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In obese and overweight women is Alternate Day Fasting (an energy restriction of at least 70%

for two or more days per week) compared to Calorie Restriction (and energy restriction of 1560% daily) a more effective means of weight loss?
It is well known that obesity is an increasingly prevalent issue on a global scale. The
raised instance of overweight and obesity are no doubt due to the increase of sedentary lifestyles
along with consumption of nutrient dense foods, often which contain high amounts of simple
sugars, sodium, and saturated fats. This is particularly the case for many adult women (obesity
has a higher prevalence for females).
These factors when combined can lead to some devastating outcomes. Some of these
include increased risk for coronary heart disease (CHD), cardiovascular disease, diabetes (DM2),
dementia, certain types of cancer (including breast cancer), and decreases life expectancy.
It has been shown, that a weight loss of as little as 5% total body weight can significantly
lower biomarkers for these conditions including heart rate, plasma lipid concentrations, glucose,
and insulin levels. Therefore it is no surprise that nutritional therapy be a premiere action
towards weight management for disease prevention.
In the pursuit of an ideal weight management strategy, daily calorie restriction (between
15-60%) has often taken the lead. Straight and simple, calories in equals calories out, and a
calorie deficit creates a weight loss. However, as is frequently the case in nutritional therapy,
there is often a lack of dietary compliance. While women are often eager to begin a new weight
loss regime, continuous calorie restriction can feel like a drastic life change; constantly assessing
portion sizes, counting calories, and avoiding once common food, can lead many to jump off the
weight loss bandwagon and binge. But what if there was another way?
While the concept of intermittent fasting (alternate day fasting, intermittent calorie
restriction) goes as far back as the age of the hunter-gatherer, it is a fairly new concept for the
modern dietitian. The idea is this: if a calorie deficit creates a weight loss, then a daily calorie

restriction of 25% would be the same as two days of a calorie restriction of 75% per week. The
resulting weight loss should be equal if not greater in the intermittent fasting group (because
during a constant energy deficit your body would increase its efficiency and therefore decrease
your basal metabolic rate).
The purpose of this review is to determine whether alternate day fasting (an energy
restriction of at least 70% for two or more days a week) is more effective than daily calorie
restriction (an energy restriction of 15-60% daily) in regards to weight loss in obese and
overweight women.
While there is much research done concerning calorie restriction, fewer exists on the
topic of alternate day fasting, far fewer with human subjects, and extremely few concerning
women specifically.
One of the first randomized trials to look at intermittent calorie restriction was conducted
in 1989 by Hill et al. During that time a new and popular diet program, the Rotation Diet,
emphasizing alternating calorie intakes per day, was suggested to “enhance weight loss while
preventing a reduction in RMR.”1 Hill attempted to test the effectiveness of this diet in
comparison to daily calorie restriction while controlling for the effect of aerobic exercise in
obese women. He found, that in the sedentary group who were involved in the alternating calorie
diet, that there was a fairly large misjudgment concerning portion sizes during the very low
calorie days causing an increase of around 300kcal. However, despite this clear limitation, they
completed the trial. The resulting conclusions suggested that both the alternating calorie diet and
the continuous calorie diet produced similar weight loss and both saw a decrease in RMR. It was
suggested that a wider range of fluctuation might achieve better results, but the average
population would be similarly unable to adhere to such a diet.

1 Katahn M. The Rotation Diet. New York: WW Norton & Co, 1986.

Rising to this challenge, 22 years later in 2011, MN Harvie et al. conducted a similar
randomized control trial; this time to compare the feasibility and effectiveness of intermittent
energy restriction (IER) and continuous energy restriction (CER).2 A comparison of a 25%
calorie restriction in the form of CER and IER (two days a week of a 75% kcal restriction),
showed interesting results. While it seemed IER was no easier to adhere to than CER, both
achieved similar body weight losses (in fact, while not significant enough to show a true
difference, weight loss was higher in the IER group, and body fat was lower). This lead Harvie to
conclude that IER “may be offered as an equivalent to CER for weight loss and reducing disease
risk.” (Harvie et al. p.721).
Findings remained consistent in several other trials. KA Varady, a leading researcher on
the topic of intermittent calorie restriction, composed an analysis of all past research concerning
which strategy (intermittent calorie restriction or continuous calorie restriction) was most
effective on weight loss. While not concerning the effectiveness solely in females, the results
were similar for both genders. Along with the common conclusion that both diets were equally
sound, it was suggested that intermittent calorie restriction resulted in the loss of less fat free
mass than continuous calorie restriction. This information might have lead to intermittent calorie
restriction becoming the preferred method for weight loss therapy; however, the option was not
so eagerly embraced by nutrition professionals as one might have hoped.
The next idea to be researched was the concept of adding intermittent fasting to daily
calorie restriction in 2012 by MC Klempel et al. This study had many variables and little baseline
to suggest the addition of fasting to daily calorie restriction would greatly change the results of

2 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 desease risk
markers: a randomized trial in young overweight women. Int J Obes (Lond) 2011, 35(5):714727.

daily calorie restriction alone, however it did demonstrate that the use of liquid meal
replacements greatly improved weight loss, perhaps mainly due to the accuracy of portion
control. (Klempel et al p.7) Suggesting that adherence to IER could be increased by the use of
liquid meal replacements during the fasting day.
The most recent information concerning the effectiveness of alternate day fasting and
intermittent calorie restriction was seen in 2013 through a before and after study conducted by
Eshghinia and Mohammadzadeh. During this six week trial, obese women were to comply to 3
days a week of a calorie restriction of 70-75%, 3 days a week of normal eating (~17001800kcal/d), and one day of eating ad libitum. While this study was not compared to daily
calorie restriction, a mean 7.1% weight loss was found. Thus exceeding the 5% needed to
improve health risks. It was concluded that this diet, therefore, was an effective and feasible
means of weight loss for obese women.
While intermittent energy restriction has yet to be determined the most effective means of
weight loss in obese and overweight women, it does appear to be a viable option for nutrition
therapy and equal in quality to calorie restriction in terms of weight loss. The research on this
topic is few and far between, and the quality of that research is not always the most accurate.
This, of course, is mainly due to the inherent flaws of self-reporting food intakes. A suggestion
was brought up in the research of Klempel et al. that perhaps the best way to maintain
consistently accurate kcal intakes would be to use pre-portioned liquid meal supplements, this
might extend to any pre-portioned form of a food during the fast day. This would also increase
the convenience and perhaps the acceptance of this weight loss therapy in the general population.
Further research should be done concerning the lean mass retaining properties of this therapeutic
option, to perhaps encourage its implementation to nutritional professionals. Alternate day
fasting (intermittent calorie restriction, intermittent fasting) is not a more effective means of

weight loss in obese women; however, it has several implications of being a more efficient
means of weight loss, and is certainly equally effective means as daily calorie restriction.