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Weighted vests as an adjunct

Intentional weight loss presents a clinical dilemma for musculoskeletal providers.

While reducing excess body weight improves overall health and decreases joint loading, it also reduces the mechanical stimulus necessary to maintain bone mass. This is particularly relevant in older adults, who are already at increased risk for osteoporosis and fragility fractures. As a result, there has been growing interest in whether weighted vests can replace some of the lost mechanical loading and help preserve skeletal health during weight reduction.

The current body of evidence suggests that weighted vests may provide a modest benefit for bone health, particularly at the hip, by partially replacing the gravitational loading lost during weight loss. Although the effect appears relatively small, it is biologically plausible and aligns with what is known about bone’s adaptive response to mechanical loading. Maintaining skeletal loading during caloric restriction may help reduce the decline in bone mineral density that often accompanies successful weight loss.

Importantly, clinicians should not expect weighted vests to improve the amount of weight lost. Across multiple investigations, participants using weighted vests achieve weight loss comparable to those following dietary interventions alone. Likewise, weighted vest use has not consistently demonstrated meaningful preservation of lean muscle mass or improvements in muscle quality. Progressive resistance training remains the most effective intervention for maintaining muscle mass and function during weight loss and should continue to be emphasized in any comprehensive weight management program.

An intriguing observation from emerging research is that individuals who used weighted vests during weight loss appeared to maintain their weight loss more successfully over time than those who did not. While the mechanism remains uncertain, improved long-term weight maintenance could represent an additional benefit worthy of further investigation.

From an orthopedic perspective, patient selection is critical. A weighted vest increases joint reaction forces throughout the lower extremity and spine, which may not be appropriate for every patient. Individuals with symptomatic hip or knee osteoarthritis, lower extremity stress injuries, spinal pathology, impaired balance, gait instability or an elevated fall risk should undergo a musculoskeletal assessment before initiating a weighted vest program. Similarly, patients with significant lower extremity pain or impaired functional mobility may tolerate additional loading poorly. The decision to use a weighted vest should therefore be individualized based on a patient’s underlying musculoskeletal health, functional status and exercise goals rather than applied as a blanket recommendation.

For orthopedic surgeons, weighted vests should be viewed as an adjunct rather than a replacement for established exercise recommendations. In appropriately selected patients, it may offer modest skeletal benefits during weight loss, but resistance training remains the cornerstone of preserving muscle mass, function and overall musculoskeletal health.

For more information:

Katherine J. Coyner, MD, MBA, FAOA, is associate professor in the department of orthopaedic surgery, sports medicine fellowship director, orthopedic team physician of the University of Connecticut Athletics and director of the Women’s Center for Motion & performance at UConn Health in Farmington, Connecticut. Coyner can be contacted at coyner@uchc.edu.

References:

• DeLong C, et al. Int J Obes (Lond). 2025;doi:10.1038/s41366-025-01795-5.
• Kelleher JL, et al. J Osteoporos Phys Act. 2017;doi:10.4172/2329-9509.1000210.
• Lynch SD, et al. J Gerontol A Biol Sci Med Sci. 2026;doi:10.1093/Gerona/glag062.
• Normandin E, et al. J Frailty Aging. 2018;doi:10.14283/jfa.2018.17.

Mixed data

The data is somewhat mixed on weighted vest use and weight loss. Given the increased caloric burn with a weighted vest, this may be a reasonable claim; however, a 2018 study did not find significant weight loss benefit of using a weighted vest when compared with not using a weighted vest. In this particular study, weight loss, fat mass, lean mass and percentage body fat were equivalent between both groups. Alternatively, a 2020 study found reduced body weight and reduced fat mass in folks using a heavier (11% of body weight) weighted vest when compared with those with lower (1% of body weight) weighted vest; however, the follow-up was very brief.

Perhaps more relevant to this particular question, a small study in 2025 found weighted vest use with caloric restriction may help to reduce weight gain for up to 2 years after the intervention when compared with caloric restriction alone. Unfortunately, this was a very small sample size, and I have not come across other studies with similar long-term follow-up.

For more information:

Sarah F. Eby, MD, PhD, is an assistant professor in physical medicine and rehabilitation at Mass General Brigham Healthcare Center in Foxborough, Massachusetts. Eby wishes to be contacted through mgbmediarelations@partners.org.

References:

• DeLong C, et al. Int J Obes (Lond). 2025;doi:10.1038/s41366-025-01795-5.
• Normandin E, et al. J Frailty Aging. 2018;doi:10.14283/jfa.2018.17.
• Ohlsson C, et al. EclinicalMedicine. 2020;doi:10.1016/j.eclinm.2020.100338.