Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Epidemiology and Population Health

Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: a systematic review and meta-analysis of randomized controlled trials

International Journal of Obesity volume 43, pages 2017–2027 (2019)Cite this article

Subjects

Abstract

Background

Intermittent dieting may be an alternative to continuous dieting for weight reduction.

Objective

To evaluate the effect of intermittent dieting versus continuous dieting on weight and body composition in overweight or obese adults.

Design

A systematic review and meta-analysis of randomized controlled trials (RCTs). Five databases were searched until February 2018 for RCTs comparing intermittent versus continuous dieting. Intermittent dieting consisted of two types: regular intermittent was caloric restriction interspersed with days of weight maintenance or ad libitum eating; intensified intermittent was caloric restriction interspersed with days of even lower caloric restriction. Continuous was continual caloric restriction. Primary outcomes were weight, body fat, lean mass, waist circumference, hip circumference, and energy expenditure. Data were pooled by the inverse variance method using random-effects models and expressed as mean differences (MD) and their 95% confidence intervals (CI).

Results

Nine trials met the inclusion criteria (n = 782), six comparing regular intermittent vs continuous (n = 553), and three comparing intensified intermittent vs continuous (n = 229). Populations were heterogeneous: obese only in five studies, and overweight or obese (mixed) in four studies. Lean mass was significantly lower in regular intermittent vs continuous (MD −0.86 kg; 95% CI −1.62 to −0.10; p = 0.03). No differences were found for the remaining outcomes for both comparisons (regular intermittent or intensified intermittent vs continuous). There was low heterogeneity of effects across trials. Subgroup effects by time to follow-up, gender, per-protocol versus intention-to-treat, enforced exercise, and diabetes were similar to main analyses.

Conclusions

This systematic review in obese and overweight individuals showed that regular intermittent dieting decreased lean mass compared to continuous dieting. There were no differences in effects for either intermittent vs continuous interventions across all other outcomes. In contrast to previous systematic reviews, this study suggested that lean mass is better preserved in continuous dieting compared to regular intermittent dieting.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American college of cardiology / American heart association task force on practice guidelines and the obesity society. Circulation. 2014;129(25Suppl 2):S102–38.

    Article  Google Scholar 

  2. Bangalore S, Fayyad R, Laskey R, DeMicco DA, Messerli FH, Waters DD. Body-weight fluctuations and outcomes in coronary disease. N Engl J Med. 2017;376:1332–40.

    Article  Google Scholar 

  3. Tremblay A, Royer MM, Chaput JP, Doucet E. Adaptive thermogenesis can make a difference in the ability of obese individuals to lose body weight. Int J Obes. 2013;37:759–64.

    Article  CAS  Google Scholar 

  4. Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study. Int J Obes. 2018;42:129–38.

    Article  CAS  Google Scholar 

  5. Wing RR, Blair E, Marcus M, Epstein LH, Harvey J. Year-long weight loss treatment for obese patients with type II diabetes: does including an intermittent very-low-calorie diet improve outcome? Am J Med. 1994;97:354–62.

    Article  CAS  Google Scholar 

  6. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.

    Article  Google Scholar 

  7. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  Google Scholar 

  8. Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997;50:683–91.

    Article  CAS  Google Scholar 

  9. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  10. Ash S, Reeves MM, Yeo S, Morrison G, Carey D, Capra S. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2003;27:797–802.

    Article  CAS  Google Scholar 

  11. Viegener B, Perri M, Nezu A, Renjilian D, McKelvey W, Schein R. Effects of an intermittent, low-fat, low-calorie diet in the behavioral treatment of obesity. Behav Ther. 1990;21:499–509.

    Article  Google Scholar 

  12. Harvie M, Wright C, Pegington M, McMullan D, Mitchell E, Martin B, et al. The effect of intermittent energy and carbohydrate restriction vs. daily energy restriction on weight loss and metabolic disease risk markers in overweight women. Br J Nutr. 2013;110:1534–47.

    Article  CAS  Google Scholar 

  13. Wing RR, Jeffery RW. Prescribed “breaks” as a means to disrupt weight control efforts. Obes Res. 2003;11:287–91.

    Article  Google Scholar 

  14. Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes. 2011;35:714–27.

    Article  CAS  Google Scholar 

  15. Keogh JB, Pedersen E, Petersen KS, Clifton PM. Effects of intermittent compared to continuous energy restriction on short-term weight loss and long-term weight loss maintenance. Clin Obes. 2014;4:150–6.

    Article  CAS  Google Scholar 

  16. Carter S, Clifton PM, Keogh JB. The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial. Diabetes Res Clin Pract. 2016;122:106–12.

    Article  CAS  Google Scholar 

  17. Davis CS, Clarke RE, Coulter SN, Rounsefell KN, Walker RE, Rauch CE, et al. Intermittent energy restriction and weight loss: a systematic review. Eur J Clin Nutr. 2016;70:292–9.

    Article  CAS  Google Scholar 

  18. Horne BD, Muhlestein JB, Anderson JL. Health effects of intermittent fasting: hormesis or harm? A systematic review. Am J Clin Nutr. 2015;102:464–70.

    Article  CAS  Google Scholar 

  19. Harris L, McGarty A, Hutchison L, Ells L, Hankey C. Short-term intermittent energy restriction interventions for weight management: a systematic review and meta-analysis. Obes Rev Off J Int Assoc Study Obes. 2018;19:1–13.

    Article  CAS  Google Scholar 

  20. Headland M, Clifton PM, Carter S, Keogh JB. Weight-loss outcomes: a systematic review and meta-analysis of intermittent energy restriction trials lasting a minimum of 6 months. Nutrients. 2016;8:354.

  21. Arguin H, Dionne IJ, Senechal M, Bouchard DR, Carpentier AC, Ardilouze JL, et al. Short- and long-term effects of continuous versus intermittent restrictive diet approaches on body composition and the metabolic profile in overweight and obese postmenopausal women: a pilot study. Menopause. 2012;19:870–6.

    Article  Google Scholar 

  22. Coutinho SR, Halset EH, Gasbakk S, Rehfeld JF, Kulseng B, Truby H, et al. Compensatory mechanisms activated with intermittent energy restriction: a randomized control trial. Clin Nutr. 2018;37:815–23.

    Article  Google Scholar 

  23. Lantz H, Peltonen M, Agren L, Torgerson JS. Intermittent versus on-demand use of a very low calorie diet: a randomized 2-year clinical trial. J Intern Med. 2003;253:463–71.

    Article  CAS  Google Scholar 

  24. Hill JO, Schlundt DG, Sbrocco T, Sharp T, Pope-Cordle J, Stetson B, et al. Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity. Am J Clin Nutr. 1989;50:248–54.

    Article  CAS  Google Scholar 

  25. Wadden TA, Mason G, Foster GD, Stunkard AJ, Prange AJ. Effects of a very low calorie diet on weight, thyroid hormones and mood. Int J Obes. 1990;14:249–58.

    CAS  PubMed  Google Scholar 

  26. Rossner S. Intermittent vs continuous VLCD therapy in obesity treatment. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1998;22:190–2.

    Article  CAS  Google Scholar 

Download references

Author contributions

The authors’ responsibilities were as follows—YMR, CMW, AVH: conceived, designed, and conducted the research study; MCD, TME, VP, YMR, AVH: collected and interpreted the data; MCD, TME, YMR, AVH: analyzed the data; MCD, TME, CMW, YMR, AVH: wrote the initial manuscript; and all authors: contributed toward the final manuscript.

Author information

Authors and Affiliations

  1. Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, School of Pharmacy, University of Connecticut, Storrs, CT, USA

    Yuani M. Roman, Mariah C. Dominguez, Tommy M. Easow, C. Michael White & Adrian V. Hernandez

  2. ProEd Communications, Inc, Cleveland, OH, USA

    Vinay Pasupuleti

  3. School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru

    Adrian V. Hernandez

Authors
  1. Yuani M. Roman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariah C. Dominguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tommy M. Easow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vinay Pasupuleti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Michael White
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adrian V. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrian V. Hernandez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roman, Y.M., Dominguez, M.C., Easow, T.M. et al. Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: a systematic review and meta-analysis of randomized controlled trials. Int J Obes 43, 2017–2027 (2019). https://doi.org/10.1038/s41366-018-0204-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-018-0204-0

This article is cited by

Search

Advanced search

Quick links