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The ole o physical ac i i y and exe cise in obesi y and weigh managemen : Time o
c i ical app aisal
Wiklund, Pe i
Wiklund, P. (2016). The ole o physical ac i i y and exe cise in obesi y and weigh
managemen : Time o c i ical app aisal. Jou nal o Spo and Heal h Science, 5(2),
151-154. h ps://doi.o g/10.1016/j.jshs.2016.04.001
2016
Re iew
The ole o physical ac i i y and exe cise in obesi y and weigh
managemen : Time o c i ical app aisal
Pe i Wiklund *
Depa men o Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä FI-40014, Finland
Recei ed 15 Janua y 2016; e ised 1 Ma ch 2016; accep ed 21 Ma ch 2016
A ailable online 8 Ap il 2016
Abs ac
The p e alence o o e weigh and obesi y has inc eased d ama ically du ing las 3 decades wi h de as a ing consequences o public heal h.
Recommended s a egies o educe obesi y ha e ocused on heal hie die and physical ac i i y (PA). Clea ly, hese app oaches ha e no been
success ul, bu whe he his is due o ailu e o es ic ene gy in ake o o main ain high le els o ene gy expendi u e has been he subjec o g ea
con o e sy. Consequen ly, he e has been a g ea deal o con usion abou he ole o PA and exe cise in obesi y and weigh managemen . In his
a icle, he heo e ical basis o conside ing educed PA and ene gy expendi u e as he cause o obesi y is app aised. Fu he , he ole o PA in ood
in ake and weigh con ol is examined. The idea ha obesi y is caused by consis en decline in daily ene gy expendi u e is no suppo ed ei he by
objec i e measu es o ene gy expendi u e o physiological heo y o weigh gain alone. Howe e , since olun a y exe cise is he mos impo an
disc e iona y componen o o al daily ene gy expendi u e, i can a ec ene gy balance. The e o e, PA and exe cise hold po en ial as pa o he
solu ion o he ongoing obesi y epidemic.
© 2016 P oduc ion and hos ing by Else ie B.V. on behal o Shanghai Uni e si y o Spo . This is an open access a icle unde he CC BY-NC-ND
license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
Keywo ds: Ene gy expendi u e; Exe cise; Obesi y; O e weigh ; Physical ac i i y
1. In oduc ion
The p e alence o o e weigh and obesi y has inc eased
subs an ially in all socie ies ac oss he globe du ing las 3
decades (Fig. 1), and all indica ions a e ha his end is likely
o con inue unaba ed in he coming yea s.1This is a majo
public heal h conce n because obesi y has a eaching nega i e
e ec s on heal h. The isk o ype 2 diabe es, ca dio ascula
disease, ce ain ypes o cance s, and e en mo ali y a e
di ec ly p opo ional o he deg ee o obesi y.2,3 Thus, i goes
wi hou saying ha he e is a need o e e se his mode n
epidemic. Public heal h ac ions o educe obesi y ha e mos ly
ocused on indi iduals, encou aging hem o ea heal hie and
o exe cise mo e. Bu so a , hese app oaches a e ailing as no
a single coun y has succeeded in educing obesi y a es in he
pas 30 yea s.4Whe he his is due o ailu e o es ic ene gy
in ake o o main ain high le els o ene gy expendi u e has ye
o be de e mined conclusi ely, and he ela i e impo ance o
hese 2 elemen s has been he subjec o spa king deba e.5–7
The lack o consensus has led o a g ea deal o con usion o
he use ulness o physical ac i i y (PA) in weigh loss, and he
media’s messages abou he u ili y o exe cise ha e no hing
bu gal anized his pe plexi y. In his a icle, I will conside he
ole o PA in obesi y de elopmen and i s use ulness in weigh
managemen .
2. Secula ends in occupa ional and household- ela ed
PA appea o be cong uen wi h he dynamics o he
popula ion weigh gain
Concep ually, obesi y is a condi ion in which he amoun o
body a exceeds he biological need o an indi idual. Obesi y is
a mani es a ion o a posi i e ene gy balance ha has been
sus ained o e an ex ended pe iod o ime. Howe e , he eason
why his condi ion has sp ead inexo ably ac oss he globe o e
he pas 3 decades wi h such speed is no well unde s ood.
Gene ally speaking, he human genome has no changed sub-
s an ially du ing his ime; he e o e, he ise in obesi y mos
likely e lec s changes in he en i onmen and/o beha io .
Du ing he pas hal -cen u y mechaniza ion has impinged upon
Pee e iew unde esponsibili y o Shanghai Uni e si y o Spo .
*E-mail add ess: [email p o ec ed]
h p://dx.doi.o g/10.1016/j.jshs.2016.04.001
2095-2546/© 2016 P oduc ion and hos ing by Else ie B.V. on behal o Shanghai Uni e si y o Spo . This is an open access a icle unde he CC BY-NC-ND
license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
A ailable online a www.sciencedi ec .com
Jou nal o Spo and Heal h Science 5 (2016) 151–154
www.jshs.o g.cn
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ScienceDi ec
ou modes o li ing in di e se ways. Consequen ly, ene gy
expendi u e equi ed o daily li ing has con inuously declined.
A ecen s udy showed ha in he US, daily ene gy expendi u e
due o wo k ela ed PA has dec eased by mo e han 100 kcal
du ing las 50 yea s in bo h men and women, and his educ ion
is associa ed wi h he inc ease in mean body weigh du ing his
ime ame.8Simila ends ha e also been obse ed in o he
coun ies including Finland, whe e daily ene gy expendi u e
du ing wo k epo edly dec eased by mo e han 50 kcal
be ween 1982 and 1992 while he a e age body weigh elen -
lessly c ep upwa d.9Mo e ecen s udies indica ed ha hese
ends ha e con inued unaba ed up o he p esen day.10,11 Sub-
s an ial educ ions in daily ene gy expendi u e ha e also
occu ed in de eloping coun ies such as China and B azil,
which ha e he highes absolu e and ela i e a es o decline in
o al PA due o educ ions in mo emen a wo k.12 Fo his
eason, i is belie ed ha he obesi y epidemic has also pen-
e a ed he low-income coun ies, pa icula ly in he u ban
a eas, and will con inue o sp ead o he o eseeable u u e.13
The e is also eason o assume ha domes ic mechaniza ion
o daily asks (wi h he ad en o labo -sa ing de ices such as
washing machines and dishwashe s) ha e educed ene gy
expendi u e o e he yea s. Indeed, i was ecen ly es ima ed
ha in women, daily housewo k- ela ed ene gy expendi u e has
dec eased by 360 kcal in he US since he 1960s.14 The au ho s
o he s udy concluded ha such educ ions in housewo k-
ela ed ene gy expendi u e migh ha e been subs an ial con-
ibu o s o he ise in p e alence o obesi y in women in las 5
decades. Because such labo -sa ing de ices a e habi ually used
in all a luen socie ies, hei con ibu ion o popula ion ene gy
balance in high-income coun ies has been conside ed
subs an i e.15 Domes ic mechaniza ion has also con ibu ed o
inc eased seden a iness, as ime spen in house wo k has been
eplaced by seden a y ac i i ies such as wa ching ele ision and
use o o he sc een based media.16 Many s udies ha e impli-
ca ed seden a y beha io , including passi e anspo a ion, wi h
weigh gain.17–19 On he o he hand, pa icipa ion in leisu e- ime
physical ac i i y (LTPA) has p og essi ely inc eased o e he
yea s;20 howe e , i appea s ha on a secula basis, his has no
been enough o o se inc eased seden a y beha io , as o al PA
is declining apidly ac oss he globe.12
3. Objec i e measu emen s o ene gy expendi u e con lic
he idea ha obesi y epidemic is a ibu able o educ ions
in daily ene gy expendi u e
Based on he e idence p esen ed abo e, i seems in ui i e
ha he ise in bodyweigh and obesi y is a ibu able o
dec eases in daily ene gy expendi u e. Howe e , on close sc u-
iny his idea seems highly imp obable, and he e is ai amoun
o e idence o suppo ha con en ion. Fi s , he “labo -sa ing”
cul u e has no changed subs an ially since he 1960s and
1970s, whe eas he obesi y p e alence s a ed o inc ease d a-
ma ically only a ound he 1980s. Second, doubly-labeled wa e
s udies (which p o ide he op imal me hod o measu e ene gy
expendi u e in ee-li ing indi iduals) show ha daily ene gy
expendi u e has no declined be ween 1980 and 2005 in Eu ope
o No h Ame ica.21 Simila ly, ecen me a-analyses o nea ly
100 doubly-labeled wa e s udies indica ed ha popula ions in
indus ialized coun ies do no ha e lowe a e o daily ene gy
expendi u e compa ed wi h popula ions in de eloping
coun ies.22 Clea ly, obese indi iduals ha e highe habi ual
ene gy expendi u e compa ed wi h no mal weigh people23 (due
o hei la ge body size and es ing me abolic a es). Leibel
e al.24 demons a ed ha 10% weigh gain inc eases daily
ene gy expendi u e om 370 o 530 kcal, depending on he
baseline weigh . The ob ious implica ion o his is ha he a e
o ene gy in ake mus also inc ease acco dingly, o he wise
weigh loss will ensue.
Consis en wi h his no ion, Swinbu n e al.25 examined U.S.
nu i ional su eillance da a and showed ha he es ima ed
daily ene gy in ake in adul s has inc eased on a e age by
500 kcal in he US be ween 1970s and 2000s. Simila indings
ha e also been epo ed om se e al Eu opean coun ies.26,27
Howe e , a mo e ecen examina ion by A che e al.28 sug-
ges ed ha once he measu es o die a y in ake in Na ional
Heal h and Nu i ion Examina ion Su ey (NHANES) we e
modi ied, no subs an ial di e ence in ene gy in ake exis ed.
Ene gy in ake canno be quan i ied as p ecisely as ene gy
expendi u e. The eason why daily ene gy in ake is no ably
smalle han simul aneously es ima ed ene gy expendi u e28,29
may be explained by selec i e mis epo ing (o e o unde ) and
ecall bias, which a e well-known ac o s ha con ound s udies
in es iga ing ene gy in ake in humans.30 Popula ion ene gy
in ake can also be assessed om he na ional ood a ailabili y
da a. These da a show ha daily ene gy in ake in he US
inc eased slowly un il he ea ly 1980s, and hen s a ed o
inc eased apidly.31 Mo eo e , a ecen global analysis con-
cluded ha inc eases in ood-ene gy supplies a e su icien o
explain inc eases in a e age popula ion body weigh , pa icu-
la ly in high-income coun ies.32 Thus, i seems unlikely ha
dec emen s in daily ene gy expendi u e a e d i ing he ongoing
obesi y epidemic.
4. The ole o PA in ood in ake and weigh con ol
Dec eases in daily ene gy expendi u e may no be he
p ima y cause o obesi y, bu ha is no o say ha PA o
Fig. 1. Changes (%) in adul obesi y p e alence o e ime in selec ed coun ies
a ound he wo ld.50 BMI =body mass index. Rep oduced wi h pe mission o
Wo ld Obesi y Fede a ion.
152 P. Wiklund
exe cise has no ole in weigh managemen and ene gy balance.
One heo y holds ha ene gy balance may be easie o achie e
when ene gy lux is high. This concep was o iginally de eloped
by Maye e al.33 in he 1950s, and has subsequen ly been
desc ibed by Blundell and King34 and Hill e al.35 Acco ding o
his heo y, a h eshold o PA exis s abo e which people a e in
he so called “ egula ed zone” o ene gy balance. Those who a e
in he egula ed zone a e able o mee high ene gy expendi u e
needs wi h ene gy in ake, hus main aining body weigh .
Howe e , hose who a e below he PA h eshold ha e lowe
ene gy expendi u e, and hus a e in he “un egula ed zone”
wi hou he ma ching dec emen s in ene gy in ake. In o he
wo ds, his heo y sugges s ha appe i e may no be app op i-
a ely egula ed a low le els o PA. This was ecen ly demon-
s a ed by Shook e al.;36 hey examined he ela ion be ween
ene gy in ake, PA, appe i e, and weigh gain du ing a 1-yea
ollow-up, and epo ed ha indi iduals wi h low PA had highe
le els o c a ings o oods compa ed wi h hose who had high
le els o PA. Fu he mo e, he au ho s no ed ha a h eshold o
achie ing ene gy balance occu ed a an ac i i y le el co e-
sponding o 7116 s eps pe day. Thus, i may be ha inc ease in
seden a iness in he cou se o he yea s has allowed much
s eepe ajec o y in popula ion weigh gain han wha would
ha e been o he wise.
Volun a y exe cise is he mos impo an disc e iona y com-
ponen o o al daily ene gy expendi u e, and hus has he po en-
ial o a ec ene gy balance. This has been illus a ed in a
numbe o longi udinal s udies. Fo example, in a p ospec i e
s udy wi h 20 yea s o ollow-up, Hankinson e al.37 showed ha
main aining high le el o PA mi iga es weigh gain signi ican ly,
pa icula ly in women. In ha s udy, ac i e indi iduals gained
less weigh du ing he ollowed pe iod compa ed wi h hose
who we e consis en ly inac i e. Simila indings ha e been
epo ed om he Finnish Twin Coho , which can be consid-
e ed as a na u al expe imen al app oach o in es iga e he ole
o PA and genes o o he amilial ac o s on u u e mo bidi y.38
Twins who ha e been consis en ly disco dan LTPA o o e 30
yea s di e signi ican ly om each o he in e ms o body
weigh and body composi ion; physically ac i e co- wins ha e
signi ican ly lowe body weigh ,39 BMI,40 and a pe cen , and
hey ha e much less (50%) isce al and hepa ic a 41 compa ed
wi h hei inac i e co- win. This e idence clea ly shows ha
pe sis en ly highe PA le el is associa ed wi h dec eased a e o
weigh gain e en a e con olling o gene ic liabili y and
childhood en i onmen . The e is also a weal h o e idence om
con olled ials ha exe cise (o PA) ca ied ou o e long
pe iods o ime can gene a e ene gy de ici and he eby induce
weigh loss.42–44 Se ies o e iews,45,46 including a Coch ane
Re iew47 (which is conside ed as he golden s anda d in assess-
ing e idence), indica e ha exe cise induces weigh loss, and
ha he weigh loss is e en g ea e when coupled wi h ene gy
es ic ion. Thus, bo h die and exe cise a e impo an compo-
nen s in he p og ams in ended o weigh loss. Howe e , he
majo i y o he weigh loss p og ams seem o ail in he long-
e m as people o en egain weigh .48 Consequen ly, a gene al
pe cep ion, pa icula ly among he layman, is ha only e y ew
succeed in long- e m main enance o weigh loss. Howe e ,
long- e m weigh loss main enance is a ques ion o beha io al
adhe ence. S udies ha e clea ly shown ha con inued adhe -
ence o die and exe cise s a egies a e associa ed wi h long-
e m success.49
5. Conclusion
The inc ease in obesi y epidemic is occu ing agains he
backg ound o con inuous decline in he ene gy expendi u e
equi ed o daily li ing. Howe e , he idea ha obesi y is
inc easing because o consis en decline in daily ene gy expen-
di u e is no suppo ed ei he by objec i e measu es o ene gy
expendi u e o physiological heo y o weigh gain. Clea ly,
obesi y esul s om excessi e ene gy in ake ha has sus ained
o e a long pe iod o ime. Cu en ly, we do no unde s and why
people consume mo e ene gy han hey expend. I may be ha
PA has he abili y o egula e ood in ake, bu in he con empo-
a y en i onmen ha is conduci e o seden a y beha io , his
egula o y mechanism has gone as ay. Inc easing PA mos
ce ainly can c ea e ene gy de ici h ough inc eased ene gy
expendi u e. Fo his eason PA and exe cise hold po en ial as
pa o he solu ion o he ongoing obesi y epidemic.
Compe ing in e es s
The au ho decla es no compe ing inancial in e es s.
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