Overweight and obesity are considered chronic non-communicable diseases by the World Health Organization (WHO). In the last decades, like a real pandemic, these diseases have increased exponentially and today affect around 37% of women and 38% of men worldwide (these figures are even higher in developed countries). This is due to high sedentary behaviors, a lack of enough physical activity and a diet too rich in calories. Obesity predisposes to many cardiometabolic problems such as insulin resistance, type 2 diabetes, metabolic syndrome, cardiovascular diseases and some cancers.
It is now established that the distribution and location of body fat in the body is more important in terms of health than the amount of body fat itself. Thus, the visceral fat mass (fat mass located mainly in the abdomen and around the organs) represents a significant danger to the metabolism. The abnormal accumulation of fat mass (ectopic) in the viscera is usually accompanied by serious metabolic changes (chronic inflammation, oxidative stress, etc.) that are detrimental to the normal functioning of the body. Fortunately, to eliminate the visceral adipose tissue and with it, the related health problems, there are various methods including lifestyle modification (diet and physical activity) and drugs. But comparatively, what is the actual impact of these two methods on visceral fat loss ?
To answer this question, an international team of researchers conducted a meta-analysis, that is an analysis gathering the results of several studies on a specific topic, comparing the effects of a pharmaceutical intervention with some drugs (Liraglutide, Orlistat , Rimonabant, Gemfibrozil, Metformin, Rosuvastatin, and Empagliflozin Ezetimibe) and those of physical exercise (endurance, endurance and resistance training or resistance training) mainly on the loss of visceral fat, and incidentally on the loss of subcutaneous fat and weight loss. To be included in the selection of this meta-analysis, the selected studies should be 1) randomized controlled trials; 2) that the measurement of the visceral adipose tissue area is an objective of the study and that it be measured via tomography or MRI; 3) that the intervention duration of the study be at least 6 months; 4) that physical exercise be supervised; 5) that the drugs used in the studies are or have been approved by the US Food & Drug Administration. A total of 17 studies, 3602 participants, were included in the meta-analysis (12 with exercise and 6 with medication, one study was in both groups).
The main results of this meta-analysis show that both types of intervention (physical exercise and drugs) can significantly reduce visceral fat. However, the results show that the impact of physical exercise on visceral fat is greater than that of drugs (SMD: -0.54 vs. -0.27), compared to control groups. It should be noted that studies using endurance have observed superior results on the decrease in visceral fat (-16.5 cm²) compared to training combining endurance and resistance training (-14 cm²) and resistance training alone ( 12.2 cm²). In addition, exercise and medication reduce subcutaneous fat, body mass and body mass index.
Nevertheless, the researchers also found that the average absolute reduction in visceral fat was greater in trials with pharmacological interventions than in those with exercise (-23.9 vs. -15.3 cm²). However, in studies with pharmacological treatment, the experimental group and the control group both adhered to a diet with calorie restriction because drugs were considered for approval as adjunctive therapies to diet. This explains the greater loss of visceral fat in these studies.
Finally, the average dropout rate under both conditions was 17.9% for exercise and 12% for people on drugs. It shows that adherence to exercise is not so bad, although it is always more difficult for some people to find motivation to exercise than to take a pill.
This meta-analysis is the first to consider only randomized controlled trials conducted over a period of more than 6 months. And the results show that the effectiveness of physical exercise to reduce visceral fat is greater than that of pharmacological interventions. However, due to a lack of common data in the different studies used, this meta-analysis could not demonstrate the effect of these different interventions on participants' health.
However, it is recognized that physical exercise coupled with a healthy diet and whose quantities would be adapted according to the needs will allow even better results on the loss of body fat and of visceral fat mass in particular. Visceral fat loss in itself improves certain metabolic factors such as insulin sensitivity, reduction of chronic inflammation, etc., but physical exercise allows many other benefits (better cardiovascular and muscular endurance, greater muscular strength, improvement of many physiological systems, etc.) that no drug therapy could provide. In addition, the much lower cost of exercising to that of a pharmacological intervention is a definite advantage for the public health finances worldwide.
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