Salis S, Shefa S, Sharma N, et al. Effects of Intermittent Fasting on Weight Loss in Asian Indian Adults with Obesity. J Assoc Physicians India 2022;70(9):62–66. DOI: 10.5005/japi-11001-0098
Interest in fad diets has probably never been as abiding and as temporal as they are in this age of social media. While the interest in weight loss is abiding, it is seldom a devotion to a particular diet or consistency in following a regimen long enough so it works. It is also important to be as scientific as possible while embarking on diets, to ensure that one does oneself a favour and not a disservice. As always, diets come in different sizes and flavours, some plucked out of quackery, while others are rooted in scientific calorie control paired with specific exercises. It is essential to zero in on the right dimensions for oneself and soldier on. In what is probably the first such data from India on the issue, the paper ‘Effects of Intermittent Fasting on Weight Loss in Asian Indian Adults with Obesity’, argues that the intermittent fasting (IF) technique could actually aid in weight loss and have additional health benefits if one pays heed to what one eats during the feeding period of the day.
The paper by Sheryl. S et al, is a collaboration between Mumbai-based nutritionists and the Chennai-based Madras Diabetes Research Foundation (MDRF) and was recently published in the Journal of the Association of Physicians of India. Intermittent fasting refers to a period of fasting up to 16 hours daily, or a 24-hour fast on alternate days, or a complete 24-hour fast twice a week on non-consecutive days. Thus, a fasting period anywhere between 12 to 20 hours can be referred to as IF. Accordingly, for each fasting cycle, the remaining hours will be considered the feeding period. While studies elsewhere have shown substantial weight loss and fat loss with IF, this limited study has shown that it is equally important to focus on what is being consumed during the feeding time.
“Fasting is not alien to our culture, and is present in many religions,” says Sheryl Salis, primary author of the paper. “People in many communities do observe fasts, from time to time, in various forms. But more recently the trend of following fad diets to lose weight rapidly has caught up. IF is among these diets, and is seen as fancy, doable.”
However, she adds that there are a lot of versions doing the rounds, including variations in the number of hours of fasting, the number of meals consumed in the feeding period and what is consumed during that period. While active handling of weight issues is important, given that worldwide, obesity has nearly tripled since 1975, it is also important to watch what people are eating and be guided by professionals while embarking on a serious regimen, she explains. “There are people who hoard and stuff themselves in a single meal they eat in a day, and there are others who wake up only during feeding hours. All of this can be extreme.” With this, grew the desire to study scientifically a group of people who were on IF, to see if there is an impact on actual weight loss, and other health parameters.
With able guidance from the MDRF who also provided the structure for the study, a total of 32 adult individuals both males and females, who were overweight or obese were assigned the diet in January 2020, just before the pandemic struck. Participants followed 12 to 16 hours of fasting with 12 to 8 hours of feeding period for three months.
Ms. Sheryl says participants were followed up every month for three months. Due to the second wave of the COVID-19 pandemic, the in-clinic anthropometric measurements were not possible post-intervention. Therefore, participants were requested to send pictures of their weight and waist circumference measures on WhatsApp or email, in addition to the information on duration and frequency of fasting and the data collected at baseline. Analysis of data post-intervention, according to the paper, showed a significant reduction in mean weight, waist circumference, BMI (body mass index), calorie intake, and increase in protein intake. Body fat % and visceral fat % showed a clinically relevant reduction.
Ranjani Harish, corresponding author in the study, and Senior Scientist and Head, Department of Translational Research, MDRF, said the big question with weight loss measures is sustainability. Here, the fasting hours were slowly and gradually ramped up, in a manner that the participants of the trial were comfortable with. Advice was provided not only for the diet, but also for sleep, stress management and exercise. Ms. Ranjani says: “We found in this small study that IF can be done in a sustainable manner. The patients did not think a fasting period of 14 hours was that hard”. The plan given to them insisted on regulating what was consumed, eating a light dinner early, increasing the protein content, and watching the calorie count. “Most patients said they could easily manage the fasting, and all participants showed positive results — weight loss and fat loss, during evaluation,” she explains.
“We deliberately kept out people who were pregnant, lactating mothers, or those with diabetes in this study. Their calorie intake and periodicity of meals requirement might have to be calibrated carefully. We do not recommend IF for children either,” Ms. Sheryl adds.
Interestingly, in post- intervention qualitative interviews conducted among participants in the trial also reported a reduction in acidity, bloating and regularity in their monthly cycles. Ms. Ranjani goes on to add that the results of this limited, but real world study were encouraging enough to plan a proper randomised control trial among a larger group of participants with diverse needs, this time, possibly without the constraints of conducting a study during a total lockdown.