The use of the Mediterranean diet and intermittent fasting in the management of obesity in the UK

Francis, Louise Eleanor (2019) The use of the Mediterranean diet and intermittent fasting in the management of obesity in the UK. Doctoral thesis, Northumbria University.

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Obesity is a global public health issue, with approximately 30% of the world’s population (equating to over 2.1 billion people) classified as overweight or obese, and 5% of worldwide deaths attributed to this disease in 2014. Because of the significance of obesity and its related comorbidities such as type 2 diabetes and cardiovascular disease alongside its economic impact, there is a clear need for a novel method to prevent and treat obesity alongside controlling weight regain in the long term. This thesis therefore aimed to investigate the use of the Mediterranean diet and intermittent fasting in combination (originally studied together during the Seven Countries Study) for health promotion by considering these patterns’ effectiveness, alongside their acceptability and feasibility to the UK public.

As shown in Figure 1 this thesis followed a series of logical phases, beginning with an evidence generation and understanding phase which suggested that there was a gap in the literature around these dietary patterns and a requirement to consolidate the literature. The second phase therefore aimed to investigate the impact of adherence to a Mediterranean diet and intermittent fasting on outcomes such as body weight and blood lipids by conducting systematic reviews and meta-analyses in order to reflect current understanding. Results suggested that both studied diets were moderately beneficial, for example results of 27 studies suggested that consumption of the Mediterranean diet was associated with improvements to total cholesterol levels, systolic blood pressure and BMI (all p>0.05), and adherence to intermittent fasting was linked to significant decreases in BMI and body fat percentage (both p<0.05).

Therefore to ensure that these eating plans were acceptable to the public, further work in phase 3 involved gathering data to investigate the use of these plans by the public. Findings of a survey of 551 respondents suggested that the UK public are not currently eating a Mediterranean diet and have not readily utilised fasting regimes in their weight loss attempts, although many reported a readiness to attempt weight loss and an acceptance of Mediterranean-style foods. A further investigation suggested that the 45 healthcare professionals who responded to an online survey did not readily recommend a Mediterranean diet or a fasting regime to their patients or use these in their own eating patterns, however respondents did report a knowledge of the benefits of these novel plans, and highlighted potential barriers to their own healthy eating and the recommendation of the Mediterranean diet to their patients. These findings were reflected in a systematic review of 17 studies.

During phase 4, all previously gathered information was used to inform a pilot study investigating the use of a lifestyle intervention involving promotion of either the Mediterranean diet or Eatwell Guide in combination with intermittent fasting. Results suggested that the public found this trial both acceptable and feasible under ‘real-life’ conditions, with a small proportion of drop-outs and generally positive feedback. Advantageous changes were noted with regards to adherence to dietary guidelines, and food diaries reflected beneficial modifications to eating habits for example increased vegetable and decreased soft drink consumption. Findings also suggested a beneficial impact of both study groups on body composition; with significant weight loss observed alongside significant reductions to blood pressure (both p<0.05) and positive changes to blood lipids, however no changes were reported with regards to physical activity levels. Results of this thesis suggest that further research into novel ways of preventing and treating obesity are required, with potential work investigating the use of various forms of intermittent fasting in combination with an eating plan known to be beneficial, such as the Mediterranean diet. This work may be of interest to policy makers or researchers who may find benefit in utilising these studies as a grounding for future investigations.

Phase 1 • Preliminary work background reading and understanding with aquisition of relevant literature

Phase 2 • Furthering understanding and making a novel contribution to knowledge by conducting systematic reviews and meta analysis in the subject area

Phase 3 • Gaining insight into practical applications of findings by designing and implementing surveys of the public and healthcare professionals

Phase 4 • Applying knowledge gained to design and conduct a dietary intervention testing hypotheses generated through previous work

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: nutrition, overweight, cardiovascular, health
Subjects: B400 Nutrition
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Applied Sciences
University Services > Graduate School > Doctor of Philosophy
Depositing User: John Coen
Date Deposited: 04 Apr 2022 14:03
Last Modified: 04 Apr 2022 14:15

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