; 133 (2): 92-103.

BackgroundThe independent effects of diet- or exercise-induced weight loss on the reduction of obesity and related comorbid conditions are not known. The effects of exercise without weight loss on fat distribution and other risk factors are also unclear.ObjectiveTo determine the effects of equivalent diet- or exercise-induced weight loss and exercise without weight loss on subcutaneous fat, visceral fat skeletal muscle mass, and insulin sensitivity in obese men.DesignRandomized, controlled trial.SettingUniversity research center.Participants52 obese men (mean body mass index [+/-SD], 31.3 +/- 2.0 kg/m2) with a mean waist circumference of 110.1 +/- 5.8 cm.InterventionParticipants were randomly assigned to one of four study groups (diet-induced weight loss, exercise-induced weight loss, exercise without weight loss, and control) and were observed for 3 months.MeasurementsChange in total, subcutaneous, and visceral fat; skeletal muscle mass; cardiovascular fitness; glucose tolerance and insulin sensitivity.ResultsBody weight decreased by 7.5 kg (8%) in both weight loss groups and did not change in the exercise without weight loss and control groups. Compared with controls, cardiovascular fitness (peak oxygen uptake) in the exercise groups improved by approximately 16% (P < 0.01). Although total fat decreased in both weight loss groups (P < 0.001), the average reduction was 1.3 kg (95% CI, 0.3 to 2.3 kg) greater in the exercise-induced weight loss group than in the diet-induced weight loss group (P = 0.03). Similar reductions in abdominal subcutaneous, visceral, and visceral fat-to-subcutaneous fat ratios were observed in the weight loss groups (P < 0.001). Abdominal and visceral fat also decreased in the exercise without weight loss group (P = 0.001). Plasma glucose and insulin values (fasting and oral glucose challenge) did not change in the treatment groups compared with controls (P = 0.10 for all comparisons). Average improvement in glucose disposal was similar in the diet-induced weight loss group (5.6 mg/kg skeletal muscle per minute) and in the exercise-induced weight loss group (7.2 mg/kg skeletal muscle per minute) (P > 0.2). However, these values were significantly greater than those in the control and exercise without weight loss groups (P < 0.001).ConclusionsWeight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. Exercise without weight loss reduces abdominal fat and prevents further weight gain.

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