Exercise and physical activity guidelines updated to reflect prevalence of weight-loss drugs and bariatric surgery

Researchers at the University of Kansas Medical Center led the first comprehensive update in 15 years to a consensus paper on the role of physical activity in the prevention of weight gain and obesity published by the American College of Sports Medicine (ACSM). The paper, “Physical Activity and Excess Body Weight and Adiposity for Adults,” released in July 2024, expands and extends prior ACSM positions published in 2001 and 2009.

The consensus statement was written by a team of 10 experts that included lead author John Jakicic, Ph.D., professor in the Division of Physical Activity and Weight Management at KU Medical Center, and Joseph Donnelly, Ed.D., professor and director of the division, who was lead author on the ACSM’s 2009 consensus paper.

The paper is the first by an organization to address guidelines for physical activity in the context of bariatric surgery and the new weight-loss medications, such as Wegovy and Zepbound, noted Jakicic. The paper asserts that physical activity should be considered beyond its potential effects on body weight for people undergoing either bariatric surgery or medication treatments. Physical activity should be considered instead within the context of holistic health and well-being. “It gives clinicians some guidance on how to think about activity when they’re thinking about medications and surgery,” said Jakicic.

The paper emphasizes that while physical activity is important for weight control, exercise also matters for a variety of health outcomes that are independent of what is happening to someone’s weight, including enhancing the maintenance and support of muscle mass and improving the health of organs such as the heart and liver. And because anti-obesity medications or bariatric surgery are so effective with weight loss, “we can take the focus off of burning calories to help with more weight loss and put the focus on activity as a means to help enhance the quality of how the body functions,” said Jakicic.

The paper also categorizes different types of activity that have different effects on health, while noting that there is no evidence that any one type of activity is better than another for the regulation of body weight. Different types of exercise can yield different health benefits. Walking, yoga and weight-training, for example, can all contribute in different ways. “We're saying there's not one ideal type, that all activity matters,” said Jakicic.

The consensus statement asserts that exercise plans are best tailored to the individual’s specific needs and goals. “If a person is weak, and for example, can’t get out of their chair very well or lift up their grandkids, then we would focus more on resistance training,” said Jakicic.

The paper also lays out eight broad areas for future research, providing a roadmap for future students. Areas of potential future research range from the medical treatment of obesity to modes and intensity of physical activity and dietary considerations, to the exploration of different strategies to support physical activity. “There’s a lot the research community can take from this paper to say, what don't we have consensus on? Now there’s a consensus paper from a leading organization saying, ‘here are the gaps.’ That’s important.”