Finding the right weight management approach for you – a comparison table

What:

• Any movement or activity that increases the heart rate. For people living with overweight and obesity, taking regular brisk walks (for around 45 minutes a day) is widely recommended as a starting point.

An option for:

• All. It is encouraged that everyone regardless of weight incorporates regular exercise into their daily lifestyle.

Typical weight loss achievable:

• Exercise alone is typically associated with a small amount of weight loss, and when paired with changes in diet, this can increase to a body weight reduction of around 5%. The more vigorous the exercise, the more likely it is sustainable long-term weight management goals can be achieved. 

Likelihood of weight regain:

• Low. With a good support system, continued high levels of activity, and a healthy diet, weight loss can be maintained long-term.  After achieving weight loss, 30-60 minutes of moderate intensity exercise is a great way to maintain your weight.

Benefit to health:

• Regardless of weight loss achieved, regular exercise is beneficial to everyone, not just people in a higher BMI category.  For people living with overweight and obesity, regular exercise of moderate to vigorous intensity is associated with:
  • Improvements to bone density (which prevents other conditions such as osteoporosis – a condition where bones are more likely to break)
  • Improvements in mental health, and a decrease in the likelihood of conditions such as depression
  • Reductions in the risk of cancers, in particular breast and colon cancer
  • Increasing the intensity of workouts can speed up how quickly you start to see benefits. So where possible, try and introduce exercises such as high intensity interval training.

Benefit to cardiovascular health:

• Regular exercise has many benefits to your cardiovascular health, cardiorespiratory fitness, and mobility. Studies have found that light exercise can slow down the progression of heart disease and lowers the risk of a serious heart attack or stroke.

What:

• The Mediterranean diet focusses on a reduction of red meat, lower intake of poultry, cheeses and white bread, and a high intake of whole grains, fruits and vegetables.

An option for:

• All. It is often a preferred lifestyle choice even for those not looking to lose weight.

Typical weight loss achievable:

• The Mediterranean diet is not typically associated with significant weight loss, or difference in waist circumference. One study that studied older adults with overweight or obesity found that on average a third of people can lose over 5% of their body weight.

Likelihood of weight regain:

• When paired with a rigorous exercise routine, and support from a healthcare professional, weight management through the Mediterranean diet can be sustained to 12 months, without weight regain.

Benefit to health:

• The Mediterranean diet is recommended as a great nutrition regime for all to follow, as it can be associated with the following benefits: 
  • Improves age related brain function
  • Reduces the chance of Alzheimer’s disease and other neurological disorders

Benefit to cardiovascular health:

• A recent Spanish study that focussed specifically on people who lived in Mediterranean countries with an already high cardiovascular risk found that, following a Mediterranean diet can reduce your risk of a major cardiovascular event by up to 30.

What:

• The keto diet focusses on low carbohydrates and higher protein and higher fat, mainly from extra virgin olive oil. 

An option for:

• People who wish to lose weight faster than other methods such as the Mediterranean diet 
• Those without micronutrient deficiency. For example, those living with obesity or overweight are more likely to have low iron or vitamin D (caused through medication or surgery), and therefore should seek medical advice before embarking on this diet 

Typical weight loss achievable:

• One study found that people living with overweight and obesity were able to achieve 5% body weight loss after one month of following a very low-calorie ketogenic diet. 

Likelihood of weight regain:

• High. The very low-calorie keto diet should only be followed for periods of 2-4 months at a time, so is recommended for rapid weight loss, rather than long-term weight management. 

Benefit to health:

• In addition to general health benefits of this level of weight management, the keto diet specifically has been associated with the following benefits 
  • Improvement in mood
  • Improvement in metabolism

Benefit to cardiovascular health:

• Besides the benefit to cardiovascular health that occurs through weight management, the keto diet is not shown to have additional benefits to your heart

What:

• Intermittent fasting is the term used to describe a weight management approach that restricts calorie-intake at certain times of the day, or week. 

An option for:

• All. For weight management, the most common intermittent fasting is alternate day fasting, where on fast days energy intake is restricted to less than 25% of energy needs.

Typical weight loss achievable:

• Studies have found that there is little difference in weight loss achievable through intermittent fasting versus other popular diets. Typically, in the short-term, around 4-8% weight loss can be achieved through this type of fasting 
• For more information on intermittent fasting, you can read a helpful Q&A article here

Likelihood of weight regain:

• Intermittent fasting should only be used as a short-term approach to weight management, and in-fact, for people living with overweight and obesity, continuous calorie restriction has a higher chance of changing the way your body signals hunger, satiety and body weight regulation, leading to long-term weight gain. 

Benefit to health:

• As well as regular benefits of weight management, this type of diet can be associated with: 
  • Improvements to gut microbiota – the millions of bacteria that live in the gastrointestinal system
  • Higher energy levels

Benefit to cardiovascular health:

• At this stage, there is limited evidence to suggest intermittent fasting can improve your cardiovascular health, however, nightly fasting (leading to better sleep) may have a positive effect on cardiometabolic disease. 

What:

• A low-calorie diet is the restriction of the number of calories you consume. When prescribed by a healthcare professional, this can either be moderate (1300-1500 kcal/day), low-calorie (900-1300 kcal/day) or very low-calorie (less than 900 kcal/day). For context, it is recommended that on average, you should consume 2000 (women) -2500 (men) kcal/day to maintain weight. 

An option for:

• All. However, a calorie deficit diet can impact quality of life, as well as other psychological factors, so should be used alongside behavioural or emotional therapy for the best results. 

Typical weight loss achievable:

• Depending on calorie restriction, this type of diet can lead to a body weight reduction of around 5% in the first 12 months. For some, this can increase to up to 10% of overall body weight. It is important to note however, that weight loss is unlikely to be achieved without behavioural support alongside. 

Likelihood of weight regain:

• High. The chances of weight-regain following a calorie deficit is significantly higher than other weight management approaches. In fact, those following a 1000 kcal per day diet are much more likely to experience weight regain than those following a 1500 kcal per day diet.
• In the long-term, expected weight loss following a low-calorie diet reduces to less than 5% of body weight lost.

Benefit to health:

• Other than a reduction in total body fat, following a calorie deficit diet does not appear to have any other significant benefits versus other weight management methods.
• It is important to note, this type of restriction can also lead to a reduction in bone density and muscle strength, both able to impact how you can exercise, so caution is advised if following for the long-term.

Benefit to cardiovascular health:

• Other than benefits associated with high levels of weight loss, a calorie-restricted diet has not resulted in any notable benefits to cardiovascular health.

What:

• Pharmacological treatments are those that work with the chemistry in your brain that causes weight gain and prevents weight loss.

An option for:

• Depending on the medication, pharmacotherapy is typically available to those with a BMI of over 30 kg/m² or those with a BMI of over 27 kg/m²  who also have another obesity related health condition (type 2 diabetes, sleep apnoea, etc) 
• These restrictions will vary, so please ask your healthcare provider using the locator below

Typical weight loss achievable:

• Over 20% of initial body weight in some instances. Depending on the medication prescribed, a significant amount of people will achieve weight loss of over 5%, and this increases to over 20% when looking at injectable weight loss treatments.

Likelihood of weight regain:

• Low, while treatment continues. For people living with obesity, the use of weight management medications is recommended for long-term weight loss and weight management. However, as obesity is a chronic condition, when medication is stopped, the chance of weight regain is high. 

Benefit to health:

• Significant body weight reduction by over 10% has further benefits to health that what can be achieved through diet and exercise along. You can read further information here, but this includes:
  • Lowers post-menopause symptoms
  • Reduces sugar cravings

Benefit to cardiovascular health:

• The more weight lost, the greater the reduction in risk to cardiovascular health. This is because weight loss of 10-15% significantly reduces blood pressure, which takes the pressure off the heart!
• More studies are currently underway to link pharmacotherapy to cardiovascular outcomes 

What:

• Bariatric surgery, or a gastric bypass/sleeve/band, is a surgical procedure designed to reduce the size of your stomach, with the goal of long-term and sustained weight loss 

An option for:

• It depends on your country, but there are a lot of restrictions about who is eligible for bariatric surgery, ranging from weight and age to lifestyle and psychological factors 
• Bariatric surgery is not offered as a first-line option to weight management 

Typical weight loss achievable:

• Between 20-40% of initial body weight, with variation based on which procedure is performed. 

Likelihood of weight regain:

• There have been many studies on long-term weight management after bariatric surgery. Most commonly, weight regain is seen after 12-18 months post-operation and while there is no average measurable number, in around a quarter of people, weight regain will be 15% of their initial body weight. 

Benefit to health:

• Much like pharmacological options, bariatric surgery can lead to greater weight loss than diet and exercise alone, and therefore the improvements to physical and mental health are greater.
• For example, studies have shown that bariatric surgery can lead to reductions in obesity-related diseases, including Type 2 diabetes, Hypertension, Obstructive Sleep Apnea and Dyslipidemia. 

Benefit to cardiovascular health:

• Bariatric surgery significantly reduces the risk of cardiovascular events such as heart attack and stroke. In addition, bariatric surgery can lead to long-term improvement to your metabolism, which helps to keep risk of cardiovascular disease low