Interpretation of the American College of Sports Medicine Consensus Statement on Physical Activity and Excess Body Weight and Adiposity in Adults

YING Zhang¹, Ziyu YANG¹, Lidi LIU², Xiaoyang LIAO¹, Yu JIA¹, Can SHEN¹, Rong YANG¹

¹ General Practice Medical Center/Day Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
² General Practice Medical Center, West China Hospital of Sichuan University, Chengdu 610041, China

Corresponding authors: Ziyu YANG, Attending physician; E-mail: 1206551668@qq.com; Lidi LIU, Attending physician; E-mail: 1661824860@qq.com

Abstract

Excess body weight and adiposity are closely related to the pathogenesis of various chronic diseases. To address this health crisis, the American College of Sports Medicine (ACSM) released the "Consensus Statement on Physical Activity and Excess Body Weight and Adiposity for Adults" in 2024, advocating for the integration of physical activity into medical treatment for overweight and obesity when clinically appropriate, and providing guidance on its application. The consensus specifically highlights: (1) For weight loss and prevention of weight gain, at least 150 minutes per week of moderate-intensity physical activity may yield the most significant effects; (2) High-intensity interval training is not superior to moderate-to-high-intensity continuous training for weight regulation; (3) Low-intensity physical activity can serve as an alternative provided energy expenditure is maintained; and (4) Various exercise modalities are equivalent for weight management, though multimodal physical activity is recommended to achieve overall health benefits beyond weight control and fat loss. This consensus emphasizes the critical role of physical activity in the prevention, treatment, and management of overweight and obesity. This guideline interpretation aims to analyze the core points of the consensus statement, provide new recommendations for preventing and treating overweight/obesity through physical activity in China, and help primary care physicians manage overweight/obese patients more effectively.

Keywords: Overweight; Obesity; Physical activity; Exercise modality; Exercise intensity; American College of Sports Medicine; Guideline interpretation

1. Definitions of Overweight and Obesity

The WHO defines obesity as excessive or abnormal fat accumulation that impairs health, while the U.S. Centers for Disease Control defines overweight/obesity as body weight exceeding the healthy range for a given height. Both institutions use BMI for further classification: 25.0–29.9 kg/m² for overweight and ≥30.0 kg/m² for obesity [1]. In China, considering population characteristics, BMI 24.0–27.9 kg/m² is defined as overweight and BMI ≥28.0 kg/m² as obesity [2]. ACSM supports using BMI as an initial screening tool for potential overweight or obesity, though waist circumference may also be needed to assess abdominal obesity and body composition, including total and regional adiposity and lean mass components such as bone, muscle, and specific organ mass (e.g., liver, heart) [5]. Body composition measurements are warranted when BMI may not accurately reflect health status or when concerns exist about lean mass or muscle loss due to obesity treatment.

2. Clinical Medical Interventions for Overweight and Obesity

2.1 Pharmacotherapy

Pharmacotherapy primarily mimics nutrient-stimulated hormones (NuSH) that act on receptors for glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). These NuSH-based therapies can reduce appetite, increase satiety, and slow gastric emptying to facilitate weight loss. Selective GLP-1 receptor agonists such as semaglutide and dual GIP/GLP-1 receptor agonists like tirzepatide have proven highly effective for weight reduction [6]. However, a potential concern is excessive loss of lean mass [7], which may negatively impact energy expenditure, musculoskeletal health, and other health outcomes [8]. Most studies on anti-obesity medications have not yet reported data on body composition changes.

Physical activity helps prevent weight and fat gain and reduces the progression of obesity-related health problems. Increased physical activity leads to greater weight loss and fat reduction in a dose-response relationship. When physical activity is combined with energy-restricted diets, weight loss is approximately 20% greater than with diet alone, with more pronounced effects as activity increases, though the impact may diminish with more severe dietary energy restriction [14]. Even without weight or fat loss, physical activity provides other health benefits for overweight and obese patients, such as reduced risks of cardiovascular disease, diabetes, and cancer [14].

2.2 Metabolic/Bariatric Surgery

Current guidelines recommend that all individuals with BMI ≥35 kg/m² should consider metabolic and bariatric surgery, as should those with BMI ≥30 kg/m² and metabolic diseases such as type 2 diabetes; for Asian populations, the threshold is BMI ≥27.5 kg/m² [9]. The European Association for the Study of Obesity concluded that aerobic exercise, resistance training, or combined exercise after metabolic/bariatric surgery can produce an additional 2.5 kg weight loss [10] and prevent declines in muscle strength, though resistance training's effect on preserving lean mass has only been observed in younger individuals [11]. Supervised aerobic activity significantly improves cardiorespiratory fitness, insulin sensitivity, and glucose effectiveness compared to unsupervised activity after metabolic/bariatric surgery [12]. Therefore, beyond considering physical activity's impact on body weight, its effects on other health-related benefits should be considered in the context of metabolic/bariatric surgery.

The consensus statement notes that anti-obesity medications and metabolic/bariatric surgery are effective treatments for overweight/obesity and related health conditions (e.g., cardiovascular disease, diabetes). Consistent with previous ACSM position statements, these interventions should be combined with dietary and physical activity behaviors tailored to individual needs, including both aerobic and resistance exercise. This combination improves cardiorespiratory fitness, muscle strength and function, and muscle mass while potentially mitigating lean mass and muscle loss during weight reduction. Long-term adherence to physical activity is necessary to maintain these benefits.

3. Preventive and Therapeutic Effects of Physical Activity on Overweight/Obesity

Physical activity helps prevent weight and fat gain and reduces the progression of obesity-related health problems. The consensus indicates that gradually increasing physical activity in an appropriate manner to achieve at least 150 minutes per week of moderate-intensity physical activity, or an equivalent dose across different intensities, may yield the most significant effects [13]. Physical activity without concurrent energy-restricted diets typically produces modest weight loss of 0.5–3.0 kg. Certain forms of physical activity may reduce visceral fat and increase muscle mass, with most evidence coming from aerobic and resistance exercise. Even without weight or fat loss, physical activity provides other health benefits for overweight and obese patients, such as reduced risks of cardiovascular disease, diabetes, and cancer [14].

Performing 200–300 minutes per week or ≥2,000 kcal/week of leisure-time physical activity helps achieve more substantial long-term weight loss. This dosage was initially recommended by ACSM and is supported by other clinical and public health guidelines [14]. However, one study found that prescribing 250 minutes/week of unsupervised physical activity in a comprehensive behavioral weight-loss program did not produce significantly greater weight loss than prescribing 150 minutes/week [15]. Therefore, initial physical activity goals can be set to gradually increase to 150 minutes/week of moderate-to-vigorous activity, with increases to higher doses as needed for better weight regulation and additional health benefits not achieved with lower doses.

Individual responses to exercise and physical activity vary, with significant inter-individual differences in the magnitude of weight change [16]. This suggests that personalized recommendations for structured exercise and physical activity may be necessary, and relevant influencing factors must be identified to inform better personalization. Another consideration is the potential impact of sedentary behavior on weight status and weight loss. ACSM's 2019 statement on sedentary behavior concluded that sedentary behavior is not associated with weight status. One study combining dietary changes with physical activity reported that changes in sedentary behavior did not predict weight loss, whereas increases in low-intensity and moderate-to-vigorous physical activity did [17].

Emerging research areas include the relationship between total energy expenditure from moderate-to-vigorous physical activity and lower body weight/fat mass, regardless of bout duration. A cross-sectional study showed that at least 150 minutes/week of moderate-to-vigorous activity, regardless of bout length, modestly reduced body weight, BMI, and waist circumference, but decreased body fat percentage required bouts lasting at least 10 minutes [18]. Whether accumulating activity bouts shorter than 10 minutes is effective for weight and obesity changes, compared to longer bouts with equal energy expenditure, remains unclear. Another emerging area is the relationship between timing of physical activity and weight/fat measures. Consistent daily activity patterns help maintain participation, though data on whether time of day affects weight and fat are limited and inconsistent. Some studies suggest afternoon activity is more effective, others favor morning exercise, and some show no difference [19]. A 15-week pilot study found similar weight loss between morning and evening exercise, though consistent daily timing, especially in the morning, may be important for maintaining participation after weight loss [20]. For individuals, optimal exercise timing may require considering health benefits alongside factors affecting participation such as occupational and family responsibilities.

4. Considerations for Physical Activity Intensity and Mode

Most studies have reported effects of moderate-to-vigorous physical activity on weight regulation, including preventing weight gain, promoting weight loss, and maintaining weight reduction. Although less studied, emerging evidence suggests low-intensity physical activity may also have potential benefits for weight regulation. High-intensity interval training (HIIT) offers another approach, but studies show it is not superior to continuous moderate-intensity activity for weight or body composition changes [21]. However, HIIT may be an option when no contraindications exist and individuals prefer it. For those unable to perform moderate or vigorous activity or with contraindications, low-intensity physical activity is a feasible alternative that can increase energy expenditure, though longer durations are needed to match the energy expenditure of moderate-to-vigorous activity. The specific dosage of low-intensity activity effective for weight regulation and obesity treatment remains unclear.

Controversy persists regarding which physical activity mode is most effective for preventing and treating overweight and obesity. To achieve overall health benefits beyond weight control and fat loss, individuals with overweight and obesity should engage in multiple modes of physical activity rather than a single mode, including: (1) aerobic activity to maintain or improve cardiorespiratory fitness; (2) resistance exercise to potentially increase muscle mass and maintain or enhance muscle strength and function; (3) mind-body exercises such as yoga to improve mobility and balance, enhance kinesthetic awareness, and influence other aspects contributing to overall health and well-being; and (4) balance training to adapt to changes in weight distribution, facilitate safe movement, and prevent falls. The theoretical framework for how different activity modes contribute to body composition, fitness components, and health within weight regulation approaches is shown in Figure 1 [FIGURE:1].

5. Dietary Intervention Recommendations

The consensus statement emphasizes that dietary intervention is crucial for weight management. Portion control strategies help prevent weight gain and may achieve weight loss through reduced energy intake. Increasing portion size at a single meal raises daily caloric intake [22], with doubled portions increasing single-meal calories by 35%. Reducing portion sizes decreases energy intake, with smaller portions reducing weight gain by approximately 0.6 kg compared to larger portions [23]. Clinical guidelines recommend reducing daily intake by 500–1,000 kcal combined with exercise to achieve 0.45–0.90 kg/week weight loss, though actual results often fall below expectations [24].

Research shows that for individuals with BMI >30 kg/m², intermittent fasting (whether time-restricted or alternate-day fasting) does not demonstrate superior weight loss compared to low-calorie diets [25], though combining exercise during fasting periods may enhance improvements in cardiometabolic markers (e.g., lipids, inflammation) and liver health, with caution needed for hypoglycemia risk. Different dietary patterns (e.g., ketogenic diet) can achieve weight loss but show no difference in lean mass preservation, and single-food interventions have limited effects [26].

Future challenges in dietary intervention for weight management include: mechanistic research to reveal physiological and neural mechanisms (e.g., appetite hormones, food reward systems) underlying energy compensation from exercise and diet; technological innovation to develop dynamic monitoring tools (e.g., wearable devices + artificial intelligence) for real-time feedback on intake and expenditure to optimize interventions; and policy advocacy to promote reduced default portion sizes by the food industry and strengthen institutionalized multidisciplinary collaboration in weight management. Future research must address individualization, multidisciplinary integration, and long-term maintenance to achieve more effective weight management.

6. Regulation of Physical Activity on Energy Intake and Eating Behavior

Research indicates that exercise-induced weight loss is typically less than expected based on objectively measured exercise energy expenditure, with changes in energy intake considered the primary pathway compensating for the exercise-induced energy deficit. Regarding acute exercise effects, a single bout of aerobic exercise does not increase hunger or energy intake within 24 hours [27], and high-intensity exercise (>70% VO₂max) temporarily suppresses post-exercise hunger, though hunger changes synchronize with gastrointestinal hormone concentrations [28]. Exercise intensity, duration, sex, and obesity status may modulate appetite responses but do not significantly affect acute energy intake compensation. Regarding medium-to-long-term effects, after 7–14 days of intervention, energy intake begins to match increased exercise energy expenditure, with approximately 30% of exercise-induced energy expenditure compensated by increased energy intake [29]. Long-term exercise training studies show similar partial compensation.

Notably, exercise training's effects on appetite regulation are complex and show significant individual variation, potentially increasing fasting hunger while enhancing postprandial satiety and improving food reward responses and eating behavior traits (especially during weight loss) to offset compensation [30]. Habitually highly active individuals may exist in an appetite "regulated zone" with enhanced appetite control sensitivity, coupling energy intake and expenditure more tightly.

The main challenges for exercise-induced weight loss involve energy compensation mechanisms, individual variation, and appetite regulation complexity. Future research must explore how to optimize exercise protocols to maximize weight loss effects.

7. Population and Individual-Specific Considerations

Overweight and obesity have become public health issues affecting diverse populations across life stages (children, adolescents, young adults, middle-aged, older adults), biological sex and gender identity, race, ethnicity, and socioeconomic strata [31], and also affect individuals with physical disabilities, mobility limitations, or intellectual and developmental disabilities, with geographic factors (e.g., urban-rural differences) potentially exacerbating the problem [32]. Physical activity has positive effects on weight regulation and health outcomes for all populations, but sustainable exercise protocols must be tailored to group characteristics. The consensus statement emphasizes that healthcare providers must recognize how social determinants of health influence obesity and exercise opportunities, incorporating individual identity characteristics (e.g., age, developmental stage, gender identity, race, socioeconomic status) into personalized interventions while addressing systemic barriers (e.g., urban-rural exercise environments, economic accessibility, cultural preferences). For individuals with physical disabilities or developmental disorders, adaptive activity programs must be provided, emphasizing functional training and professional support, with cost-sensitive approaches to ensure facility accessibility [25]. Additionally, healthcare providers should identify clinical intolerance, physiological deconditioning, or subjective tolerance differences that may limit exercise participation to ensure intervention safety and feasibility. Future breakthroughs are needed in precision, equity, adaptability, and interdisciplinary integration to achieve more effective obesity prevention and treatment.

The consensus encourages using self-monitoring technologies (apps, smartwatches) that are engaging and provide relevant feedback to raise awareness of physical activity and dietary behaviors. Group dynamics, role modeling, and peer leadership can also promote and maintain physical activity, with new evidence showing group-based weight-loss treatment programs yield better outcomes. Since emotional experiences may be significant barriers to physical activity participation for overweight/obese populations, strategies should address potential influencing factors, including reconsidering physical and social environments. These strategies should be inclusive, recommending non-weight-bearing activities when appropriate, promoting autonomy, incorporating gamification, avoiding stigmatizing language, and supporting realistic weight-loss expectations to prevent frustration from unrealistic goals.

8. Future Research Directions

ACSM's "Consensus Statement on Physical Activity and Excess Body Weight and Adiposity for Adults" updates previous recommendations, further emphasizing physical activity's central role in weight and body composition regulation and proposing future research directions (Table 1 [TABLE:1]) to strengthen scientific evidence for clinical and public health interventions. As the country with the largest overweight/obese population globally, and with obesity trends still rising, China must continue strengthening relevant research to provide evidence for localized obesity prevention measures toward the Healthy China 2030 goals. Existing domestic guidelines include the "Chinese Physical Activity Guidelines for Chinese Population (2021)," "Chinese Physical Activity Guidelines for Children and Adolescents," "Physical Activity Guidelines for Older Adults," and "Chinese Expert Consensus on Exercise Prescription (2023)." ACSM's advocacy for inclusive approaches to promote universal physical activity participation offers important implications for China: optimizing urban planning and public fitness facilities to provide convenient, accessible exercise environments for diverse populations, while emphasizing physical education for children and adolescents to cultivate lifelong exercise habits. In general practice, individualized exercise prescriptions can be combined with traditional Chinese fitness practices (e.g., Baduanjin, Tai Chi, square dancing) and coordinated dietary management to build a comprehensive, multi-level overweight/obesity prevention and control system tailored to Chinese populations, from clinical to community settings, preventing and controlling obesity and its complications.

Author Contributions: Ying Zhang and Ziyu Yang conceptualized the article, drafted and revised the manuscript, and take overall responsibility; Lidi Liu, Yu Jia, Can Shen, and Rong Yang provided guidance and revisions; Lidi Liu conducted feasibility analysis, participated in revisions, supervised the project, and controlled quality.

Conflict of Interest: The authors declare no conflicts of interest.

ORCID IDs:
Lidi Liu: https://orcid.org/0009-0009-8608-181X
Ziyu Yang: https://orcid.org/0000-0001-6153-5613

Table 1. Areas for Future Research in Each of the Topical Areas

Topical Area Key Research Directions Clinical interventions for overweight/obesity • Define physical activity doses (duration, frequency, intensity) that produce multiple health benefits (including weight and body composition improvements) and their combined application with anti-obesity medications or metabolic/bariatric surgery
• Investigate differential effects of combined exercise modalities with medical interventions on obesity treatment
• Examine individual variation in responses to combined exercise and weight-loss treatments
• Explore whether specific strategies are needed for anti-obesity medications or metabolic/bariatric surgery to effectively improve initial participation and long-term adherence to physical activity interventions Physical activity dose • Investigate influencing factors of different exercise modes, doses, intensities, and timing on weight, body composition, and other health outcomes in overweight/obese populations
• Conduct prospective RCTs analyzing effects of single exercise bout duration on weight, body composition, and health indicators while controlling for total energy expenditure
• Conduct prospective RCTs examining effects of exercise timing (morning vs. evening) on weight, body composition, and health indicators while controlling for total energy expenditure
• Conduct studies with supervised exercise or objective activity measurement to quantify and verify whether prescribed exercise mode, dose, intensity, bout duration, and timing are achieved Exercise intensity considerations • Investigate whether low-intensity physical activity (with equal energy expenditure) differs from moderate-to-high-intensity activity in effects on weight, body composition, and health outcomes
• Examine whether activity intensity affects exercise participation and adherence in overweight/obese populations and related individual factors (e.g., body image dissatisfaction, emotional responses)
• Investigate health and psychosocial effects of replacing sedentary time with other activity intensities (including low-intensity) and their impact on weight regulation and health benefits Exercise mode considerations • Investigate differential effects of various exercise modes (with equal energy expenditure) on weight, body composition, and health outcomes
• Compare multimodal versus single-mode exercise interventions on weight, body composition, and health outcomes
• Examine whether the sequence of adding different exercise modes in interventions differentially affects weight, body composition, and health outcomes Dietary considerations • Evaluate feasibility and effectiveness of precision nutrition by examining individual variation in weight-loss responses to different dietary interventions
• Investigate whether specific dietary patterns provide health benefits beyond weight loss and fat reduction Physical activity regulation of energy intake and eating behavior • Current research focuses on appetite effects of increased exercise, while specific appetite effects of sedentary behavior and experimental activity restriction remain poorly understood
• Long-term exercise training studies integrating metabolic physiological adaptations with psychological/behavioral responses are needed to understand how homeostatic and hedonic eating mechanisms and environmental factors shape compensatory eating behaviors
• Parsing individual variation in exercise-induced appetite responses and weight-loss sensitivity remains central to developing compensatory eating interventions, requiring study designs and statistical methods that distinguish between- and within-individual variation and assess reproducibility and plasticity of such variation Population and individual-specific considerations • Optimize exercise dose, intensity, and mode for populations and individuals to improve effectiveness for weight regulation, obesity treatment, and obesity-related disease management
• Identify factors causing participation differences across populations and individuals to develop targeted, inclusive intervention strategies
• Reveal biological, behavioral, and environmental factors underlying heterogeneous intervention responses at population and individual levels, affecting weight regulation, obesity treatment, and disease management Strategies to promote physical activity participation and maintenance • Explore intervention pathways to improve affective exercise experiences in overweight/obese populations, including: modifying exercise formats (non-weight-bearing, interval training, self-selected intensity, size-adapted equipment); changing cognitive appraisal (gamification, autonomy support); optimizing physical (temperature/humidity) and social environments (social support, reducing psychological threat)
• Investigate how psychosocial factors (e.g., body image dissatisfaction, affective responses to intensity) influence exercise prescription to reduce sedentary time and improve health through personalized programs
• Conduct prospective studies evaluating effective strategies for promoting participation and maintenance (digital tools, behavioral tracking, interpersonal support, medical follow-up, professional guidance), analyzing mechanisms for reducing sedentary behavior

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Received: May 21, 2025; Revised: June 27, 2025
Edited by: Lin Zou