Review | Published:

Fasting for weight loss: an effective strategy or latest dieting trend?

International Journal of Obesity volume 39, pages 727733 (2015) | Download Citation

These data were presented as part of a debate at the International Congress of Nutrition in September 2013.

Abstract

With the increasing obesity epidemic comes the search for effective dietary approaches for calorie restriction and weight loss. Here I examine whether fasting is the latest ‘fad diet’ as portrayed in popular media and discuss whether it is a safe and effective approach or whether it is an idiosyncratic diet trend that promotes short-term weight loss, with no concern for long-term weight maintenance. Fasting has long been used under historical and experimental conditions and has recently been popularised by ‘intermittent fasting’ or ‘modified fasting’ regimes, in which a very low-calorie allowance is allowed, on alternate days (ADF) or 2 days a week (5:2 diet), where ‘normal’ eating is resumed on non-diet days. It is a simple concept, which makes it easy to follow with no difficult calorie counting every other day. This approach does seem to promote weight loss, but is linked to hunger, which can be a limiting factor for maintaining food restriction. The potential health benefits of fasting can be related to both the acute food restriction and chronic influence of weight loss; the long-term effect of chronic food restriction in humans is not yet clear, but may be a potentially interesting future dietary strategy for longevity, particularly given the overweight epidemic. One approach does not fit all in the quest to achieve body weight control, but this could be a dietary strategy for consideration. With the obesity epidemic comes the search for dietary strategies to (i) prevent weight gain, (ii) promote weight loss and (iii) prevent weight regain. With over half of the population of the United Kingdom and other developed countries being collectively overweight or obese, there is considerable pressure to achieve these goals, from both a public health and a clinical perspective. Certainly not one dietary approach will solve these complex problems. Although there is some long-term success with gastric surgical options for morbid obesity, there is still a requirement for dietary approaches for weight management for the overweight and obese population, particularly as invasive interventions carry post-operative risk of death due to complications. Effective dietary interventions are required that promote long-term adherence and sustained beneficial effects on metabolic and disease markers. In general, such interventions need to be palatable and satiating, meet minimal nutritional requirements, promote loss of fat and preserve lean body mass, ensure long-term safety, be simple to administer and monitor and have widespread public health utility. Intermittent fasting or alternate day fasting may be an option for achieving weight loss and maintenance.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , . Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 2013; 97: 505–516.

  2. 2.

    . Safety and efficacy of high-protein diets for weight loss. Proc Nutr Soc 2012; 71: 339–349.

  3. 3.

    , , , , , et al. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr 2012; 66: 780–788.

  4. 4.

    , , . Long term weight maintenance after advice to consume low carbohydrate, higher protein diets - a systematic review and meta analysis. Nutr Metab Cardiovasc Dis 2013; 24: 224–235.

  5. 5.

    , , , , , et al. High-protein, reduced-carbohydrate weight-loss diets promote metabolite profiles likely to be detrimental to colonic health. Am J Clin Nutr 2011; 93: 1062–1072.

  6. 6.

    . Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219–234.

  7. 7.

    , , , , , et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307: 56–65.

  8. 8.

    . Effect of starvation and very low calorie diets on protein-energy interrelationships in lean and obese subjects. In: Scrimshaw N, Schurch B (eds) Protein-Energy Interactions. International Dietary Energy Consultancy Group, Proceedings of an IDECG workshop. Nestle Foundation: Lausanne, 1991; 249–284.

  9. 9.

    , . Calorie Deficiencies and Protein Deficiencies. Churchill: London, UK, 1951.

  10. 10.

    , , , , . Food restriction and binge eating: A study of former prisoners of war. J Ab Psych 1994; 103: 409–411.

  11. 11.

    . Psychological Consequences of Food Restriction. J Am Diet Ass 1996; 96: 589–592.

  12. 12.

    , , , , . The Biology of Human Starvation. The University of Minnesota Press, North Central Publishing: Minneapolis, MN, USA, 1950.

  13. 13.

    , , . Food intake during and outside Ramadan. East Mediterr Health J 2003; 9: 131–140.

  14. 14.

    , , , , , et al. Food intake, and anthropometrical and biological parameters in adult Tunisians during fasting at Ramadan. East Mediterr Health J 2002; 8: 603–611.

  15. 15.

    , , , , . Appetite changes under free-living conditions during Ramadan fasting. Appetite 1998; 31: 159–170.

  16. 16.

    , . Features of a successful therapeutic fast of 382 days duration. Postgrad Med J 1973; 49: 203–209.

  17. 17.

    . Chemical and Physiological Studies of a Man Fasting Thirtyone Days. Proc Natl Acad Sci USA 1915; 1: 228–231.

  18. 18.

    . Fasting as an introduction to the treatment of obesity. Metabolism 1959; 8: 214–220.

  19. 19.

    , , , . Correction and control of intractable obesity. Practicable application of intermittent periods of total fasting. JAMA 1962; 181: 309–312.

  20. 20.

    , , . Prolonged starvation as treatment for severe obesity. JAMA 1964; 187: 140.

  21. 21.

    . Starvation in man. N Engl J Med 1970; 282: 668–675.

  22. 22.

    , , . Very low calorie diets: their efficacy, safety, and future. Ann Intern Med 1983; 99: 675–684.

  23. 23.

    , , . Hunger during total starvation. Lancet 1966; 1: 1343–1344.

  24. 24.

    , , , , . Metabolic balance of obese subjects during fasting. Arch Intern Med 1966; 118: 3–8.

  25. 25.

    , , , . Hunger/craving responses and reactivity to food stimuli during fasting and dieting. Int J Obes 1990; 14: 679–688.

  26. 26.

    , , . Is dieting good for you?: Prevalence, duration and associated weight and behaviour changes for specific weight loss strategies over four years in US adults. Int J Obes Relat Metab Disord 1999; 23: 320–327.

  27. 27.

    , , , , , et al. Effect of an acute fast on energy compensation and feeding behaviour in lean men and women. Int J Obes Relat Metab Disord 2002; 26: 1623–1628.

  28. 28.

    , , , , , et al. Effect of intermittent fasting and refeeding on insulin action in healthy men. J Appl Physiol (1985) 2005; 99: 2128–2136.

  29. 29.

    , , , , . Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism. Am J Clin Nutr 2005; 81: 69–73.

  30. 30.

    , , , . Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults. Am J Clin Nutr 2009; 90: 1138–1143.

  31. 31.

    , , . Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet. Metabolism 2013; 62: 137–143.

  32. 32.

    , , , , . Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans. Obesity 2013; 21: 1370–1379.

  33. 33.

    , , , , , et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J 2013; 12: 146.

  34. 34.

    . Fasting - the ultimate diet? Obes Rev 2007; 8: 211–222.

  35. 35.

    , , . Obesity, inflammation, and insulin resistance. Gastroenterology 2007; 132: 2169–2180.

  36. 36.

    , , , . The obesity-cancer link: lessons learned from a fatless mouse. Cancer Res 2007; 67: 2391–2393.

  37. 37.

    . Adipose tissue as an endocrine organ. Obesity 2006; 14: S242–S249.

  38. 38.

    , . Minireview: the role of oxidative stress in relation to caloric restriction and longevity. Endocrinology 2005; 146: 3713–3717.

  39. 39.

    . Adipocyte-derived hormones, cytokines, and mediators. Endocrine 2006; 29: 81–90.

  40. 40.

    , . Aging, adiposity, and calorie restriction. JAMA 2007; 297: 986–994.

  41. 41.

    , , , , . Calorie restriction, aging, and cancer prevention: mechanisms of action and applicability to humans. Annu Rev Med 2003; 54: 131–152.

  42. 42.

    , . Alternate-day fasting and chronic disease prevention :a review of human and animal trials. Am J Clin Nutr 2007; 86: 7–13.

  43. 43.

    , , . Dose effects of modified alternate-day fasting regimens on in vivo cell proliferation and plasma insulin-like growth factor-1 in mice. J Appl Physiol 2007; 103: 547–551.

  44. 44.

    , , , , . Effects of modified alternate-day fasting regimens on adipocyte size, triglyceride metabolism and plasma adiponectin levels in mice. J Lipid Res 2007; 48: 2212–2219.

  45. 45.

    , , , , . Dietary and physical activity adaptations to alternate day modified fasting: implications for optimal weight loss. Nutr J 2010; 9: 35.

  46. 46.

    , , , . Mitochondrial production of reactive oxygen species and incidence of age-associated lymphoma in OF1 mice: effect of alternate-day fasting. Mech Ageing Dev 2005; 126: 1185–1191.

  47. 47.

    , , . Evolution, stress, and longevity. J Anat 2000; 197: 587–590.

  48. 48.

    , . Do calorie restriction or alternate-day fasting regimens modulate adipose tissue physiology in a way that reduces chronic disease risk? Nutr Rev 2008; 66: 333–342.

  49. 49.

    . What you should know about calorie restriction. J Am Dietet Assoc 2004; 104: 1524–1525.

  50. 50.

    , . Can dietary restriction increase longevity in all species, particularly in human beings? Introduction to a debate among experts. Biogerontol 2006; 7: 123–125.

  51. 51.

    , , . The effect on health of alternate day calorie restriction; Eating less and more than needed on alternate days prolongs life. Med Hypotheses 2006; 67: 209–211.

  52. 52.

    , , , , , et al. 'Bone mineral density response to caloric restriction-induced weight loss or exercise-induced weight loss: a randomized controlled trial". Arch Int Med 2006; 166: 2502–2510.

  53. 53.

    , , . What are the roles of calorie restriction and diet quality in promoting healthy longevity? Ageing Res Rev 2014; 13C: 38–45.

Download references

Acknowledgements

Financial Support: We gratefully acknowledge support from the Scottish Government Rural and Environment Science and Analysis Service.

Author information

Affiliations

  1. University of Aberdeen Rowett Institute of Nutrition and Health, Abrdeen, Scotland, UK

    • A Johnstone

Authors

  1. Search for A Johnstone in:

Competing interests

AMJ is a consultant for the food industry retail sector and conducted contract research for food industry partners.

Corresponding author

Correspondence to A Johnstone.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/ijo.2014.214