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.^2,3

An option for:

• All. It is encouraged that everyone regardless of weight incorporates regular exercise into their daily lifestyle.²

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 that sustainable long-term weight management goals can be achieved.⁴

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.⁴  After achieving weight loss, 30–60 minutes of moderate intensity exercise is a great way to maintain your weight.²

Benefit to health:

• Regardless of weight loss achieved, regular exercise is beneficial to everyone, not just people in a higher BMI category.² For people living with overweight and obesity, regular exercise of moderate to vigorous intensity is associated with:^2,5
  
  
  • 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.²

Benefit to cardiovascular health:

• Regular exercise has many benefits to your cardiovascular health, cardiorespiratory fitness and mobility.² 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.⁵

What:

• The Mediterranean diet focuses on a reduction of red meat, lower intake of poultry, cheeses and white bread, and a high intake of whole grains, fruits and vegetables.¹

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.⁶ One study that examined older adults with overweight or obesity found that on average, a third of people can lose over 5% of their body weight.⁷

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.⁷

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:⁸
  • Improves age-related brain function.
  • Reduces the risk of Alzheimer’s disease and other neurological disorders.

Benefit to cardiovascular health:

• A recent Spanish study that focused 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%.⁶

What:

• The keto diet focuses on low carbohydrates and higher protein and higher fat, mainly from extra virgin olive oil.⁹

An option for:

• People who wish to lose weight faster than other methods such as the Mediterranean diet.⁹ 
• Those without micronutrient deficiency. For example, those living with overweight or obesity 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.¹

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.⁹

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.⁹

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:¹⁰ 
  • 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.¹⁰

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.¹¹

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.¹

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.¹²

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.¹³ 

Benefit to health:

• As well as regular benefits of weight management, this type of diet can be associated with:¹¹
  • 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.¹¹

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) to 2500 (men) kcal/day to maintain weight.¹⁴ 

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.¹

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.¹⁵ For some, this can increase to up to 10% of overall body weight.¹⁵ It is important to note however, that weight loss is unlikely to be achieved without behavioural support alongside.¹

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.¹⁵
• In the long-term, expected weight loss following a low-calorie diet reduces to less than 5% of body weight lost.¹

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.¹⁶
• 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.¹

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.¹

What:

• Pharmacological treatments are those that work with the chemistry in your brain that causes weight gain and prevents weight loss.¹⁷

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 weight-related health condition such as type 2 diabetes and sleep apnoea.¹⁸

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.¹⁸

Likelihood of weight regain:

• Low, while treatment continues.
  For people living with overweight or 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.¹⁸

Benefit to health:

• Significant body weight reduction by over 10% has further benefits to health than what can be achieved through diet and exercise alone. This includes:^19,20
  • Lower post-menopause symptoms.
  • Reduced sugar cravings.

Benefit to cardiovascular health:

• The more weight lost, the greater the reduction in risk to cardiovascular health issues. For example, weight loss of 10–15% significantly reduces high blood pressure, which takes the pressure off the heart.²¹

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.²²

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.²³
• Bariatric surgery is not offered as a first-line option for weight management.²³ 

Typical weight loss achievable:

• Between 20–40% of initial body weight, with variation based on which procedure is performed.²²

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.²⁴ 

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.²³
• For example, studies have shown that bariatric surgery can lead to reductions in weight-related diseases, including type 2 diabetes, hypertension, obstructive sleep apnoea and dyslipidaemia.²⁵

Benefit to cardiovascular health:

• Bariatric surgery significantly reduces the risk of cardiovascular events such as heart attack and stroke.²⁶ In addition, bariatric surgery can lead to long-term improvement to your metabolism, which helps to keep risk of cardiovascular disease low.²⁶