A new global analysis suggests alternate-day fasting may offer slightly greater benefits for weight and cholesterol management than intermittent fasting, according to evidence from nearly 100 clinical trials. As interest in dietary strategies grows in Thailand, especially amidst rising rates of metabolic syndrome and obesity, this research highlights fresh possibilities—and caveats—for Thai readers considering alternative nutritional approaches.
With 2.5 billion adults worldwide classed as overweight and more than 890 million living with obesity according to the World Health Organization (who.int), weight management is an increasingly urgent public health issue. Thailand is not exempt, with national surveys showing the prevalence of overweight and obesity rising steadily in recent years (healthdata.org). These trends are tightly linked to escalating rates of high blood pressure, type 2 diabetes, and cardiovascular disease, deeply affecting Thai families and healthcare systems alike.
Intermittent fasting, a regimen alternating periods of eating and fasting, has surged in popularity globally and in Thailand, finding support at wellness clinics and in health-focused social media communities. Common variations include 16:8 time-restricted eating (16 hours fasting, 8 hours eating) and the 5:2 diet. Another, less familiar, approach is alternate-day fasting, where individuals fast for a full 24 hours every other day.
The new study, which systematically reviewed 99 randomized clinical trials involving over 6,500 adults, compared the metabolic and weight-related effects of several dietary strategies: alternate-day fasting, intermittent fasting (including time-restricted eating), continuous calorie restriction, and unrestricted eating. Researchers discovered that alternate-day fasting was the only method that led to modestly greater reductions in body weight and improvements in metabolic markers—specifically, reductions in both total and LDL (“bad”) cholesterol—compared to continuous calorie restriction or time-restricted eating (AOL report).
Drilling deeper, the study’s participants averaged a body mass index (BMI) of 31, indicating they were, on the whole, obese. Some 90% already had pre-existing health conditions related to metabolic dysregulation. The findings are especially relevant for high-risk groups in Thailand, including those with significant abdominal obesity and metabolic syndrome, which are rising concerns even among working-age adults and urban youth (samitivejhospitals.com).
Yet, the study authors caution that while alternate-day fasting yielded better results compared to other strategies, the average weight loss did not reach the “clinically significant” threshold of at least 2 kilograms for obese individuals. “Longer-duration trials are needed to further substantiate these findings,” the researchers wrote, highlighting that most included trials lasted less than a year. Future research must also focus on how alternate-day fasting affects diverse populations, and whether any metabolic gains persist over years rather than months.
“This approach could be added to the therapeutic toolkit for managing weight and metabolic health,” the authors note, but emphasize that intermittent fasting and alternate-day fasting are not replacements for traditional dietary or medical strategies—they are best seen as potential complements within a broader, patient-centered model.
The scientific community remains divided about the long-term sustainability and adherence to fasting regimens. Prior research, such as a key randomized controlled trial published in JAMA Internal Medicine, found that although alternate-day fasting could produce similar weight loss to daily calorie restriction, adherence to the regimen was actually lower, and dropout rates were higher among those assigned to alternate-day fasting (PMC article). This is a crucial consideration in Thailand, where family meal culture and Buddhist fasting traditions can both support and complicate strict dietary interventions.
For example, alternate-day fasting may echo the lunar fasting (“ubosot”) practiced on Buddhist holy days, but strict adherence on a weekly or daily basis has not been widely adopted in the Thai context outside monastic settings. Nutrition professionals at major Bangkok hospitals have observed that while some Thais report benefits from intermittent fasting, many find the social and psychological challenges of long fasting periods difficult to overcome (Bangkok Hospital).
Dr. Benjamin Lebwohl, a Columbia University Medical Center physician and lead researcher of a large meta-analysis published in The BMJ in 2025, stresses the importance of tailoring interventions. “Fasting regimens can help certain patients, but they’re not a panacea. Factors like culture, daily environment, and social support networks play a huge role in whether changes stick,” he asserted. Thai dietitians echo this, pointing out that the country’s rich food-sharing culture and the value placed on rice-based meals can make strict alternate-day fasting socially isolating for some.
Critically, “no single diet fits every patient,” noted a senior nutritionist at a leading Bangkok hospital. At their clinic, nutrition counseling emphasizes flexibility and sustainability over rigid rules—a philosophy validated by earlier research showing that individualized weight-loss plans are more sustainable and effective long-term than “one-size-fits-all” approaches.
From a scientific and clinical perspective, alternate-day fasting appears to mildly outperform time-restricted eating and continuous calorie-cutting in the short term, but falls short of delivering dramatic weight loss or breakthroughs for most people living with obesity. In practical terms, this means that Thai adults considering alternate-day fasting should do so under the guidance of trained medical professionals, particularly if they have metabolic disorders or take medications that could interact with fasting protocols.
It’s also essential to recognize that the Thai Ministry of Public Health has not issued official guidelines for alternate-day or intermittent fasting, though several major health centers have published introductory materials on their websites (samitivejhospitals.com). Thai guidelines for weight control still prioritize steady calorie reduction, increased intake of fruits and vegetables, regular exercise, and the avoidance of processed snacks.
Looking ahead, the future of dietary interventions for obesity in Thailand will likely blend global research insights with local tradition and contemporary Thai lifestyles. The latest research demonstrates that alternate-day fasting offers some advantages over intermittent fasting, but also raises new questions about feasibility, acceptability, and effectiveness over the long run. As medical teams in Thailand increasingly confront the burden of metabolic syndrome, expect more integration of fasting strategies with established Thai public health advice—always tailored to the unique needs of individual patients and families.
For Thais interested in exploring alternate-day fasting: consult your physician before starting, especially if you have underlying health conditions; seek guidance from registered dietitians familiar with fasting protocols; approach any dietary change as a long-term lifestyle shift, not a quick fix; and, importantly, listen to your own body’s response. Balanced, sustainable, and culturally sensitive approaches are key to any lasting health improvement for Thai communities.
Sources:
- “This dieting approach may be more effective than intermittent fasting, scientists say” – AOL
- “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial” – PMC
- “All you need to know about intermittent fasting” – Samitivej Hospital
- “Intermittent Fasting (IF): An effective tool for weight loss” – Bangkok Hospital
- “Global, regional, and national prevalence of overweight and obesity” – World Health Organization
- “Thailand: Overweight and obesity data” – Institute for Health Metrics Evaluation