4:3 Intermittent fasting shows modestly greater weight loss than daily caloric restriction

Embargoed for release until 5:00 p.m. ET on Monday 31 March 2025   

Follow @Annalsofim on X, Facebook, Instagram, threads, and Linkedin        
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
----------------------------      

1. 4:3 Intermittent fasting shows modestly greater weight loss than daily caloric restriction

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01631  

URL goes live when the embargo lifts            

A randomized clinical trial compared the effects of 4:3 intermittent fasting versus daily caloric restriction on weight loss when combined with comprehensive behavioral support in adults with overweight or obesity. The data showed that 4:3 intermittent fasting resulted in modestly greater weight loss over 12 months. The results are published in Annals of Internal Medicine. 

Researchers from University of Colorado School of Medicine and colleagues randomly assigned 165 adults with overweight or obesity to either 4:3 intermittent fasting or calorie restriction for 12 months to compare weight loss between interventions. Participants in the 4:3 intermittent fasting group undertook a modified fast to produce an 80% energy restriction for 3 nonconsecutive days per week. On non-fast days, participants in the 4:3 intermittent fasting group did not have to restrict energy intake,  but were encouraged to make healthy food choices. Participants in the calorie restriction group were prescribed a daily calorie goal designed to produce a 34.3% energy deficit. All participants were given a free gym membership and encouraged to exercise for at least 300 minutes per week. In addition to group-based behavioral support, participants received instruction in calorie counting and a guide to target dietary macronutrient content of 55% carbohydrates, 15% protein and 30% fat.

At 12 months, participants in the 4:3 intermittent fasting group had a –7.6% change in body weight compared to –5% in the calorie restriction group. 58% of those in the fasting group achieved weight loss of at least 5% at 12 months vs 47% in the calorie restriction group. Participants in the fasting group also achieved more favorable changes cardiometabolic outcomes including systolic blood pressure, total and low-density lipoprotein cholesterol levels, and fasting glucose level. According to the authors, the findings suggest that because fasting does not require participants to focus on counting calories and restricting food intake every single day, it may result in greater adherence and should be considered within the range of evidence-based dietary weight loss approaches. 
 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Danielle M. Ostendorf, PhD, please email Tyra Haag at tyra.haag@tennessee.edu or call 865-974-5460. To speak with first author and PI of the study, Victoria Catenacci, MD or senior author, Edward Melanson, PhD please email Georgann Van Gemert at GEORGANN.VANGEMERT@CUANSCHUTZ.EDU.

----------------------------      

2. Use of GLP-1RAs tripled among people without diabetes between 2018 and 2022, resulting in $5.8 billion in expenditures

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02878

URL goes live when the embargo lifts            

An analysis of nationally representative survey data examined trends in glucagon-like peptide-1 receptor agonist (GLP-1RA) use and expenditure among people in the United States without diabetes. The researchers found that between 2018 and 2022, the number of adults without diabetes taking GLP-1RAs increased more than three-fold, leading to $5.8 billion in annual expenditures by 2022. The study is published in Annals of Internal Medicine. 

Researchers from The University of Melbourne analyzed data from the Medical Expenditure Panel Survey (MEPS) Household Component from 2018 to 2022. The data sample included 89,854 adults aged 18 or older who had no prior diabetes diagnosis other than gestational diabetes. The researchers estimated the number and proportion of people who filled at least 1 GLP-1RA prescription each year and the annual national expenditure on GLP-1RAs. Between 2018 and 2021, the annual prevalence of GLP-1RA use was 0.1%. By 2022, this prevalence increased to 0.4%, with an estimate of 854,728 adults without diabetes using GLP-1RAs nationwide. Annual expenditure on GLP-1RAs among adults without diabetes increased from $1.6 billion between 2018 and 2021 to $5.8 billion in 2022, with a mean overall cost of $1540.00 per prescription. From 2018 to 2022, the mean number of prescriptions per user was 4.1. Overall, GLP1-RA use and expenditures among those without diabetes increased between 2018 to 2022. Despite this, adoption remained limited, with only one in 250 adults without diabetes using a GLP-1RA in 2022. These findings provide the first characterization of nationwide GLP-1RA use and spending among individuals without diabetes to guide ongoing discussions about balancing the sustainability of health care spending against improving accessibility and affordability of GLP-1RA medications moving forward. 
 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with first author Cade Shadbolt please email University of Melbourne Media and Public Affairs team at media-enquiries@unimelb.edu.au.

----------------------------  

3. New ACP position paper urges policymakers to prioritize improving rural health and health care

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03577

URL goes live when the embargo lifts           

Rural communities in the United States face a dire health crisis that threatens the population’s well-being, says the American College of Physicians, in a new policy published today in the Annals of Internal Medicine. Improving Health and Health Care in Rural Communities: A Position Paper from the American College of Physicians, says that it is critical that policymakers prioritize and direct attention to improving rural health and health care.

Among the recommendations that ACP makes, they call for efforts to identify and address challenges that disproportionately impact rural populations. ACP reaffirms its call for policymakers to evaluate and implement public policy interventions that address underlying social drivers of health that disproportionately and negatively impact rural communities and perpetuate rural health inequities. Additionally, ACP urges policymakers to consistently and sufficiently fund and support health care programs and facilities that serve rural communities.

The paper goes on to highlight the need to better support physicians and other members of the health care workforce in rural areas, noting that medical education should incorporate education on rural health issues. ACP calls for increased efforts to increase and retain the rural physician workforce, including for efforts to expand opportunities for additional international medical graduates. ACP recognizes the role that reimbursement plays in recruiting and retaining physicians in rural areas and urges policymakers to adopt incentives that support physician recruitment and retention. Finally, ACP says that appropriate exceptions should be made to licensure requirements for interstate care, in order to ensure access to telehealth services in underserved areas.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

----------------------------  

4. Patient navigation programs boost follow-up colonoscopy adherence after abnormal stool tests

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01885  

URL goes live when the embargo lifts            

A randomized controlled trial aimed to determine whether a patient navigation intervention given to people with an abnormal stool test increased follow-up colonoscopy completion at one year. The researchers found that patient navigation improved follow-up colonoscopy completion rates after an abnormal stool test, suggesting this is a highly effective intervention for patients eligible for a colonoscopy. The study is published in Annals of Internal Medicine.  

Researchers from Kaiser Permanente Center for Health Research, University of Arizona Cancer Center, and colleagues studied data for 967 patients aged 50 to 75 years at Sea Mar Community Health Centers, a federally qualified health center (FQHC) in western Washington State who had received an abnormal fecal test result in the prior month. The researchers compared the effectiveness of a patient navigation program to usual care outreach on the receipt of a colonoscopy after an abnormal stool test. The researchers also developed a risk prediction model that calculated a patient’s probability of obtaining a follow-up colonoscopy without a navigation intervention to determine if those with low probability scores were more affected by the intervention. The patient navigation program covered six areas: introduction and barrier assessment, barrier resolution, bowel preparation instruction, bowel preparation reminder, colonoscopy check-in, and understanding of colonoscopy result and resting interval. The intervention was delivered in both English and Spanish by a centralized, full-time navigator. Navigators mailed introductory letters and delivered live calls and text messages to patients addressing the six topic areas at different scheduled times. The patient navigators also worked with community-based organizations to coordinate reduced-cost care and free ride-sharing services to help patients in the intervention group obtain their colonoscopies. For patients in the usual care group, a centralized referral coordinator contacted patients with a colonoscopy referral to schedule an appointment; patients not initially reached were recontacted 30 and 45 days after the referral date and received up to two contact attempts. 

The researchers found that 55.1% of patients in the intervention group and 42.1% of patients in the usual care group received a colonoscopy within a year. Bowel preparation accuracy was similar for both the intervention and usual care groups. Among those with the lowest probability of obtaining a follow-up colonoscopy, the navigation intervention increased colonoscopy receipt for 2.7 percentage points compared with 15.5 percentage points for those with moderate probability and 14.8 percentage points for those with high probability. Overall, the patient navigation intervention significantly increased one year follow up colonoscopy completion in those who received an abnormal stool test, resulting in a 13-percentage point increase. Additionally, the program effectiveness did not differ significantly by the probability of patients receiving a follow up colonoscopy without patient navigation.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Gloria D. Coronado, PhD, please email Mark Febbo at markanthonyf@arizona.edu.

----------------------------      

5. 1 in 10 adults with substance use disorder are hospitalized, suggesting potential benefits of hospital-based SUD screening and treatment programs

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03385

URL goes live when the embargo lifts            

An analysis of a national sample of adults with substance abuse disorders (SUDs) aimed to describe the prevalence of hospitalizations among this population to inform the potential impact of hospital-based treatment programs. The analysis found that one in 10 adults in the U.S. with SUD reported a hospitalization in the past year. The findings suggest the potential for hospital-based SUD screening and treatment. The study is published in Annals of Internal Medicine.  

Researchers from the University of Colorado School of Medicine and Yale School of Medicine studied data from 60 million U.S. adults with SUD identified from the 2022 National Survey on Drug Use and Health. Substance use disorder included alcohol use disorder (AUD), opioid use disorder (OUD), stimulant use disorder (StUD), and cannabis use disorder (CUD). The primary outcome was self-reported past-year hospitalizations of any cause. The researchers estimated the proportion and number of U.S. adults who reported hospitalizations and used prevalence ratios to describe difference in demographic, socioeconomic and medical characteristics in hospitalized and nonhospitalized adults. The researchers found that 5.8 million of a weighted sample of 60 million adults with SUD reported a hospitalization in the past year. Among those with OUD, 23.6 percent reported a hospitalization. Adults hospitalized were more likely to be older, have two or more medical comorbid conditions and have a serious mental illness. They were also less likely to be uninsured, with the exception of those with AUD. The researchers note that these findings likely underestimate the true prevalence of hospitalizations in those with SUD because they do not account for readmissions, unhoused patients who do not reside in shelters or incarcerated patients.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Eden Y. Bernstein, MD, MPH, please email Rachel Fischer at RACHAEL.FISCHER@CUANSCHUTZ.EDU.

----------------------------    

6. Unifying Efforts to Empower Equitable Obesity Care: Synopsis of an American College of Physicians and Council of Subspecialty Societies Summit

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00675

URL goes live when the embargo lifts  

Obesity is a leading cause of morbidity and mortality with wide-ranging health consequences that cross-cut many medical specialties. Despite the emergence of effective and promising new therapies, many barriers to comprehensive obesity care remain. As part of their commitment to improving obesity care, the American College of Physicians (ACP) and its Council of Subspecialty Societies (CSS) held a summit in Fall of 2023, to identify barriers and opportunities for collaborative action in the domains of physician education; healthcare policy and care delivery; and addressing weight bias. This report is published in Annals of Internal Medicine and summarizes the summit proceedings and post-summit efforts.

Key themes of the summit centered on knowledge, advocacy, action, and compassion and the need for culture change and paradigm shifts in obesity care. To effectively engage clinicians in obesity management, ACP-CSS recognized that improvements in three major domains were critical: physician education; healthcare policy and care delivery; and addressing weight bias.

The goals of the summit were to better understand how to address these barriers and to foster collaborative efforts among professional clinical organizations to develop and implement solutions. Data presented at the summit underscored the rise and high prevalence of obesity in adults in various demographic groups, attributed often to rise in less healthy eating and sedentary lifestyle; changes in food production, marketing of affordable but less healthy foods, and mixed messages about what constitutes a healthy diet; the rise in technology; and changes in the fixed environment. The summit acknowledged that these changes disproportionately affect the socioeconomically disadvantaged.

Summit participants also discussed that obesity treatment paradigms have often centered around intensive behavioral lifestyle change interventions that were only modestly effective, difficult to implement and sustain (especially for the socioeconomically disadvantaged), and poorly reimbursed and underfunded.

Further, the lack of medical education and post-graduate training about obesity and nutrition was acknowledged-- resulting in competency gaps in the current clinical workforce.  Obesity is also often viewed as being primarily within the purview of general internal medicine and other primary care clinicians whose workforce numbers are dwindling. Finally, despite advances in our understanding of the causes and contributors of obesity, weight bias and stigma remain.

The summit concluded by highlighting priorities and specific steps for how medical professional societies might collaborate to improve clinical education, optimize obesity care delivery, and reduce stigma and bias. Recommendations for next steps include:

• Leveraging and improving already available educational and clinical resources;
• Developing obesity education and care standards that incorporate patients’ perspectives and address social determinants of health;
• Developing community and public, private partnerships to improve access and public awareness and;
• Coordinating messaging and policy advocacy efforts to mitigate the longstanding obesity epidemic.

Summit participants also identified metrics to evaluate outcomes in these areas.

ACP has been and continues to be active in providing resources and disseminating high-quality research for internal medicine physicians and the medical community through our Advancing Equitable Chronic Obesity Care | ACP Online which includes physician education and resources (e.g. ACP’s Obesity Management Hub, Annals’ Overweight and Obesity Collection and In the Clinic series on Obesity, and ACP/Annals Virtual forum on Overweight and Obesity); advocacy for conducive public and healthcare payment policies; and engagement with patients and communities at the population level.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

----------------------------   

7. Annals supplement highlights important new evidence readers ‘may have missed’ in 2024

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01164 

URL goes live when the embargo lifts      

A supplement published in Annals of Internal Medicine highlights important new evidence published in 2024 that readers may have missed. The editors say the intent is to provide internal medicine physicians and other clinicians a brief overview of selected new evidence of relevance to those who practice outside of each of the 8 disciplines featured: nephrology, cardiology, infectious disease, rheumatology, oncology, endocrinology, gastroenterology/hepatology, and pulmonology. The objective is to highlight novelty in each subspecialty field that may impact the practice of general internal medicine where a consult with a specialist may or may not be needed. “What You May Have Missed” is an annual feature stemming from a partnership between Annals of Internal Medicine and McMaster University.

Media contacts: For an embargoed PDF by topic or to speak with Annals Editor in Chief Christine Laine, MD, MPH, please contact Angela Collom at acollom@acponline.org.

----------------------------