Health-enhancing physical activity in obesity management: the need to (seriously) go beyond weight loss

There are many false hopes around the impact of physical activity and exercise in obesity management, especially regarding weight loss. Narrowly focusing on weight loss only leads to disappointment for patients and practitioners. Indeed, in persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight and fat loss compared to the absence of training. However the magnitude of this effect remains modest, amounting to only 2–3 kg additional weight or fat loss on average. We therefore argue that this conversation needs to be re-oriented towards the many potential health benefits of physical activity that can be seen beyond weight loss. Exercise training has been shown to improve the cardiometabolic risk profile by effects including decreasing abdominal visceral fat and improving insulin sensitivity. Aerobic, as well as combined aerobic and resistance (i.e. strength) training, increase cardiorespiratory fitness, a major risk factor for ill health. Resistance training improves muscle strength, another major component of physical fitness, even in the absence of a significant change in muscle mass. Beyond body mass loss, recognizing the broad value of physical activity/exercise in improving health and quality of life of people with obesity is a crucial perspective shift.