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.

  • Article
  • Published:

Clinical Research

Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults

International Journal of Obesity volume 43, pages 2028–2036 (2019)Cite this article

Subjects

A Correction to this article was published on 06 March 2019

This article has been updated

Abstract

Background and Objective

Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight loss. There are few long-term trials comparing efficacy of these methods. The objective was to compare the effects of CER to two forms of IER; a week-on-week-off energy restriction and a 5:2 program, during which participants restricted their energy intake severely for 2 days and ate as usual for 5 days, on weight loss, body composition, blood lipids, and glucose.

Subjects and Methods

A one-year randomized parallel trial was conducted at the University of South Australia, Adelaide, Australia. Participants were 332 overweight and obese adults, ages 18–72 years, who were randomized to 1 of 3 groups: CER (4200 kJ/day for women and 5040 kJ/day for men), week-on-week-off energy restriction (alternating between the same energy restriction as the continuous group for one week and one week of habitual diet), or 5:2 (2100 kJ/day on modified fast days each week for women and 2520 kJ/day for men, the 2 days of energy restriction could be consecutive or non-consecutive). Primary outcome was weight loss, and secondary outcomes were changes in body composition, blood lipids, and glucose.

Results

For the 146 individuals who completed the study (124 female, 22 male, mean BMI 33 kg/m2) mean weight loss, and body fat loss at 12 months was similar in the three intervention groups, −6.6 kg for CER, −5.1 kg for the week-on, week-off and −5.0 kg for 5:2 (p = 0.2 time by diet). Discontinuation rates were not different (p = 0.4). HDL-cholesterol rose (7%) and triglycerides decreased (13%) at 12 months with no differences between groups. No changes were seen for fasting glucose or LDL-cholesterol.

Discussion and Conclusion

The two forms of IER were not statistically different for weight loss, body composition, and cardiometabolic risk factors compared to CER.

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

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

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

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

  • 06 March 2019

    Table 4 is still missing from both versions. It was labeled Table 3 in the first version but a reviewer wanted an extra table in the methods which became Table 1.

References

  1. World Health Organization. Obesity and overweight World Health Organization. 2015. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 1 April 2015.

  2. Scherer PE, Hill AJ. Obesity, diabetes, and cardiovascular diseases: a compendium. Circ Res. 2016;118:1703–5.

  3. Wearing SC, Henning EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal disorders associated with obesity: a biochemical perspective. Obes Rev. 2006;7:239–50.

    Article  CAS  Google Scholar 

  4. Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr. 2003;22:331–9.

  5. Aucott L, Poobalan A, Smith WCS, Avenell A, Jung R, Broom J, et al. Weight loss in obese diabetic and non-diabetic indviduals and long-term diabetes outcomes—a systematic review. Diabetes Obes Metab. 2004;6:85–94.

    Article  CAS  Google Scholar 

  6. Barr ELM, Magliano DJ, Zimmet PZ, Polkinghorne KR, Atkins RC, Dunstan DW, et al. AusDiab 2005: The Australian Diabetes, Obesity and Lifestyle Study—tracking the accelerating epidemic: its causes and outcomes. Melbourne: Internationl Diabetes Institute; 2006.

    Google Scholar 

  7. Harvey AE, Lashinger LM, Hursting SD. The growing challenge of obesity and cancer: an inflammatory issue. Ann N Y Acad Sci. 2011;1229:45–52.

    Article  CAS  Google Scholar 

  8. Vucenik I, Stains JP. Obesity and cancer risk: evidence, mechanisms, and recommendations. Ann N Y Acad Sci. 2012;1271:37–43.

    Article  CAS  Google Scholar 

  9. Varady KA. Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss? Obes Rev. 2011;12:e593–601.

    Article  CAS  Google Scholar 

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

  11. Harvie M, Pegington M. 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.

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

  13. Conley M, Le Fevre L, Haywood C, Proietto J. Is two days of intermittent energy restirction per week a feasible weight loss approach in obese males? A randomsied pilot study. Nutr Diet. 2017;75:65–72. Australia

    Article  Google Scholar 

  14. 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.

  15. 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. 2017;42:129–38.

  16. 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. 2015;8:1–12.

    Article  Google Scholar 

  17. Trepanowski JF, Kroeger CM, Barnosky AR, Klempel M, Bhutani S, Hoddy KK, et al. Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults a randomized clinical trial. JAMA Intern Med. 2017;177:930–8.

  18. Sundfor TM, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: a randomized 1-year trial. Nutr Metab Cardiovasc Dis. 2018;28:698–706.

    Article  CAS  Google Scholar 

  19. Noakes M, Keogh JB, Foster PR, Clifton PM. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr. 2005;81:1298–306.

    Article  CAS  Google Scholar 

  20. Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, et al. Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials. Mol Cell Endocrinol. 2015;418 Pt 2:153–72.

  21. Bhutani S, Klempel M, Kroeger CM, Trepanowski JF, Varady KA. Alternate day fasting and endurance exercise combine to reduce body weight and favourably alter plasma lipids in obese humans. Obesity. 2013;21:1370–9.

    Article  CAS  Google Scholar 

  22. Hoddy KK, Kroeger CM, Trepanowski JF, Barnosky A, Bhutani S, Varady KA. Meal timing during alternate day fasting: impact on body weight and cardiovascular disease risk in obese adults. [Erratum appears in Obesity. 2014;23:914]. Obesity. 2014;22:2524–31.

  23. Klempel MC, Kroeger CM, Varady KA. 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;62:137–43.

    Article  CAS  Google Scholar 

  24. Varady KA, Bhutani S, Church EC, Klempel MC. Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults. Am J Clin Nutr. 2009;90:1138–43.

    Article  CAS  Google Scholar 

  25. Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, et al. Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial. JAMA Intern Med. 2017;177:930–8.

    Article  Google Scholar 

  26. 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. 2017;42:129–38.

  27. The National Health and Medical Research Council. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Australia, 2009.

Download references

Acknowledgements

We thank Eva Pedersen for her assistance with study preparation and study participants. PMC is supported by an NHMRC Principal Research Fellowship. MLH was supported by a University of South Australia Postgraduate Award, funded jointly by the University of South Australia and the Research Training Program.

Author information

Authors and Affiliations

  1. Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    Michelle Louise Headland, Peter Marshall Clifton & Jennifer Beatrice Keogh

  2. Alliance for Research in Exercise, Nutrition and Activity (ARENA), Adelaide, SA, Australia

    Michelle Louise Headland, Peter Marshall Clifton & Jennifer Beatrice Keogh

Authors
  1. Michelle Louise Headland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Marshall Clifton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Beatrice Keogh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PMC and JKB designed the research; MLH: conducted the research and had primary responsibility for the final content on the manuscript; MLH and PMC: analyzed data; and all authors: wrote the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Jennifer Beatrice Keogh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Headland, M.L., Clifton, P.M. & Keogh, J.B. Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults. Int J Obes 43, 2028–2036 (2019). https://doi.org/10.1038/s41366-018-0247-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-018-0247-2

This article is cited by

Search

Advanced search

Quick links