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Research ArticleResearch

Intermittent fasting and weight loss

Systematic review

Stephanie Welton, Robert Minty, Teresa O’Driscoll, Hannah Willms, Denise Poirier, Sharen Madden and Len Kelly
Canadian Family Physician February 2020, 66 (2) 117-125;
Stephanie Welton
Researcher for the Anishinaabe Bimaadiziwin Research Program in Sioux Lookout, Ont.
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Robert Minty
Family physician practising at the Sioux Lookout Meno Ya Win Health Centre and Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine.
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Teresa O’Driscoll
Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine in Sioux Lookout.
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Hannah Willms
Research assistant in the Anishinaabe Bimaadiziwin Research Program.
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Denise Poirier
Primary care nurse at the Hugh Allan Clinic in Sioux Lookout.
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Sharen Madden
Associate Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine in Sioux Lookout.
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Len Kelly
Research consultant for the Sioux Lookout Meno Ya Win Health Centre.
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  • For correspondence: lkelly@mcmaster.ca
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    Table 1.

    Summary of IF studies: Total IF participants = 944.

    STUDY, YNPOPULATION*LEVEL OF EVIDENCEDURATIONWEIGHT LOSS, % OF BASELINE WEIGHTINTERVENTION†KEY RESULT
    Anton et al,10 201910Obese, > 65 yII4 wk2.216-h daily fast; self-reportedIF is feasible in older adults and leads to weight loss
    Antoni et al,11 201841Overweight and obeseIUntil 5% weight loss is reached5.32-d fast (25% of caloric needs) and 5-d ad libitum calorie intake vs CR; self-reported59 d to achieve 5% weight loss with IF; not statistically different in CR group (73 d)
    Arnason et al,12 201710Obese, T2DII2 wk1.418- to 20-h daily fast as a goal, but average fast was 16.8 h; 2-wk follow-up; self-reportedShort-term IF might be safe in patients with T2D and might improve glycemic control
    Bhutani et al,13 2013
    Bhutani et al,14 2013
    64ObeseI12 wk3.2Alternated 25% of caloric needs with ad libitum calorie intake vs usual diet with or without exercise; self-reportedIF in combination with exercise is more effective than either method alone
    Bowen et al,15 2018136Overweight and obeseI16 wk10.63-d fast, 3-d CR, and 1-d ad libitum intake vs CR; 8-wk maintenance; self-reportedCR combined with IF does not improve on weight loss of CR alone
    Carter et al,16 201651Obese, T2DI12 wk5.92-d fast (1670 to 2500 kJ/d) and 5-d usual diet vs CR; self-reportedIF is a viable alternative to CR for weight loss and glycemic control in T2D
    Carter et al,17 2018
    Carter et al,18 2019
    137Obese, T2DI52 wk6.82-d fast (25% of usual calorie intake) and 5-d usual diet vs CR; 1-y follow-up; self-reportedSimilar decrease in HbA1c level and weight with IF or CR; weight is stable and HbA1c level climbs in follow-up
    Catenacci et al,19 201626ObeseI8 wk8.7Alternated 0% usual calorie intake with ad libitum intake vs CR; 24-wk follow-up; monitoredIF is a safe weight-loss strategy; no increase in risk of weight regain
    Cho et al,20 201931Overweight and obeseI8 wk5.0Alternated 25% usual calorie intake with ad libitum intake vs usual diet with or without exercise; self-reportedExercise does not improve weight loss for IF alone
    Corley et al,21 201841Obese, T2DII12 wk0.82-d fast (2 small snacks, 1 light meal) and 5-d ad libitum intake; self-reportedIF safe in T2D; promotes weight loss and glycemic control
    Coutinho et al,22 201835ObeseI12 wk13.03-d fast (25% of caloric needs) and 4-d full caloric needs vs CR; self-reportedSimilar weight losses result from IF and CR
    Eshghinia and Gapparov,23 201126Obese womenII4 wk4.93-d fast (25% to 40% of usual caloric intake) and 4-d CR (10% decrease in usual caloric intake) per wk; self-reportedShort-term IF with CR is a viable weight-loss strategy in obesity
    Eshghinia and Mohammadzadeh,24 201315Obese womenII6 wk7.13-d fast (25% to 30% of caloric needs), 3-d usual diet, and 1-d ad libitum intake; self-reportedShort-term IF is a viable weight loss strategy in obesity
    Gabel et al,25 2018
    Gabel et al,26 2019
    46ObeseI12 wk3.216-h fast daily vs usual-diet historical controls; self-reportedIF leads to weight loss compared with baseline and control group
    Harvie et al,27 2011107Obese womenI24 wk7.92-d fast (very low-calorie intake) and 5-d usual diet vs CR; self-reportedIF is as effective as CR for weight loss and insulin sensitivity
    Headland et al,28 2019244ObeseI52 wk5.62-d fast (25% of usual calorie intake) and 5-d usual diet vs CR; self-reportedIF and CR have similar weight loss results at 1 y
    Hoddy et al,29 2014
    Hoddy et al,30 2015
    Hoddy et al,31 2016
    Hoddy et al,32 2016
    59ObeseI8 wk4.2Alternated daily 25% of baseline caloric needs with ad libitum caloric intake; self-reportedIF is a safe weight-loss strategy; no increased risk of disordered eating; might decrease insulin resistance
    Hutchison et al,33 201988Overweight and obese womenI8 wk4.63-d fast (32%–37% of energy requirements) and 4 d at 100% or 145% of energy requirements vs CR and control group; self-reportedCombining CR and IF is more effective for weight loss than either alone
    Kahleova et al,34 201454Obese, T2DI12 wk3.916-h daily fast vs CR; self-reportedIF is more effective than CR for weight loss and glycemic control in T2D
    Klempel et al,35 2012
    Kroeger et al,36 2012
    54Obese womenII8 wk3.41-d fast (very low-calorie intake) and 6-d CR; self-reportedIF combined with CR promotes weight loss in obese women
    Klempel et al,37 2013
    Klempel et al,38 2013
    Klempel et al,39 2013
    Varady et al,40 2015
    32Obese womenII8 wk4.5Alternated 25% of usual calorie intake with 125% of usual calorie intake; high-fat vs low-fat diet; self-reportedIF is effective for weight loss with a high-fat or low-fat diet composition
    Schübel et al,41 2018150ObeseI12 wk6.42-d fast (25% of calorie requirements) and 5-d usual diet vs CR and control group; 12-wk maintenance; 26-wk follow-up; self-reportedWeight loss and maintenance is similar in IF and CR
    Sundfør et al,42 2018112ObeseI26 wk8.42-d fast (20% of calorie requirements) and 5-d usual diet vs CR; 26-wk maintenance; self-reportedWeight loss and maintenance are similar in IF and CR
    Trepanowski et al,43 2017
    Trepanowski et al,44 2018
    Kroeger et al,45 2018
    Kalam et al,46 2019
    79ObeseI24 wk6.0Alternated 25% of usual calorie intake with 125% of usual calorie intake vs CR and control group; 24-wk follow-up; self-reportedIF promotes weight loss and weight maintenance similar to CR
    Varady et al,47 2009
    Bhutani et al,48 2010
    16ObeseII8 wk5.8Alternated 25% of energy needs with ad libitum caloric intake; self-reportedIF is a viable option for weight loss in obese individuals
    Varady et al,49 201330ObeseI12 wk6.5Alternated 25% of baseline energy needs with ad libitum caloric intake vs usual diet; monitoredIF is effective for weight loss in obese individuals
    Zuo et al,50 201640ObeseII12 wk10.01-d fast (430 kcal) and 6-d high-protein diet; 52-wk follow-up; monitoredIF with a high-protein diet is effective for weight loss, with low risk of weight regain
    • CR—calorie restriction, HbA1c—hemoglobin A1c, IF—intermittent fasting, T2D—type 2 diabetes.

    • ↵* Where sex is not specified, both men and women were enrolled.

    • ↵† Self-reported indicates participants reported consumption in food diaries; monitored indicates investigators monitored participants’ consumption.

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    Table 2.

    Outcomes of risk factors for cardiovascular disease and type 2 diabetes in 26 individual studies of 22 intermittent fasting trials enrolling obese adults without type 2 diabetes

    RISK FACTOROUTCOMENSTUDIES
    Blood pressure↔324Examined in 16 studies, with no change in 9 studies10,13,27,29,35,37,42,43,47
    ↓226Examined in 16 studies, with a decrease in 7 studies11,15,21,24,25,49,50
    Body weight↓764Decrease seen in 22 studies10,11,13,15,19,20,22–25,27–29,33,35,37,41–43,49,47,50
    BMI↓566Decrease seen in the 16 studies measuring BMI10,13,15,19,20,23–25,28,29,35,37,42,43,47,50
    Diabetes
      • Glucose level↔409Examined in 17 studies, with no change in 11 studies10,19,24,25,27,32,35,38,40,42,43
    ↓192Examined in 17 studies, with a decrease in 5 studies13,15,20,23,41
    ↑24Examined in 17 studies, with an increase in 1 study11
      • HbA1c level↓54Decrease seen in the 1 study measuring HbA1c level42
      • Insulin level↓407Decrease in 8 studies, decreasing trend in 3 of 11 studies measuring insulin level11,13,15,19,20,25,27,32,35,41,43
    • BMI—body mass index, HbA1c—hemoglobin A1c.

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    Table 3.

    Outcomes of risk factors for cardiovascular disease and type 2 diabetes in 5 intermittent fasting studies enrolling obese adults with type 2 diabetes

    RISK FACTOROUTCOMENSTUDIES
    Blood pressureNANANot studied in obese patients with type 2 diabetes
    Body weight↓174Decrease seen in all 5 studies12,16,17,21,34
    BMI↓174Decrease seen in all 5 studies12,16,17,21,34
    Diabetes
      • Glucose level↓78Decrease seen in the 3 studies measuring glucose level12,21,34
      • HbA1c level↓164Decrease seen in the 4 studies measuring HbA1c level16,17,21,34
      • Insulin level↓27Decrease seen in the 1 study measuring insulin level34
    • BMI—body mass index, HbA1c—hemoglobin A1c, NA—not available.

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Canadian Family Physician: 66 (2)
Canadian Family Physician
Vol. 66, Issue 2
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Intermittent fasting and weight loss
Stephanie Welton, Robert Minty, Teresa O’Driscoll, Hannah Willms, Denise Poirier, Sharen Madden, Len Kelly
Canadian Family Physician Feb 2020, 66 (2) 117-125;

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Stephanie Welton, Robert Minty, Teresa O’Driscoll, Hannah Willms, Denise Poirier, Sharen Madden, Len Kelly
Canadian Family Physician Feb 2020, 66 (2) 117-125;
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