Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss

Corey A Rynders, Elizabeth A Thomas, Adnin Zaman, Zhaoxing Pan, Victoria A Catenacci, Edward L Melanson, Corey A Rynders, Elizabeth A Thomas, Adnin Zaman, Zhaoxing Pan, Victoria A Catenacci, Edward L Melanson

Abstract

The current obesity epidemic is staggering in terms of its magnitude and public health impact. Current guidelines recommend continuous energy restriction (CER) along with a comprehensive lifestyle intervention as the cornerstone of obesity treatment, yet this approach produces modest weight loss on average. Recently, there has been increased interest in identifying alternative dietary weight loss strategies that involve restricting energy intake to certain periods of the day or prolonging the fasting interval between meals (i.e., intermittent energy restriction, IER). These strategies include intermittent fasting (IMF; >60% energy restriction on 2-3 days per week, or on alternate days) and time-restricted feeding (TRF; limiting the daily period of food intake to 8-10 h or less on most days of the week). Here, we summarize the current evidence for IER regimens as treatments for overweight and obesity. Specifically, we review randomized trials of ≥8 weeks in duration performed in adults with overweight or obesity (BMI ≥ 25 kg/m2) in which an IER paradigm (IMF or TRF) was compared to CER, with the primary outcome being weight loss. Overall, the available evidence suggests that IER paradigms produce equivalent weight loss when compared to CER, with 9 out of 11 studies reviewed showing no differences between groups in weight or body fat loss.

Keywords: alternate day fasting; meal timing; obesity; weight loss.

Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the writing of the manuscript or in the decision to publish. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Figures

Figure 1
Figure 1
Popular variations of intermittent energy restriction. Within the circles, each ring represents a distinct 24 h day. Green shaded areas represent eating periods. Grey shaded areas indicate the sleeping time, and white circles/spaces indicate fasting periods. Intermittent fasting (IMF) is characterized by recurring periods (e.g., 16–48 h) with little or no energy intake. Many variations have been used to study the effects of IMF on body weight, including (A) alternate day fasting (zero calorie intake on fast days), (B) alternate day modified fasting (>60% energy restriction on fast days), and (C) fasting or modified fasting on two days per week (2DW). (D) Periodic fasting involves fasting for 2 to as many as 21 or more days. This IMF paradigm is acknowledged in the present review but will not be discussed as there are few studies in the literature. Time-restricted feeding (TRF) is characterized by eating patterns that are restricted to a short (<8–10 h) interval each day, such as during the (E) early or (F) middle portion of the day.
Figure 2
Figure 2
How IMF and TRF impact daily behavioral rhythms is entirely unknown, but will be important for understanding the durability of these interventions. Wearable devices such as activity monitors, light sensors, and continuous glucose monitors provide an opportunity to capture free-living behavior. Including these measures in clinical studies may help to identify phenotypes of individuals who are likely to benefit the most from fasting or timed feeding.

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