Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis

Harris, Leanne; Hamilton, Sharon; Azevedo, Liane B.; Olajide, Joan; De Brún, Caroline; Waller, Gillian; Whittaker, Vicki; Sharp, Tracey; Lean, Mike; Hankey, Catherine; Ells, Louisa

doi:10.11124/jbisrir-2016-003248

Cited by 319Dietary Effects on HealthDiet and metabolism studiesObesity, Physical Activity, Diet

Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis

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Harris, Leanne, Hamilton, Sharon, Azevedo, Liane B., Olajide, Joan, De Brún, Caroline, Waller, Gillian, Whittaker, Vicki, Sharp, Tracey +3 more·2018·JBI Database of Systematic Reviews and Implementation Reports

DOI 10.11124/jbisrir-2016-003248

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Abstract

Objective: To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment. Introduction: Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited. Inclusion criteria: This review included overweight or obese (BMI ≥25 kg/m 2 ) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment ( ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events. Methods: A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses. Results: Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (−4.14 kg; 95% CI −6.30 kg to −1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (−1.03 kg; 95% CI −2.46 kg to 0.40 kg; p = 0.156). Conclusions: Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review.

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In 3 systematic reviews and meta-analyses of time-restricted eating and/or intermittent fasting versus control, weight loss ranged from 1 to 4 kg and triglycerides decreased by 6 to 12 mg/dL.
“In 3 systematic reviews and meta-analyses conducted to evaluate the effects of time-restricted eating and/or intermittent fasting (vs control) on weight loss and cardiometabolic risk factors, weight loss ranged from 1 to 4 kg and triglycerides decreased by 6 to 12 mg/dL (70-72).”
From 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia (2021) · cites this paper as [70]
The Abstract (page unavailable) reports 4.14 kg more weight loss with intermittent energy restriction than with no treatment, supporting the weight-loss portion approximately. Table 4 and the Secondary cardio-metabolic outcomes section (pages unavailable) do not support the claimed 6–12 mg/dL triglyceride decrease: the pooled difference versus continuous energy restriction was −0.03 mmol/L and was not significant; the review also reports no significant difference versus no treatment. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Triglycerides are reduced with intermittent fasting in proportion to weight loss.
“Triglycerides are reduced with intermittent fasting in proportion to weight loss.”
From 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia (2021) · cites this paper as [70]
The Secondary cardio-metabolic outcomes section reports a small estimated triglyceride reduction with intermittent energy restriction compared with continuous energy restriction, but it was not statistically significant. The review does not establish that triglycerides fall in proportion to weight loss; it also reports no significant triglyceride difference compared with no treatment. Page numbers are unavailable in our copy. (LLM, conf=0.76)
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“…drug treatments (e.g., insulin, sulfonylurea) [108]. o Unclear if sustainable on a lifetime basis for a lifelong disease (i.e., obesity) [99]. o Most long-term evidence of ef ﬁ cacy, health bene ﬁ ts and safety are derived from animal studies [104]. o Prolonged fasting (weeks or more)…”
BackgroundInfluential
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Authors: Harris, L., Hamilton, S., Azevedo, L. B., Olajide, J., De Brún, C., Waller, G., Whittaker, V., Sharp, T., Lean, M., Hankey, C., & Ells, L.
Affiliations: University of Glasgow (GB)
Teesside University (GB)
Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom
Independent Public Health Consultant, United Kingdom
College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
Corresponding author: Hankey, Catherine
Ells, Louisa
ORCID: Harris, Leanne
Hamilton, Sharon
Azevedo, Liane B.
Waller, Gillian
Whittaker, Vicki
Ells, Louisa
Venue: JBI Database of Systematic Reviews and Implementation Reports
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2018-02
Volume: 16
Issue: 2
Pages: 507-547
ISSN: 2202-4433 (ISSN-L)
DOI: 10.11124/jbisrir-2016-003248
OpenAlex: W2915213530
Cited by: 319
References: 37
Citations by year: 2026: 14 · 2025: 27 · 2024: 54 · 2023: 54 · 2022: 47 · 2021: 50 · 2020: 43 · 2019: 20 · 2018: 9 · 2017: 1
FWCI: 4.01
Type: journal article
Language: en
Open access: green
eprints.gla.ac.uk
Licence: cc-by-sa
Locations: The JBI Database of Systematic Reviews and Implementation Reports (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
TeesRep (Teesside University) (submittedVersion, cc-by-nc-nd)
Teesside University Research Portal (Teesside University) (submittedVersion, cc-by-nc-nd)
International Journal of Evidence-Based Healthcare
Funders: Medical Research Council (MR/K02325X/1)
Topics: Health Sciences › Medicine › Physiology › Dietary Effects on Health
Health Sciences › Medicine › Physiology › Diet and metabolism studies
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords: intermittent fasting, intermittent energy restriction, alternate-day fasting, obesity treatment, overweight, weight loss, body weight, body mass index, waist circumference, fat mass, cardiometabolic outcomes, blood glucose, insulin, lipoprotein profile, blood pressure, continuous energy restriction, lifestyle intervention, adverse events, quality of life, physical activity, dietary adherence, adults, usual care
MeSH terms: Adult, Diet, Reducing, Fasting, Female, Humans, Male, Obesity, Weight Loss, Treatment Outcome, Overweight

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Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis

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