Obesity and eating disorders can be prevented and treated by Intermittent Fasting and Caloric Restriction.
Scientific evidence:
The effect of a 48 h fast on the physiological responses to food ingestion in normal-weight women. Gallen IW1, Macdonald IA, Mansell PI. Br J Nutr. 1990 Jan;63(1):53-64.
The thermogenic, cardiovascular and metabolic responses to a 30 kJ/kg body-weight test meal were studied in eight normal-weight, healthy female subjects after a 6 or 48 h fast. There was no significant change in metabolic rate following the 48 h fast, but plasma glucose, insulin, noradrenaline and respiratory exchange ratio were all reduced, and plasma beta-hydroxybutyrate was increased. Forearm blood flow was increased, with reduction in diastolic blood pressure. After the 48 h fast, there was a reduction in the metabolic rate response 40-90 min after food (control + 0.54 (SE 0.05), 48 h fast + 0.27 (SE 0.12) kJ/min, P less than 0.01), and in forearm blood flow and diastolic blood pressure responses, but increases in heart rate, blood glucose and plasma insulin responses to the ingestion of the test meal. There was no significant relationship between plasma catecholamine concentration and food ingestion or metabolic rate. Fasting induced considerable adaptation in these subjects and altered some of the physiological responses to food ingestion.
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Leucine, glucose, and energy metabolism after 3 days of fasting in healthy human subjects. Nair KS1, Woolf PD, Welle SL, Matthews DE. Am J Clin Nutr. 1987 Oct;46(4):557-62.
Adaptations of leucine and glucose metabolism to 3 d of fasting were examined in six healthy young men by use of L-[1-13C]leucine and D[6,6-2H2]glucose as tracers. Leucine flux increased 31% and leucine oxidation increased 46% after 3 d of fasting compared with leucine flux and oxidation after an overnight fast. Glucose production rate declined 38% and resting metabolic rate decreased 8% during fasting. Plasma concentrations of testosterone, insulin, and triiodothyronine were reduced by fasting whereas plasma glucagon concentrations were increased. We conclude that there is increased proteolysis and oxidation of leucine on short-term fasting even though glucose production and energy expenditure decreased.
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Enhanced thermogenic response to epinephrine after 48-h starvation in humans. Am J Physiol. 1990 Jan;258(1 Pt 2):R87-93. Mansell PI1, Fellows IW, Macdonald IA.
The effects of 48-h starvation on the physiological responses to a 30-min infusion of epinephrine at 25 ng.min-1.kg body wt-1 were studied in 11 normal-weight healthy young subjects. Starvation led to considerable alterations in basal metabolism including a significant (mean 3.6%) increase in resting metabolic rate. During the infusions, plasma epinephrine concentration rose less in the starved state (+1.47 nmol/l) than in the normally fed state (+1.73 nmol/l) (SE 0.06 nmol/l; P less than 0.05). The maximum increments (mean +/- SE) in heart rate induced by epinephrine were 11.9 +/- 1.3 beats/min in the normally fed state and 20.1 +/- 2.0 beats/min in the starved state (P less than 0.001); the corresponding mean increments in blood glycerol concentration were 0.07 and 0.14 mmol/l (SE 0.01 mmol/l; P less than 0.01). The increase in the metabolic rate above base line during the final 10 min of the epinephrine infusion was 0.58 +/- 0.18 kJ/min in the normally fed state and 0.78 +/- 0.14 kJ/min in the starved state (P less than 0.01). The chronotropic, lipolytic, and thermogenic effects of infused epinephrine were therefore enhanced by prior starvation, despite the lower plasma epinephrine levels.
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Treatment modalities of obesity: what fits whom? Diabetes Care. 2008 Feb;31 Suppl 2:S269-77. Hainer V, Toplak H, Mitrakou A. Institute of Endocrinology, Narodni 8, 116 94 Prague 1, Czech Republic.
The prevalence of obesity is increasing in both developed and developing countries, with rates reaching approximately 10-35% among adults in the Euro-American region. Obesity is associated with increased risks of cardiovascular diseases, type 2 diabetes, arthritis, and some type of cancers. Obesity significantly affects the quality of life and reduces the average life expectancy. The effective treatment of obesity should address both the medical and the social burden of this disease. Obesity needs to be treated within the health care system as any other complex disease, with empathy and without prejudice.
Both health care providers and patients should know that the obesity treatment is a lifelong task. They should also set realistic goals before starting the treatment, whereas keeping in mind that even a modest weight loss of 5-15% significantly reduces obesity-related health risks. Essential treatment of obesity includes low-calorie low-fat diets, increased physical activity, and strategies contributing to the modification of lifestyle. Anti-obesity drugs facilitate weight loss and contribute to further amelioration of obesity-related health risks. A short-term weight loss, up to 6 months, is usually achieved easily. However, the long-term weight management is often associated with a lack of compliance, failures, and a high dropout rate. Regular physical activity, cognitive behavioral modification of lifestyle, and administration of anti-obesity drugs improve weight loss maintenance. Bariatric surgery is an effective strategy to treat severely obese patients. Bariatric surgery leads to a substantial improvement of comorbidities as well as to a reduction in overall mortality by 25-50% during the long-term follow-up. Obesity treatment should be individually tailored and the following factors should be taken into account: sex, the degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts. In the future, an evaluation of hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for a particular obese patient. A multilevel obesity management network of mutually collaborating facilities should be established to provide individually tailored treatment. Centers of excellence in obesity management represented by multidisciplinary teams should provide comprehensive programs for the treatment of obesity derived from evidence-based medicine.
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Evidence that fasting can treat obesity. Changes in food cravings during low-calorie and very-low-calorie diets. Obesity (Silver Spring). 2006 Jan;14(1):115-21.Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
OBJECTIVE: This study examined food cravings during a primarily food-based low-calorie diet (LCD) and a supplement-based very-LCD (VLCD). RESEARCH METHODS AND PROCEDURES: The Food Craving Inventory (FCI) was used to measure general cravings and cravings for specific types of foods (sweets, high fats, carbohydrates/starches, and fast food fats). The FCI was completed by participants in the LCD and VLCD programs at baseline and after 11 weeks of dieting. The VLCD group also completed the FCI at Week 6 and after 5 weeks of a refeeding phase, when their diet consisted primarily of solid food. RESULTS: From baseline to Week 12, craving decreases were greater for the VLCD group than for the LCD group on all measures. All craving measures decreased significantly for the VLCD group. The LCD group experienced a marginally significant decrease in sweet cravings. Within the VLCD group, all craving measures decreased significantly by Week 6 and did not change thereafter, including after resumption of solid food intake, and craving scores during all dieting points were lower than baseline. Changes in cravings were not related to weight loss.
DISCUSSION: Cravings did not increase during either diet; all changes represented decreases. Compared with a primarily food-based diet (LCD), a more restrictive supplement-based diet (VLCD) resulted in significantly larger decreases in food cravings that occurred by the end of the 5th week of supplement use and did not rebound with resumption of solid food intake. The results of this study suggest that food cravings diminish with calorie restriction.
Effect of a very low calorie diet on the diagnostic category of individuals with binge eating disorder. Indications for fasting. Obesity Int J Eat Disord 2002 Jan;31(1):49-56. Raymond NC, de Zwaan M, Mitchell JE, Ackard D, Thuras P. Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.
This study examined the factors associated with the diagnostic outcome of obese individuals with and without binge eating disorder (BED) 1 year after completing a very low calorie diet (VLCD) program. METHOD: Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms. Diagnoses before and after VLCD were obtained using the Structured Clinical Interview for DSM-IV (SCID) interviews. The severity of psychiatric symptoms were assessed using various rating scales.
RESULTS: Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later. None of the baseline factors were statistically associated with outcome.
DISCUSSION: Although the main hypothesis was not supported, absence of a BED diagnosis at 12-month follow-up after a VLCD diet appears to be associated with less weight gain at 1-year follow-up regardless of baseline diagnosis.
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Very-low-calorie diets and sustained weight loss. (A review) Obes Res 2001 Nov;9 Suppl 4:295S-301S . Saris WH. Nutrition and Toxicology Research Institue Maastricht, Maastricht University, The Netherlands. To review of the literature on the topic of very-low-calorie diets (VLCDs) and the long-term weight-maintenance success in the treatment of obesity.
RESEARCH METHODS AND PROCEDURES: A literature search of the following keywords: VLCD, long-term weight maintenance, and dietary treatment of obesity. RESULTS: VLCDs and low-calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long-term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from -7% to 122% at the 1-year follow-up to 26% to 121% at the 5-year follow-up. There is evidence that a greater initial weight loss using VLCDs with an active follow-up weight-maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance.
CONCLUSIONS: VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long-term weight-maintenance success.
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Treatment of extreme obesity with a very low calorie diet. Med Pregl 2001 Nov-Dec;54(11-12):534-8. Ivkovic-Lazar T. Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Institut za interne bolesti, Klinicki centar, Novi Sad.
This paper presents the results of treatment of very obese persons with a very-low-calorie diet (VLCD).
MATERIAL AND METHODS: A group of 28 extremely obese subjects, average age 32 years, was treated in the course of one month by the following regime: 3-4 l of mineral water with “Enemon” pulv. 3 x 1 and vitamin substitution and allopurinol 300 mg/day
RESULTS: In addition to a statistically significant (p < 0.5) loss of body mass, significant changes were observed in regard to decrease of atherogenic lipid profile (cholesterol, triglycerides, LDL-cholesterol, apoprotein B), as well as lowered level of hyperinsulinism which, though, was not statistically significant. The degree of protein catabolism did not reach statistical significance, and the results were also more favourable with respect to potential changes in electrolytes, as well as with respect to the degree of hyperuricemia in regard to subjects being under the regime of total starvation.
DISCUSSION AND CONCLUSIONS: VLCD represents an extremely efficient and safe therapeutic procedure which, apart from body mass loss, is characterized by favourable changes in metabolism of lipids and a decrease in hyperinsulinism, which eventually results in reduction of the risk from early and accelerated atherosclerosis.
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Treatment of diabetes in patients with severe obesity. Biomed Pharmacother 2000 Mar;54(2):74-9. Scheen AJ. Department of Medicine, CHU Sart Tilman (B35), Liege 1, Belgium.
Besides genetic predisposition, obesity is the most important risk factor for the development of diabetes mellitus, and weight reduction has been shown to markedly improve blood glucose control in obese subjects with type 2 diabetes. Therapeutic strategies for the obese diabetic patient include: 1) promoting weight loss through lifestyle modifications (hypocaloric diet and exercise) and anti-obesity drugs (orlistat, sibutramine, etc.); 2) improving blood glucose control, essentially through the reduction of insulin resistance (metformin, eventually thiazolidinediones) or insulin need (alpha-glucosidase inhibitors) and, at a later stage, the correction of defective insulin secretion (sulphonylureas, repaglinide) or low circulating insulin levels (exogenous insulin); and 3) treating common associated risk factors, such as arterial hypertension and dyslipidaemias, to improve cardiovascular prognosis. When morbid obesity is present, both restoring a good glycemic control and correcting associated risk factors can only be obtained through marked and sustained weight loss. This primary objective justifies more aggressive weight reduction programmes, including very low-calorie diets and bariatric surgery, but only within a multidisciplinary approach and in well-selected patients .
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Diet and exercise in addition to psychotherapy, in the treatment of patients suffering from eating disorders with obesity. Høie LH, Myking E, Reine EC, Bruusgaard D. Norsk Legesenter, Oslo, Norway. Eat Weight Disord. 1997 Dec;2(4):207-10.
Treating patients with eating disorders is often a controversial issue, and obesity adds another difficulty to the treatment regimen. In this study we wanted to evaluate the outcome on body weight in patients suffering from eating disorders with obesity, by adding dietary treatment and exercise to ongoing psychotherapy. The prospective intervention study included 18 obese, female patients in primary health care and outpatient clinic with a BMI > or = 27 kg/m2 with eating disorders, nine of whom were diagnosed with bulimia according to the American Psychiatric Association. The patients had had psychotherapy for at least 2 years in a treatment programme which was chosen by a psychologist. This had had no influence on the patients’ weight problem, and an additional diet and exercise regime was added to the ongoing psychotherapy through an eight-week very low calorie diet (VLCD) treatment (Nutrilett), during which the patients also participated in weekly group exercise. The patients were followed-up regularly during a 6-month period. During the 8-week VLCD treatment, which was completed by 16 patients (89%), mean body weight in the group decreased significantly from 98.8 kg to 88.6 kg. Six months after the initial treatment, average weight loss was further significantly reduced to 82.5 kg. The findings of the present study suggest that by combining ongoing psychotherapy with a well-balanced VLCD treatment and exercise it is possible to achieve substantial weight reduction in patients suffering from eating disorders with obesity.
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Treatment response in obese binge eaters: preliminary results using a very low calorie diet (VLCD) and behavior therapy. LaPorte DJ. Department of Psychology, University of Maryland, Catonsville 21228.Addict Behav. 1992;17(3):247-57.
The present study compared the treatment response of male and female obese binge eaters and nonbinge eaters attending a university-based weight reduction program employing a very low calorie diet (VLCD) and concurrent behavior therapy. Twenty-nine percent of female patients (n = 19) and 22% of male patients (n = 6) were characterized as binge eaters based on their scores on the Binge Eating Scale. No significant differences were found between binge and nonbinge groups on measures of weight loss, adherence to the diet, or drop-out rate, although a trend towards greater attrition in the binge group (32%) relative to the nonbinge group (17%) was noted. However, binge eaters had significantly higher pretreatment levels of trait anxiety, state anxiety, and depression as well as higher within treatment levels of anxiety and depression despite significant reductions in depression over the course of treatment. Further examination revealed a binge status X sex interaction effect on state anxiety. Binge-eating females had significantly higher anxiety levels pretreatment and throughout the 10 weeks of the study. No differences between binge and nonbinge males on levels of anxiety were found. These preliminary results tentatively suggest that a VLCD in conjunction with behavior therapy may be an effective method of weight loss for this segment of the obese population, but that elevated levels of anxiety persist in female patients. Future studies must address the long-term maintenance of weight loss in this population as well as other treatment strategies.
