Time-Restricted Eating Beats Calorie Counting for Weight Loss in Type 2 Diabetes

This study in the JAMA network open explored if time-restricted eating (TRE) could be a better alternative to calorie restriction (CR) for weight loss and managing blood sugar in adults with type 2 diabetes. In a 6-month trial, those following TRE lost more weight than the CR and control groups. While both TRE and CR helped lower blood sugar, only TRE showed weight loss. Participants found TRE easier to stick to and ate fewer calories overall. No serious side effects were reported. TRE seems like a promising option, but larger studies are needed to confirm these findings.

Key points

Question: Is time-restricted eating (TRE) more effective than calorie restriction (CR) for weight loss and HbA1c control in adults with type 2 diabetes?

Study: A 6-month randomized clinical trial with 75 participants.

Findings:

• Weight loss: TRE was better than CR (-3.6% vs. -1.8%). Both were better than the control group.

• HbA1c: Both TRE and CR lowered HbA1c (-0.91% and -0.94%, respectively) compared to controls, but there was no difference between the two groups.

• Safety: No serious adverse events were reported.

Meaning: TRE without calorie counting may be an effective alternative to CR for weight loss and HbA1c control in type 2 diabetes. More research is needed to confirm these findings.

Additional points:

• Participants in the TRE group ate only between 12 pm and 8 pm.

• Both TRE and CR participants reduced their calorie intake compared to the control group.

• Adherence to the TRE protocol was good, with participants following the eating window on average 6.1 days per week.

Limitations:

• Relatively small sample size.

• Short follow-up period.

• More research is needed to understand the long-term effects of TRE on health outcomes.

Overall: this study suggests that TRE may be a beneficial dietary strategy for people with type 2 diabetes who are looking to lose weight and control their blood sugar. However, it is important to talk to your doctor before starting any new diet, especially if you have any underlying health conditions.

In recent years, the exploration of innovative dietary strategies for managing Type 2 Diabetes (T2D) and obesity has gained significant attention. Among these strategies, time-restricted eating (TRE) has emerged as a promising approach. This article delves into the findings of a randomized clinical trial, shedding light on the efficacy of 8-hour TRE in comparison to daily calorie restriction (CR) and a control condition, specifically focusing on its impact on weight loss and HbA1c levels in individuals with T2D and obesity.

Understanding the Trial Results

The randomized clinical trial revealed compelling insights into the effectiveness of 8-hour TRE as an alternative dietary strategy. Notably, participants in the TRE group experienced greater weight loss compared to those in the CR and control groups. This finding underscores the potential of TRE as a viable option for individuals struggling with weight management, particularly those with T2D and obesity.

Problem: Calorie restriction (CR) is difficult for many people with type 2 diabetes (T2D) to maintain. Time-restricted eating (TRE) could be a more appealing alternative.

Study: 6-month randomized clinical trial with 75 adults with T2D and obesity comparing:

• TRE: Eat all food between 12 pm-8 and 8 p.m. daily (8-hour window) - no calorie counting

• CR: Reduce daily calorie intake by 25%

• Control: Maintain usual diet and exercise

Findings:

• Primary: The TRE group lost more weight than CR (-3.6% vs. -1.8%) and control (-1.8%). Both TRE and CR lost more than control.

• Secondary: No difference in HbA1c reduction between groups (all slightly reduced).

• Safety: No serious adverse events were reported.

Limitations:

• Small study size

• Short follow-up period

Conclusion: TRE may be a promising alternative to CR for weight loss in T2D, but more research is needed.

Additional notes:

• Participants in the TRE group adhered to the eating window well (6.1 days/week average).

• Both the TRE and CR groups reduced calorie intake compared to the control.

• Further research is needed to understand the long-term effects of TRE on health outcomes.

Weight Loss and Adherence

The trial results demonstrated that adherence to the intervention was notably higher in the TRE group, highlighting the feasibility and acceptability of this approach among participants. This aspect is crucial, as adherence plays a pivotal role in the long-term success of any dietary intervention. The simplicity of TRE, which involves only counting time instead of calories, likely contributed to its superior adherence rates compared to CR.

Impact on HbA1c Levels

Although both the TRE and CR groups exhibited similar reductions in HbA1c levels relative to the control group, the TRE intervention yielded greater weight loss. This finding suggests that factors beyond weight loss alone may influence glycemic control in individuals with T2D. Notably, both TRE and CR groups received individualized diabetes nutrition counseling, which could have contributed to the improvements in HbA1c levels observed across the board.

Comparing with Previous Studies

The trial findings align with earlier research on the efficacy of TRE in T2D populations. Previous studies have demonstrated varying degrees of weight loss with TRE interventions of different durations. However, the 8-hour TRE intervention in this trial yielded slightly greater weight loss compared to existing reports. This underscores the potential of extended TRE durations for achieving meaningful weight reduction outcomes.

Safety and Considerations

One key aspect highlighted by the trial is the safety of TRE, particularly for individuals using diet alone or medications to manage their T2D. However, for those on sulfonylureas and/or insulin, adopting a TRE regimen may necessitate medication adjustments and regular monitoring, especially during the initial stages of the diet.

Addressing Racial and Ethnic Disparities

Given the disproportionate prevalence of T2D among Hispanic and non-Hispanic black adults in the US, the trial's findings hold significant implications for addressing health disparities. The efficacy of TRE in promoting weight loss and improving glycemic control in a sample representative of these groups underscores its potential as an accessible and culturally relevant dietary intervention.

Limitations and Future Directions

While the trial provides valuable insights, it is not without limitations. The relatively short duration of the trial and the lack of participant blinding are notable constraints. Additionally, the trial population's medication usage at baseline could have influenced the weight loss outcomes. Future research endeavors should aim to address these limitations through larger-scale randomized controlled trials with longer follow-up periods.

Conclusion

In conclusion, the findings of this randomized clinical trial underscore the efficacy of 8-hour TRE as an effective dietary strategy for weight loss and HbA1c level reductions in individuals with T2D and obesity. By offering a simpler and more sustainable alternative to traditional calorie counting, TRE has the potential to empower individuals to manage their health effectively.

Journal Reference

Pavlou, V., Cienfuegos, S., Lin, S., Ezpeleta, M., Ready, K., Corapi, S., Wu, J., Lopez, J., Gabel, K., Tussing-Humphreys, L., Oddo, V. M., Alexandria, S. J., Sanchez, J., Unterman, T., Chow, L. S., Vidmar, A. P., & Varady, K. A. (2023). Effect of Time-Restricted Eating on Weight Loss in Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA network open, 6(10), e2339337. https://doi.org/10.1001/jamanetworkopen.2023.39337

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