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Background Alternate day fasting (ADF; ad libitum intake “feed day” alternated with 75% restriction “fast day”), is effective for weight loss, but the safety of the diet has been questioned. Accordingly, this study examined occurrences of adverse events and eating disorder symptoms during ADF. Findings Obese subjects (n = 59) participated in an 8-week ADF protocol where food was provided on the fast day. Body weight decreased (P < 0.0001) by 4.2 ± 0.3%. Some subjects reported constipation (17%), water retention (2%), dizziness (<20%), and general weakness (<15%). Bad breath doubled from baseline (14%) to post-treatment (29%), though not significantly. Depression and binge eating decreased (P < 0.01) with ADF. Purgative behavior and fear of fatness remained unchanged. ADF helped subjects increase (P < 0.01) restrictive eating and improve (P < 0.01) body image perception. Conclusions Therefore, ADF produces minimal adverse outcomes, and has either benign or beneficial effects on eating disorder symptoms.
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... Binge eating decreased over the course of the trial but no effect of group was found; additionally, disinhibition was found to be significantly lower in the IF group suggesting this group was less inclined to 'lose control' of their diet. Relatedly, other studies have noted increases in restriction associated with various forms of IF such as alternate day fasting 2 (ADF; Bhutani et al., 2013;Hoddy et al., 2015). Restriction is a core feature of many ED assessments (e.g., Fairburn & Beglin, 2008) that is associated with increases in disordered eating, and resistance to ED treatment Halmi, 2013). ...
... Given that IF is growing in popularity and fasting itself is considered an extreme weight control behavior, we were interested in assessing ED symptoms and symptom severity-including the presence and severity of restriction among intermittent fasters (Pike, 2019). Understanding the presence and severity of restriction among intermittent fasters would provide one piece of specific evidence about the risk associated with IF. Hoddy et al. (2015) observed favorable changes in body image among individuals engaging in ADF. For individuals high in restraint and disinhibition body image improved after the fasting period which may positively reinforce further restriction and promote continued use of unhealthy weight control behaviors (Schaumberg et al., 2015). ...
... While previous studies do not interpret increases in restraint among intermittent fasters as evidence of ED symptomatology, our results do align with previous findings of elevated restraint among those engaging in IF (Beaulieu et al., 2020;Bhutani et al., 2013;Hoddy et al., 2015). These findings are concerning in light of existing research which identifies restraint as a core feature of EDs, and a factor associated with increases in disordered eating, and resistance to ED treatment Halmi, 2013). ...
Article
Intermittent fasting (IF) is an emerging dietary trend that remains understudied. This study aimed to describe the implementation and eating disorder (ED) symptomatology, relevant to engagement in IF among both men and women. Intermittent fasters (N = 44 women, N = 20 men) recruited from Amazon Mechanical Turk, Reddit, and a Midwestern University were administered a demographic questionnaire, an assessment of ED symptomatology (Eating Disorder Examination Questionnaire; EDE-Q), and asked about their IF use. To assess the level of ED symptomatology among individuals using IF community and clinical norms were used for comparison. We hypothesized a) men and women engaging IF would score higher on the EDE-Q and b) more individuals engaging in IF would endorse ED behaviors (e.g., self-induced vomiting) than community norms. Intermittent fasters reported fasting for approximately 16 hours daily and for weight loss purposes. Men and women engaging in IF scored significantly higher than community norms on all subscales of the EDE-Q, with 31.25% of participants’ EDE-Q scores being at or above the clinical EDE-Q cut-off. Men and women engaging in IF reported engaging in ED behaviors. Results suggest that IF is associated with ED symptomatology. Further research on psychological characteristics and temporal order of the association between IF and ED symptomatology is warranted.
... The excluded studies after full text assessment with reasons for exclusion are available in the supplementary material (Table S2). In sequence, 14 studies including 562 participants met the eligibility criteria and were considered for the qualitative synthesis; of these, eight were designed as RCTs (Hussin et al. 2013;Kahleova et al. 2015;Tay et al. 2020;Bowen et al. 2018;Fitzgerald et al. 2018;Hayward et al. 2014;Teng et al. 2011;Teong et al. 2021) and six as nonRCTs (Bains et al. 2021;Kessler et al. 2018;Widhalm, Pöppelmeyer, and Helk 2017;Parr et al. 2020;Hoddy et al. 2015;Kim et al. 2020) (Figure 1). The included studies were conducted in different countries: 4 in the USA, 3 in Australia, 2 in Malaysia, and 1 in Austria, the Czech Republic, Germany, Korea, and New Zealand, and all of them were performed between 2011 and 2021. ...
... The included studies were conducted in different countries: 4 in the USA, 3 in Australia, 2 in Malaysia, and 1 in Austria, the Czech Republic, Germany, Korea, and New Zealand, and all of them were performed between 2011 and 2021. Finally, the quantitative synthesis was based on four RCTs (between-group differences) reporting data for depression (Hussin et al. 2013; Fitzgerald et al. 2018;Teong et al. 2021;Kahleova et al. 2015), in addition to 12 trials for which SMDs within-groups were calculated for depression, anxiety, and mood state (Bains et al. 2021;Bowen et al. 2018;Fitzgerald et al. 2018;Hussin et al. 2013;Kahleova et al. 2015;Kessler et al. 2018;Parr et al. 2020;Tay et al. 2020;Teong et al. 2021;Widhalm, Pöppelmeyer, and Helk 2017;Kim et al. 2020;Hoddy et al. 2015). ...
... Among the 10 studies addressing the effects of different IF interventions on depression, 6 were RCTs (Fitzgerald et al. 2018;Hussin et al. 2013;Kahleova et al. 2015;Tay et al. 2020;Teng et al. 2011;Teong et al. 2021), of which 5 were parallel and 1 was a crossover design (Kahleova et al. 2015), and 4 were non-RCTs (Kessler et al. 2018;Parr et al. 2020;Hoddy et al. 2015;Kim et al. 2020), from which 1 of them had a control group (Kessler et al. 2018). ...
Article
Accumulating evidence supports the benefits of intermittent fasting (IF) as a dietary strategy for cardiometabolic health and weight control. However, little is known about the potential implications of IF on mental disorders. The aim of this review was to synthesize evidence regarding the effects of IF on mental disorders (depression, anxiety, and mood state) in the general population. we conducted a systematic search in five databases from inception to January 2022. Randomized and nonrandomized clinical trials (RCTs/nonRCTs) were included. A random effects method was used to pool standardized mean differences (SMDs) and 95% CIs. A total of 14 studies involving 562 individuals were included, of which 8 were RCTs and 6 were nonRCTs. IF showed a moderate and positive effect on depression scores when compared to control groups (SMD: 0.41; 95%CI: 0.05 to 0.76; I2 =45%; n = 4). Conversely, within-group analyses did not show any significant effect of iF on anxiety (SMD: 0.10; 95%CI: −0.09 to 0.30; I2 =0%; n = 5) or mood state (SMD: 0.14; 95%CI: −0.09 to 0.37; I2 =59%; n = 7). IF modalities did not negatively impact mental disorders in the general population. In fact, IF showed a positive influence on diminishing depression scores, and did not modify anxiety or mood. PROSPERO REGISTRATION NUMBER CRD42021285438
... scores < 17) at the beginning of the study. Although few studies have investigated the effects of intermittent fasting on binge eating (56,57) , to date, there is no robust evidence to suggest that nutritional strategies with energy restriction trigger binge eating in people with obesity (58) . Lastly, we found an improvement in sleep quality after all interventions, which is similar to the findings of one previous study (10) but not all investigations (14) . ...
Article
This exploratory study investigated the effects of early vs . delayed time-restricted eating (TRE) plus caloric restriction (CR) on body weight, body composition, and cardiometabolic parameters in adults with overweight and obesity. Adults (20 to 40 years) were randomized to 1 of 3 groups for 8 weeks: early TRE (eTRE; 8:00-16:00) plus CR, delayed TRE (dTRE; 12:00-20:00) plus CR, or only CR (CR; 8:00-20:00). All groups were prescribed a 25% energy deficit relative to daily energy requirements. Thirteen participants completed the study in the eTRE and CR groups, and eleven in the dTRE group (n=37). After the interventions, there was no significant difference between the three groups for any of the outcomes. Compared to baseline, significant decreases were observed in body weight (eTRE group: -4.2 kg; 95% CI, -5.6 to -2.7; dTRE group: -4.8 Kg; 95% CI, -5.9 to -3.7; CR: -4.0 kg; 95% CI, -5.9 to -2.1), fat mass (eTRE group: -2.9 kg; 95% CI, -3.9 to -1.9; dTRE group: -3.6 Kg; 95% CI, -4.6 to -2.5; CR: -3.1 kg; 95% CI, -4.3 to -1.8), and fasting glucose levels (eTRE group: -4 mg/dL; 95% CI, -8 to -1; dTRE group: -2 mg/dL; 95% CI, -8 to 3; CR: -3 mg/dL; 95% CI, -8 to 2). In a free-living setting, TRE with a caloric deficit, regardless of the time of day, promotes similar benefits in weight loss, body composition and cardiometabolic parameters. However, given the exploratory nature of our study, further investigation is needed to confirm these findings.
... ADF typically involves alternating periods of 36 h of fasting followed by 12 h of ad libitum food consumption [18,19]. Some forms of ADF allow one meal contain-ing~25% of the individual's baseline caloric needs, consumed typically in the afternoon during fast periods [20]. Whole-day fasting strategies usually involve 1-2 days of severe caloric restriction or complete food abstinence followed by ad libitum feeding the rest of the week [21,22]. ...
Article
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Mice fed a high fat diet (HFD) ab libitum show corneal dysregulation, as evidenced by decreased sensitivity and impaired wound healing. Time-restricted (TR) feeding can effectively mitigate the cardiometabolic effects of an HFD. To determine if TR feeding attenuates HFD-induced corneal dysregulation, this study evaluated 6-week-old C57BL/6 mice fed an ad libitum normal diet (ND), an ad libitum HFD, or a time-restricted (TR) HFD for 10 days. Corneal sensitivity was measured using a Cochet-Bonnet aesthesiometer. A corneal epithelial abrasion wound was created, and wound closure was monitored for 30 h. Neutrophil and platelet recruitment were assessed by immunofluorescence microscopy. TR HFD fed mice gained less weight (p < 0.0001), had less visceral fat (p = 0.015), and had reduced numbers of adipose tissue macrophages and T cells (p < 0.05) compared to ad libitum HFD fed mice. Corneal sensitivity was reduced in ad libitum HFD and TR HFD fed mice compared to ad libitum ND fed mice (p < 0.0001). Following epithelial abrasion, corneal wound closure was delayed (~6 h), and neutrophil and platelet recruitment was dysregulated similarly in ad libitum and TR HFD fed mice. TR HFD feeding appears to mitigate adipose tissue inflammation and adiposity, while the cornea remains sensitive to the pathologic effects of HFD feeding.
Article
Intermittent fasting diets have become very popular in the past few years, as they can produce clinically significant weight loss. These diets can be defined, in the simplest of terms, as periods of fasting alternating with periods of eating. The most studied forms of intermittent fasting include: alternate day fasting (0-500 kcal per 'fast day' alternating with ad libitum intake on 'feast days'); the 5:2 diet (two fast days and five feast days per week) and time-restricted eating (only eating within a prescribed window of time each day). Despite the recent surge in the popularity of fasting, only a few studies have examined the health benefits of these diets in humans. The goal of this Review is to summarize these preliminary findings and give insights into the effects of intermittent fasting on body weight and risk factors for cardiometabolic diseases in humans. This Review also assesses the safety of these regimens, and offers some practical advice for how to incorporate intermittent fasting diets into everyday life. Recommendations for future research are also presented.
Chapter
There is now significant support in the literature that food addiction (FA) is a real entity, and there is early research highlights certain interventions that might soon prove to be helpful for people who suffer from the disorder. However, more work to identify efficacious and safe treatments is needed. Several neurostimulation techniques, cognitive trainings, psychosocial interventions, medications, and natural compounds that restore normal functioning in addictive circuits might also help treat disordered eating. Efforts to repurpose treatments that are known to help in substance use disorder (SUD) for use in FA populations should be prioritized. More research into establishing the efficacy of existing treatments for obesity and eating disorders (EDs) associated with binge eating [bulimia nervosa, binge eating disorder (BED)] for use in FA is also important; what we have learned in the last several decades about the role of hedonic eating pathways could also inform this research. Furthermore, testing and establishing the most effective and safe nutritional interventions for all disorders associated with overeating will be essential for this field to move forward, especially in the area of an abstinence-based approach: What should the treatment of FA look like from a dietary perspective, should it be individually tailored or uniform, and for whom will abstinence-based approaches be safe? Relatedly, research to identify who is more likely to respond to which treatment (treatment matching research), which takes into account the heterogeneity of these disorders, is needed for all forms of treatment. Finally, to answer the questions broached in Chap. 5 about the validity and utility of FA, there is a great need for a FA-specific research. Below, we give more details on of some of these research needs; this chapter is intended to generate ideas for researchers in this field.
Chapter
Obesity rates have reached epidemic levels in the United States and many other countries, and prevalence rates are continuing to grow worldwide. Elevated body mass index (BMI) leads to a variety of mental health and physical problems. A growing tendency towards sedentary lifestyles and the increasingly widespread availability of high-fat, high-sugar, highly processed foods are the most important causes. Other causes, contributors, and risk factors include particular demographics, lifestyle issues, medical and psychiatric problems, medications, psychological traits, prenatal and childhood insults, and genetic factors. Some of these risk factors are especially important to identify if preventable (e.g., sedentary lifestyle) or reversible (e.g., hypothyroidism or underlying psychiatric problems). Standard treatments for overweight and obesity involve various forms of dietary, physical exercise, and behavioral support regimes. No single nutritional intervention has come out a strong winner compared to any other in terms of weight loss promotion and maintenance, which has lead most practitioners to espouse a “calories in < calories out” approach. Medications and bariatric surgery are also viable options for some individuals.
Chapter
There is a myriad of established behavioral, lifestyle (physical activity), pharmacotherapeutic, nutritional, and surgical interventions for obesity (Chap. 2) and for the treatment of binge eating disorder (BED) and bulimia nervosa (BN) (Chap. 3). Dietary modification and physical activity, with or without the usage of psychosocial treatment like mindfulness or cognitive behavioral therapy (CBT) (Lin and Qu. Obes Surg. 30:1988–2002, 2020; Yang et al. Obes Rev. 20:1628–1641, 2019; Fuentes Artiles et al. Obes Rev. 20:1619–627, 2019; Reilly et al. Obes Rev. 20(Suppl 1):61–73, 2019; Franz et al. J Am Diet Assoc. 107:1755–1767, 2007), are the most commonly utilized interventions for weight loss because they are simple and have low economic burden and risk (Chap. 2). CBT-based psychotherapy with nutritional counseling aiming to reduce or eliminate binging behavior rather than promote weight loss is typically suggested for treatment of BED and BN (Chap. 3) (Fairburn CG. Overcoming binge eating, second edition: the proven program to learn why you binge and how you can stop. New York: The Guilford Press; 2013; Fairburn et al. Behav Res Ther. 41:509–528, 2003; Fairburn CG. Cognitive behavior therapy and eating disorders. The Guilford Press; 2008). However, the lack of associated weight loss from these interventions poses significant problems for those with both and eating disorder (ED) and obesity, especially if there are significant weight-associated health consequences (Sysko R, Delvin M. Binge eating disorder in adults: overview of treatment [Internet]. UpToDate. 2018 [cited 2018]. Available from: https://www.uptodate.com/contents/binge-eating-disorder-in-adults-overview-of-treatment; Pacanowski et al. Obesity. 26:838–844, 2018; Hilbert et al. Int J Eat Disord. 53:1353–1376, 2020). Medications and even surgery might be chosen as treatment approaches for some people with these disorders (Chaps. 2 and 3), but are only marginally effective, and have adverse effects (Lin and Qu. Obes Surg. 30:1988–2002, 2020). In order to significantly impact the burden of disease caused by obesity and the mental distress caused by EDs, more safe and effective treatments are needed.
Chapter
While fasting is an ancient practice, research over the last decade has highlighted its potential as a method of obtaining weight loss and other cardiometabolic health benefits. Several different patterns of fasting have emerged, including alternate-day fasting (ADF), 5:2 intermittent fasting (IF), time-restricted eating (TRE), and periodic fasting. Preclinical data in animals are impressive, demonstrating that periods of zero or few calories can result in not just weight loss, but other health benefits. Subsequent data in humans have been steadily accumulating and show beneficial effects in populations at high risk for atherosclerotic cardiovascular disease, including patients with overweight or obesity, type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), and also patients at a normal weight. One mechanism behind these benefits may be related to a metabolic switch from use of glucose as fuel in the fed state to use of ketones, which influence genes involved in health and longevity and improve cellular response to stress. It is important to evaluate the data as well as the feasibility and safety of each fasting method. Certain fasting patterns may be appropriate to recommend to select patients as lifestyle modification for prevention of cardiovascular disease.
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The ability of modified alternate-day fasting (ADF; ie, consuming 25% of energy needs on the fast day and ad libitum food intake on the following day) to facilitate weight loss and lower vascular disease risk in obese individuals remains unknown. This study examined the effects of ADF that is administered under controlled compared with self-implemented conditions on body weight and coronary artery disease (CAD) risk indicators in obese adults. Sixteen obese subjects (12 women, 4 men) completed a 10-wk trial, which consisted of 3 phases: 1) a 2-wk control phase, 2) a 4-wk weight loss/ADF controlled food intake phase, and 3) a 4-wk weight loss/ADF self-selected food intake phase. Dietary adherence remained high throughout the controlled food intake phase (days adherent: 86%) and the self-selected food intake phase (days adherent: 89%). The rate of weight loss remained constant during controlled food intake (0.67 +/- 0.1 kg/wk) and self-selected food intake phases (0.68 +/- 0.1 kg/wk). Body weight decreased (P < 0.001) by 5.6 +/- 1.0 kg (5.8 +/- 1.1%) after 8 wk of diet. Percentage body fat decreased (P < 0.01) from 45 +/- 2% to 42 +/- 2%. Total cholesterol, LDL cholesterol, and triacylglycerol concentrations decreased (P < 0.01) by 21 +/- 4%, 25 +/- 10%, and 32 +/- 6%, respectively, after 8 wk of ADF, whereas HDL cholesterol remained unchanged. Systolic blood pressure decreased (P < 0.05) from 124 +/- 5 to 116 +/- 3 mm Hg. These findings suggest that ADF is a viable diet option to help obese individuals lose weight and decrease CAD risk. This trial was registered at clinicaltrials.gov as UIC-004-2009.
Article
Objective: This study examined whether the combination of alternate day fasting (ADF) plus exercise produces superior changes in body composition and plasma lipid levels when compared to each intervention alone. Design and methods: Obese subjects (n = 64) were randomized to 1 of 4 groups for 12 weeks: 1) combination (ADF plus endurance exercise), 2) ADF, 3) exercise, or 4) control. Results: Body weight was reduced (P < 0.05) by 6 ± 4 kg, 3 ± 1 kg, and 1 ± 0 kg in the combination, ADF, and exercise groups, respectively. Fat mass and waist circumference decreased (P < 0.001), while lean mass was retained in the combination group. Low-density lipoprotein (LDL) cholesterol decreased (12 ± 5%, P < 0.05) and high-density lipoprotein (HDL) cholesterol increased (18 ± 9%, P < 0.05) in the combination group only. LDL particle size increased (P < 0.001) by 4 ± 1 Å and 5 ± 1 Å in the combination and ADF groups, respectively. The proportion of small HDL particles decreased (P < 0.01) in the combination group only. Conclusions: These findings suggest that the combination produces superior changes in body weight, body composition, and lipid indicators of heart disease risk, when compared to individual treatments.
Article
Unlabelled: Alternate day fasting (ADF) with a low-fat (LF) diet is effective for weight loss and cardio-protection. However, the applicability of these findings is questionable as the majority of Americans consume a high-fat (HF) diet. Objective: The goal of this study was to determine if these beneficial changes in body weight and coronary heart disease (CHD) risk can be reproduced if an HF background diet is used in place of an LF diet during ADF. Methods: Thirty-two obese subjects were randomized to an ADF-HF (45% fat) or ADF-LF diet (25% fat), which consisted of two phases: 1) a 2-week baseline weight maintenance period, and 2) an 8-week ADF weight loss period. All food was provided during the study. Results: Body weight was reduced (P<0.0001) by ADF-HF (4.8%±1.1%) and by ADF-LF (4.2%±0.8%). Fat mass decreased (P<0.0001) by ADF-HF (5.4±1.5 kg) and ADF-LF (4.2±0.6 kg). Fat free mass remained unchanged. Waist circumference decreased (P<0.001) by ADF-HF (7.2±1.5 cm) and ADF-LF (7.3±0.9 cm). LDL cholesterol and triacylglycerol concentrations were reduced (P<0.001) by both interventions (ADF-HF: 18.3%±4.6%, 13.7%±4.8%; and ADF-LF: 24.8%±2.6%, 14.3%±4.4%). HDL cholesterol, blood pressure, and heart rate remained unchanged. There were no between-group differences for any parameter. Conclusion: These findings suggest that an ADF-HF diet is equally as effective as an ADF-LF diet in helping obese subjects lose weight and improve CHD risk factors.
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Article
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The purpose of this investigation was to develop a brief self-report inventory which could be used to evaluate treatment outcome for anorexia and bulimia nervosa. The Multifactorial Assessment of Eating Disorders Symptoms (MAEDS) was constructed to measure six symptom clusters which have been found to be central to the eating disorders: depression, binge eating, purgative behavior, fear of fatness, restrictive eating, and avoidance of forbidden foods. The factor structure of the MAEDS was found to be stable and it was found to have satisfactory reliability and validity. Normative data were collected so that raw scores could be converted to standardized scores. While still in the experimental stages, the MAEDS shows promise as a valid and economical measure of treatment interventions for anorexia and bulimia nervosa.
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This document presents guidelines for reducing the risk of cardiovascular disease by dietary and other lifestyle practices. Since the previous publication of these guidelines by the American Heart Association,1 the overall approach has been modified to emphasize their relation to specific goals that the AHA considers of greatest importance for lowering the risk of heart disease and stroke. The revised guidelines place increased emphasis on foods and an overall eating pattern and the need for all Americans to achieve and maintain a healthy body weight (Table⇓). View this table: Table 1. Summary of Dietary Guidelines The major guidelines are designed for the general population and collectively replace the “Step 1” designation used for earlier AHA population-wide dietary recommendations. More individualized approaches involving medical nutrition therapy for specific subgroups (for example, those with lipid disorders, diabetes, and preexisting cardiovascular disease) replace the previous “Step 2” diet for higher-risk individuals. The major emphasis for weight management should be on avoidance of excess total energy intake and a regular pattern of physical activity. Fat intake of ≤30% of total energy is recommended to assist in limiting consumption of total energy as well as saturated fat. The guidelines continue to advocate a population-wide limitation of dietary saturated fat to <10% of energy and cholesterol to <300 mg/d. Specific intakes for individuals should be based on cholesterol and lipoprotein levels and the presence of existing heart disease, diabetes, and other risk factors. Because of increased evidence for the cardiovascular benefits of fish (particularly fatty fish), consumption of at least 2 fish servings per week is now recommended. Finally, recent studies support a major benefit on blood pressure of consuming vegetables, fruits, and low-fat dairy products, as well as limiting salt intake (<6 grams per day) and alcohol (no more than 2 drinks per day for men and …