Which one would be the main driver in weight loss management? Longterm compliance, physical activity or dietary quality (less UPF and nutrients balance)
Multiple trials show how the quality of diet and composition influences weight loss and physical activity is always been a booster, although weight regain is a challenge in the long term compliance and represents the most important issue to solve in the obesity care management.
Opinion from different experts might help in gaining knowledge on this field
Opinion from different experts might help in gaining knowledge on this field
3 Answers
Ian James Martins
Dietary quality has an important effect on weight loss management. The use of low fat high carbohydrate diets are very important for the treatment of obesity but the consumption of activators versus inhibitors in these diets will determine the success of dietary quality on weight loss management. The anti-aging gene Sirtuin 1 is critical to the treatment of obesity and weight loss management. Sirtuin 1 is important to mitochondrial function that determines the metabolism of fatty acids. Dietary quality may require the consumption of Sirtuin 1 activators versus Sirtuin 1 inhibitors to allow long term compliance and weight loss management. Dietary quality that control appetite dysregulation are critical to weight loss management.
RELEVANT REFERENCES:
1. Appetite dysregulation and obesity in Western Countries Ian J Martins · First edited by Emma Jones.
2. Unhealthy Nutrigenomic Diets Accelerate NAFLD and Adiposity in Global communities. Journal of molecular and genetic medicine: an international journal of biomedical research 03/2015; 9(1).
3. Anti-Aging Genes Improve Appetite Regulation and Reverse Cell Senescence and Apoptosis in Global Populations. Advances in Aging Research, 2016, 5, 9-26
Arvind
Various dietary strategies—such as hypocaloric diets, meal replacements, low-fat, high-protein, high-fiber, very-low-calorie plans, millet-based approaches, and intermittent fasting—offer differing results for weight management. Lasting success relies on personalised, multi-faceted interventions supported by ongoing guidance and environmental modifications. Physical and emotional support, like counselling and group programs, are especially helpful in structured settings. Ultimately, sustained behavioural change, education, support networks, and tailored activity and diet plans are key to effective long-term management. Use of anti-obesity drugs should be avoided due to serious risks, including vision problems and potentially fatal side effects, as highlighted by a recent high-profile incident. The drugs to reduce obesity must be avoided because of visual impairment and life-threatening side effects. Recently, a Bollywood actress, Shaifali Jariwala, died because of the consumption of such drugs.
ZJT
Clinical trials and meta-analyses are fairly consistent in finding that diet quality—i.e., reducing ultra-processed foods (UPFs) and achieving optimal macronutrient balance—most significantly and strongly influences both short-term weight reduction and long-term weight maintenance.
Evidence supporting: DASH, Mediterranean, and low-carbohydrate eating reduce weight more effectively, improve insulin sensitivity, and decrease cardiovascular risk. A 2019 NIH study by Hall et al. showed that UPF consumption increases caloric intake and body fat, independently of satiety or food quantity. Protein-dense, fiber-dense, low-glycemic meals increase satiety and decrease energy intake, improving adherence.
Expert opinion: "Calories count, but the composition of food determines how calories affect hormones, hunger, and metabolism." — Dr. Dariush Mozaffarian, Tufts University
2. Physical Activity: Enforcing, Not Primary, Mechanism
Physical activity is needed to maintain weight and metabolic health but not very effective at causing weight loss per se.
Key points: Exercise increases fat oxidation, insulin sensitivity, and maintenance of lean mass that can support long-term weight stability. Energy compensation (i.e., excess intake post-exercise) and minor energy expenditure, however, make it a second mechanism in short-term weight loss. In weight maintenance, activity durations in excess of 250–300 minutes/week are commonly needed.
Expert opinion: "Exercise is essential for weight control, not as much for weight loss. It's your policy of insurance." — Dr. James Hill, co-director, National Weight Control Registry
3. Long-Term Compliance: The Bottleneck De Jour
Even with optimal diet and exercise programs, long-term compliance is the Achilles' heel in the management of obesity.
Critical determinants: Motivation, behavioral support, environmental cues, and psychological stressors determine a profound impact on adherence. More than 80% of individuals regain weight within 2–5 years if not followed with long-term follow-up. Long-term adherence is made possible with the help of self-monitoring, cognitive-behavioral therapy, motivational interviewing, and even pharmacologic therapy (such as GLP-1 agonists).
Expert opinion: "The biology of weight regain is fierce—unless we talk about the long game of adherence, all diets fail eventually." — Dr. Yoni Freedhoff, Bariatric Physician
Conclusion:
The initial weight reduction driver is nutritionally sound, high-quality food intake, but eventual success requires compliance, augmented with exercise and behavioral strategies. No single component in a vacuum; an individualized, global, multidisciplinary strategy is the most critical key.