Effects of Diet, Exercise, and Electrical Muscle Stimulation in Overweight and Obese Women

This randomized controlled study included 75 women aged 19-45 years with overweight or obesity (BMI ≥25 kg/m²). Eligible participants were randomly assigned to three intervention groups, with 25 participants in each group.

All participants received an individualized energy-restricted dietary program designed to provide an energy deficit of approximately 500 kcal/day. The dietary plans provided approximately 55-60% of total energy from carbohydrates, 12-15% from protein, and 25-30% from fat, with a target dietary fiber intake of 25-30 g/day. Participants attended weekly follow-up visits throughout the intervention.

Participants in the Diet Group received the individualized dietary intervention alone. Participants in the Diet + Exercise Group received the same dietary intervention and were instructed to perform at least 30 minutes of moderate-intensity walking daily throughout the six-week intervention. Participants in the Diet + EMS Group received the dietary intervention together with localized abdominal electrical muscle stimulation. EMS was administered twice weekly on non-consecutive days for six weeks, for a total of 12 sessions. Each EMS session lasted approximately 25 minutes.

Anthropometric assessments included body weight, BMI, waist circumference, hip circumference, neck circumference, mid-upper arm circumference, body fat percentage, fat mass, and fat-free mass. Selected biochemical parameters were assessed using fasting blood samples. Appetite-related outcomes, including hunger, satiety, and desire to eat, were evaluated using a Visual Analog Scale (VAS).

Measurements were obtained at baseline and after completion of the six-week intervention. The primary objective was to compare changes in anthropometric outcomes among the three intervention groups. Additional evaluations examined changes in biochemical parameters and subjective appetite-related outcomes.

Inclusion criteria

• Female participants aged 19-45 years
• Body mass index (BMI) ≥25.0 kg/m²
• No more than a 5% change in body weight during the previous 3 months
• Premenopausal
• Not participating in a regular exercise program
• Applying to the center for weight management
• Willing to participate and providing written informed consent

Exclusion criteria

• History of thrombosis or active thrombotic risk
• Diagnosed hypertension
• Pregnancy or lactation
• Epilepsy
• History of abdominal, gastric, or inguinal hernia
• Cardiac pacemaker or other implanted electronic device
• Metallic prostheses or large implants
• Bariatric surgery within the previous 6 months
• Use of pharmacological treatments that could affect weight loss, including GLP-1 receptor agonists or corticosteroids
• Diabetes mellitus
• Malignancy
• Advanced renal or hepatic disease
• Any medical condition contraindicating EMS application