Intermittent fasting is a good weight loss tool, but not if patients binge in the evening

Key takeaways:

• Time-restricted feeding can be a beneficial method for calorie restriction but is not superior to other diets.
• A presenter offered tips for coaching patients on their weight loss journey.

SAN DIEGO — Time-restricted feeding offers benefits for weight loss, but it is not superior to other calorie-restriction diets, according to a presenter at the ACP Internal Medicine Meeting.

Michelle E. Hauser, MD, MS, MPA, FACP, FACLM, a clinical associate professor and director of the weight management program at Stanford University and creator of a weight management program that is used in multiple states in the Veterans Affairs system, addressed the “hot topic” of time-restricted feeding — otherwise known as intermittent fasting.

“Time-restricted feeding is the technical term,” said Hauser, who is also a chef. “That just means that all of your calorie intake is confined to a specified timeframe.”

Though the most common timeframe is 8 hours, it can vary to as few as 4 hours or as many as 10. There are variations of the diet, like early time-restricted feeding, which is just a shift in the timeframe, and alternate-day fasting.

“There are a lot of studies comparing time-restricted feeding to a control diet or usual care. Most of those studies do show that there's weight loss associated with that,” Hauser said. “However, when they include arms where they're comparing to a calorie-restricted diet that's not time-restricted, then there doesn't tend to be a benefit over that.”

Since time-restricted feeding can be an effective strategy for weight loss but does not appear to be superior to other calorie-restricted diets, she said she recommends it to patients only if the constraints of time restriction are what helps them cut back on calories in general.

However, time-restricted feeding can also potentially cause problems. For example, “people do tend to make better diet choices earlier in the day when they haven't had this hunger built up over hours of time.”

The diet pattern she said she sees most commonly associated with difficulty losing weight and among patients in obesity medicine clinics is consuming few calories throughout the day “but the vast majority in the evening.”

“Because people tend to then get kind of overwhelmed by their hunger late in the day, you tend to crave very calorie-dense things,” Hauser said. “If all we were doing was time restriction, it wouldn't necessarily change the contents of this diet.”

Hauser also offered a tips for physicians coaching patients on lifestyle changes, the first of which was to start with the positive.

“Whenever I’m coaching or talking to someone, I want to start by talking about what they’re doing well. I mean, they’re here,” she said. “Having something that shows that you believe in them, that you see that they’re already making changes, that they’re motivated, is important.”

That can include asking questions about what the patient likes, Hauser said — “different factors related to the way they and their family eat.” Not only does this build trust, but it also helps the physician gauge what they can recommend that the patient would be more likely to stick with.

The other tips Hauser recommended were to:

• have resources available for the types of diets being recommended, especially those with colorful pictures;
• have patients set a goal before they leave the clinic; and
• try to get patients out of an “all-or-nothing” approach to making lifestyle changes.