Ramadan fasting and weight change trajectories: Time-varying association of weight during and after Ramadan in low-income and refugee populations

Abstract

Obesity is a significant driver of the global burden of non-communicable diseases. Fasting is one approach that has been shown to improve health outcomes. However, the effects of Ramadan fasting differ in that the type, frequency, quantity, and time of food consumption vary. This phenomenon requires in-depth evaluation considering that 90% of Muslims (~2 billion people) fast during Ramadan. To address this issue, we evaluated the pattern of weight change during and following Ramadan for a total of 52 weeks. The study was conducted in Amman, Jordan. Between 2012 and 2015, 913 participants were recruited as part of a trial investigating the efficacy of a weight loss intervention among those with or at risk for diabetes. Weight was measured weekly starting at the beginning of Ramadan, and changes were analyzed using discrete and spline models adjusted for age, sex, and trial group. Results show slight weight gain within the first two weeks and weight loss in the subsequent weeks. During the first week of Ramadan, the estimate for a weight reduction was 0·427 kg, (95% CI: -0·007, 0·861), increasing to 1·567 kg, (95% CI: 2·547, 3·527) at week 26. There was clear evidence of gradual weight gain from about 4 to 15 weeks and a drop towards the end of the investigation at week 28 (-0·12kg, 95% CI: -0·89, 0·56). Our results show that weight changes occurred during and after Ramadan. Weight fluctuations may affect health risks, and thus, findings from this study can inform interventions. Public health agencies could leverage this period of dietary change to sustain some of the benefits of fasting. The authors (DEZ, EFD) acknowledge the Mulago Foundation, the Horace W. Goldsmith Foundation, Robert Wood Johnson Foundation, and the World Diabetes Foundation. TRIAL REGISTRATION. Clinicaltrials.gov registry identifier: NCT01596244.

Social network enhanced behavioral interventions for diabetes and obesity: A 3 arm randomized trial with 2 years follow-up in Jordan

“…The overall net effect across all time periods between the Full MCP and the controls and between the Basic MCP and the controls were analyzed as the joint test of all the time-by-group interaction coefficients. Because of the hierarchal social network nested structure of the study setting, and because of the major influence of Ramadan on eating and fasting in Muslim society and prior Ramadan-related body weight effects found in Jordan [ 28 , 29 ], all analyses adjusted for age, sex, fasting, cohort wave, neighborhood, day of week, and external current event factors (Ramadan and political unrest), and key interactions with the external factors. We also conducted two-arm head-to-head analysis comparing individual arms, as well as stratified analysis by obesity status at baseline and by gender.…”

“…One intervention, the Microclinic Program (MCP) has been designed to address these issues [18][19][20][21][22][23][24][25][26][27][28][29]. After completing a successful cohort analysis of a 4-month program and followed for 2 years demonstrating sustained weight-loss and improvements in blood glucose and cholesterol among diabetic and at-risk Jordanians [30], and after conducting a 2-arm trial in Appalachia-Kentucky [19,20], the MCP program was adopted by the United Nation's Relief Works Agency as its core diabetes management program for refugees in Jordan, West Bank, Gaza, and Lebanon [27].…”

Chrononutrition in the context of Ramadan: Potential implications

“…It is also important to note that in most individuals this weight reverts to its pre-Ramadan levels in a matter of few weeks post-Ramadan. 20,21…”