How does exercise support dietary approaches to weight loss and better health?


  • Katarina Tomljenović Borer The University of Michigan, School of Kinesiology Ann Arbor



obesity morbidities, exercise, insulin, leptin, body weight


The rapid global rise of obesity incurs a heavy personal and healthcare burden due to obesity-associated morbidities and shortening of life. The purpose of this review is to provide evidence-based strategies for prevention, reversal, and mitigation of obesity and its sequelae. To that end, this review highlights the features of human physiology that favor fat accretion and interfere with fat loss. Strategies for prevention of obesity include understanding the basis for the strong motivating properties of palatable food, for human inability to consciously detect calories eaten or calories expended through exercise, for metabolic and hormonal adaptations to negative energy balance that drive weight regain, and for evolutionary natural selection which likely led to high human capacity for fat storage. Reversal of obesity is difficult primarily due to metabolic, hormonal, and behavioral reactions to body fat loss. Reduced resting metabolic rate presents a physiological challenge whether the weight loss is achieved through dietary restriction or energy expenditure of exercise. Increased insulin sensitivity after body fat loss drives resynthesis of storage substrates including triglycerides in the adipose tissue, muscle glycogen, and proteins, thus contributing to weight regain. Reduced basal plasma leptin concentration elicits a strong hunger drive. Mitigation of obesity-associated morbidities involves adding exercise energy expenditure to deliberate control of the quantity of food eaten, reducing postprandial hyperinsulinemia by lowering the carbohydrate load of the diet, and exercising after, rather than before, the meals to facilitate improved glucose tolerance.

Author Biography

Katarina Tomljenović Borer, The University of Michigan, School of Kinesiology Ann Arbor

Preofessor Emerita


Adams, K. F., Schatzkin, A., Harris, T. B., Kipnis, V., Mouw, T., Ballard-Barbash, R., ... Leitzmann, M. F. (2006). Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. New England Journal of Medicine, 355(8), 763-778.

Bagdade, J. D. (1968). Basal insulin and obesity. Lancet, 292(7568), 630-631.

Berridge, K. C. (2009). 'Liking' and 'wanting' food rewards: brain substrates and roles in eating disorders. Physiolology & Behavior, 97(5), 537-550.

Borer, K. T. (2005). Physical activity in the prevention and amelioration of osteoporosis in women: interaction of mechanical, hormonal and dietary factors. Sports Medicine, 35(9), 779-830.

Borer, K. T. (2008). How effective is exercise in producing fat loss? Kinesiology, 40(2), 127-138.

Borer, K. T. (2010). Nonhomeostatic control of human appetite and physical activity in regulation of energy balance. Exercise and Sport Science Review, 38(3), 114-121.

Borer, K. T. (2014). Counterregulation of insulin by leptin as key component of autonomic regulation of body weight. World Journal of Diabetes, 5(5), 606-629.

Borer, K. T. (2019). Understanding human physiological limitations and societal pressures in favor of overeating helps to avoid obesity. Nutrients, 11(2). E227.

Borer, K. T., Potter, C. D., & Fileccia, N. (1983). Basis for hypoactivity that accompanies rapid weight gain in hamsters. Physiology & Behavior, 30(3), 389-397.

Borer, K. T., Wuorinen, E., Chao, C., & Burant, C. (2005). Exercise energy expenditure is not consciously detected due to oro-gastric, not metabolic, basis of hunger sensation. Appetite, 45(2), 177-181.

Borer, K. T, Wuorinen E., Ku K., & Burant, C. (2009). Appetite responds to changes in meal content, whereas ghrelin, leptin, and insulin track changes in energy availability. Journal of Clinical Endocrinology and Metabolism, 94(7), 2290-2298.

Chakravarthy, M. V., & Booth, F. W. (2004). Eating, exercise, and "thrifty" genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. Journal of Applied Physiology, 96(1), 3-10.

Cohen, E., Cragg, M., deFonseka, J., Hite, A., Rosenberg, M., & Zhou, B. (2015). Statistical review of US macronutrient consumption data, 1965–2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition, 31(5), 727–732.

Considine, R. V., Sinha, M. K., Heiman, M. L., Kriauciunas, A., Stephens, T. W., Nyce, M. R., ... Caro, J. F. (1996). Serum immunoreactive-leptin concentrations in normal-weight and obese humans. New England Journal of Medicine, 334(5), 292-295.

Després, J. P., Lamarche, B., Mauriège, P., Cantin, B., Dagenais, G. R., Moorjani, S., & Lupien, P.-J. (1996). Hyperinsulinemia as an independent risk factor for ischemic heart disease. New England Journal of Medicine, 334(15), 952-958.

Després, J.-P. (2016). Physical activity, sedentary behaviours, and cardiovascular health: When will cardiorespiratory fitness become a vital sign? Canadian Journal of Cardiology, 32(4), 505-513.

Dietary Guidelines for Americans, (2010). US Department of Agriculture and US Department of Health and Human Services. 7th Edition. Washington, DC: U.S. Government Printing Office; 2010.

Farag, Y. M. & Gaballa, M. R. (2011). Diabesity: an overview of a rising epidemic. Nephrology, Dialysis, Transplantation, 26(1), 28-35.

Farooqi, I. S. & O'Rahilly, S. (2014). 20 years of leptin: human disorders of leptin action. Journal of Endocrinology, 223(1), T63-70.

Field, A. E., Coakley, E. H., Must, A., Spadano, J. L., Laird, N., Dietz, W. H., ... Colditz, G. A. (2001). Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Archives of Internal Medicine, 161(13), 1581-1586.

Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs (Millwood), 28(5), W822-W831.

Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., ... Hall, K. D. (2016). Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, 24(8), 1612–1619.

Fox, C. S., Pencina, M. J., Meigs, J. B., Vasan, R. S., Levitzky, Y. S., & D'Agostino, R. B. Sr. (2006). Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham Heart Study. Circulation, 113(25), 2914-2918.

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., … Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. American College of Sports Medicine position stand. Medicine & Science in Sports & Exercise. 43(7), 1334-1359

Guebre-Egziabher, F., Alix, P. M., Koppe, L., Pelletier, C. C., Kalbacher, E., Fouque, D., Soulage, C. O. (2013). Ectopic lipid accumulation: A potential cause for metabolic disturbances and a contributor to the alteration of kidney function. Biochimie, 95(11), 1971-1979.

Hales, C. M., Carrol, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief, 288, 1-8. Retrieved from

Heden, T. D., Winn, N. C., Mari, A., Booth, F. W., Rector, R. S., Thyfault, J. P., Kanaley, J. A., (2015). Postdinner resistance exercise improves postprandial risk factors more effectively than predinner resistance exercise in patients with type 2 diabetes. Journal of Applied Physiology, 118(5), 624-634.

Heldstab, S. A., van Schaik, C. P., & Isler, K. (2016). Being fat and smart: A comparative analysis of the fat-brain trade-off in mammals. Journal of Human Evolution, 100, 25-34.

Iantorno, M., Campia, U., Di Daniele, N., Nistico, S., Forleo, G. B., Cardillo, C., & Tesauro, M. (2014). Obesity, inflammation and endothelial dysfunction. Journal of Biological Regulators and Homeostatic Agents, 28(2), 169-176. PMID:25001649.

Kendall, A., Levitsky, D. A., Strupp, B. J., & Lissner, L. (1991). Weight loss on a low-fat diet: consequence of the imprecision of the control of food intake in humans. American Journal of Clinical Nutrition, 53(5), 1124–1129.

King, N. A., Burley, V. J., & Blundell, J. E. (1994). Exercise-induced suppression of appetite: Effects on food intake and implications for energy balance. European Journal of Clinical Nutrition 48, 715–724. PMID: 7835326.

Kirkham, T. C., & Williams, C. M. (2001). Synergistic efects of opioid and cannabinoid antagonists on food intake. Psychopharmacology (Berlin), 153(2), 267-270.

Knuth, N. D., Johannsen, D. L., Tamboli, R. A., Marks-Shulman, P. A., Huizenga, R., Chen, K. Y., ... Hall, K. D. (2014). Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring), 22(12), 2563-2569.

Knuth, N. D, Johannsen, D. L., Tamboli, R. A., Marks-Shulman, P. A., Huizenga, R., Chen, K. Y., ... Hall, K. D. (2016). Erratum: Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring), 24(10), 2248.

Lieberman, D. E. (2013). The story of the human body. Pantheon Books, New York.

Lin, P. J. & Borer, K. T. (2016). Third exposure to a reduced carbohydrate meal lowers evening postprandial insulin and GIP responses and HOMA-IR estimate of insulin resistance. PLoS One, 11(10): e0165378.

Lorenzo, C., Wagenknecht, L. E., Rewers, M. J., Karter, A. J., Bergman, R. N., Hanley, A. J., Haffner, S. M. (2010). Disposition index, glucose effectiveness, and conversion to type 2 diabetes: The Insulin Resistance Atherosclerosis Study (IRAS). Diabetes Care, 33(9):2098-2103.

Lovren, F., Teoh, H., & Verma, S. (2015). Obesity and atherosclerosis: mechanistic insights. Canadian Journal of Cardiology, 31(2), 177-183.

McGuire, M. T., Wing, R. R., Klem, M. L., Seagle, H. M., Hill, J. O. (1998). Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight? International Journal of Obesity and Related Metabolic Disorders, 22(6), 572-577.

Mendelson, C. R. (1996). Mechanisms of hormone action. In: Textbook of Endocrine Physiology, 3rd ed., New York: Oxford University Press, pp 29-65.

Muller-Riemenschneider, F., Reinhold, T., Berghofer, A., & Willich, S. N. (2008). Health-economic burden of obesity in Europe. European Journal of Epidemiology, 23, 499-509.

NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet, 390(10113), 2627-2642.

National Diabetes Statistics Report (2017). Centers for Disease Control and Prevention, US Department of Health and Human Services. Retrieved from

Neuman, M. G., French, S. W., French, B. A., Seitz, H. K., Cohen, L. B., Mueller, S., ... Malnick, S. (2014). Alcoholic and non-alcoholic steatohepatitis. Experimental and Molecular Patholology, 97(3), 492-510.

Nowotny, K., Jung, T., Höhn, A., Weber, D., & Grune, T. (2015). Advanced glycation end products and oxidative stress in type 2 diabetes mellitus. Biomolecules, 5(1), 194-222.

Olefsky, J. M., & Reaven, G. M. (1975). Effects of age and obesity on insulin binding to isolated adipocytes. Endocrinology, 96(6), 1486-1498.

Pontzer, H. (2015). Constrained total energy expenditure and the evolutionary biology of energy balance. Exercise and Sport Sciences Reviews, 43(3), 110-106.

Rankinen, T., Sarzynski, M. A., Ghosh, S., & Bouchard, C. (2015). Are there genetic paths common to obesity, cardiovascular disease outcomes, and cardiovascular risk factors? Circulation Research, 116(5), 909-922.

Rising, R., Harper, I. T., Fontvielle, A. M., Ferraro, R. T., Spraul, M., & Ravussin, E. (1994). Determinants of total daily energy expenditure: variability in physical activity American Journal of Clinical Nutrition, 59(4), 800–804.

Ritz, E., Rychlik, I., Locatelli, F., & Halimi, S. (1999). End-stage renal failure in type 2 diabetes: a medical catastrophe of worldwide dimensions, American Journal of Kidney Disease, 34(5), 795-808.

Rodríguez-Ojea, A., Jiménez, S., Berdasco, A., Esquivel, M. (2002). The nutrition transition in Cuba in the nineties: an overview. Public health Nutrition, 5(1A), 129-133.

Rosenbaum, M., & Leibel, R. L. (2014). 20 years of leptin: role of leptin in energy homeostasis in humans. Journal of Endocrinology, 223(1), T83-T96.

Ruff, C. B., Trinkaus, E., & Holliday, T. W. (1997). Body mass and encephalization in Pleistocene Homo. Nature, 387(6629), 173-176.

Sallis, R. E. (2009). Exercise is medicine and physicians need to prescribe it! British Journal of Sports Medicine, 43(1), 3-4.

Samad, F. & Ruf, W. (2013). Inflammation, obesity, and thrombosis. Blood, 122, 3415-3422.

Samuel, V. T., Petersen, K. F., & Shulman, G. I. (2010). Lipid-induced insulin resistance: Unravelling the mechanism. Lancet, 375(9733), 2267-2277.

Schenk, S., & Horowitz, J. F. (2007). Acute exercise increases triglyceride synthesis in skeletal muscle and prevents fatty acid-induced insulin resistance. Journal of Clinical Investigation, 117(6), 1690-1698.

Schulz, L. O. & Schoeller, D. A. (1994). A compilation of total daily energy expenditures and body weights in healthy adults. American Journal of Clinical Nutrition, 60(5), 676-681.

Schwartz, M. W., Woods, S. C., Porte, D., Seeley, R. J., Baskin, D. G. (2000). Central nervous system control of food intake. Nature, 404, 661–671.

Sclafani, A. & Springer, D. (1976). Dietary obesity in adult rats: Similarities to hypothalamic and human obesity syndromes. Physiology & Behavior, 17(3), 461-471.

Shulman, G. I. (2014a). Insulin resistance, dyslipidemia, and cardiometabolic disease. New England Journal of Medicine, 371(23), 1131-1141.

Shulman, G. I. (2014b). Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. New England Journal of Medicine, 371(23), 2237-2238.

Sobhani, I., Bado, A., Vissuzaine, C., Buyse, M., Kermorgant, S., Laigneau, J. P., ... Lewin, M. J. M. (2000). Leptin secretion and leptin receptor in the human stomach. Gut, 47(2), 178-183.

Stewart, W. K., & Fleming, L. W. (1973). Features of a successful therapeutic fast of 382 days' duration. Postgraduate Medical Journal, 49(569), 203–209.

Stini, W. (1981). Body composition and nutrient reserves in evolutionary perspective. World Review of Nutrition and Dietetics, 37, 55–83.

Taira, S., Shimabakuro, M., Higa, M., Yabiku, K., Kozuka C., Ueda, R., ... Masuzaki, H. (2013). Lipid deposition in various sites of the skeletal muscles and liver exhibits a positive correlation with visceral fat accumulation in middle-aged Japanese men with metabolic syndrome. Internal Medicine, 52(14), 1561-1571.

Taylor, R. (2013). Banting memorial Lecture 2012: Reversing the twin cycles of type 2 diabetes. Diabetic Medicine, 30(3), 267-275.

Than, N. N. & Newsome, P. N. (2015). A concise review of non-alcoholic fatty liver disease. Atherosclerosis, 239(1), 192-202.

van der Zijl, N. J., Goossens, G. H., Moors, C. C., van Raalte, D. H., Muskiet, M. H., Pouwels, P. J. ... Diamant, M. (2011). Ectopic fat storage in the pancreas, liver, and abdominal fat depots: impact on ß-cell function in individuals with impaired glucose metabolism. Journal of Clinical Endocrinology and Metabolism, 96(2), 459-467.

van Dijk, J. W., Manders, R. J., Hartgens, F., Stehouwer, C. D., Praet, S. F., & van Loon, L. J. (2011). Postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients. Diabetes Research and Clinical Practice, 93(1), 31–37.

Vaněčková, I., Maletínská, L., Behuliak, M., Nagelová, V., Zicha, J., & Kuneš, J. (2014). Obesity-related hypertension: possible pathophysiological mechanisms. Journal of Endocrinology, 223(3), R63-R78.

Wing, R. R., Espeland, M. A., Clark, J. M., Hazuda, H. P., Knowler, W. C., Pownall, H. J., ... Wagenknecht, L. (2016). Association of weight loss maintenance and weight regain on 4-year changes in CVD risk factors: The Action for Health in Diabetes (Look AHEAD) Clinical Trial. Diabetes Care, 39(8), 1345-1355.

Wuorinen, E. C. & Borer, K. T. (2013). Circadian and ultradian components of hunger in human non-homeostatic meal-to-meal eating. Physiology and Behavior, 122, 8-16.

Yazıcı, D. & Sezer, H. (2017). Insulin resistance, obesity and lipotoxicity. Advances in Experimental Medicine and Biology, 960, 277-304.




How to Cite

Tomljenović Borer, K. (2019). How does exercise support dietary approaches to weight loss and better health?. Annales Kinesiologiae, 10(1), 31–58.