Efficacy, Safety and Acceptability of a Very-Low-Energy Diet in Adolescents with Obesity: A Fast Track to Health Sub-Study.

Megan L Gow, Hiba Jebeile, Eve T House, Shirley Alexander, Louise A Baur, Justin Brown, Clare E Collins, Chris T Cowell, Kaitlin Day, Sarah P Garnett, Alicia Grunseit, Mary-Kate Inkster, Cathy Kwok, Sarah Lang, Susan J Paxton, Helen Truby, Krista A Varady, Natalie B Lister

Journal: Nutrients 2024;16(18):3125

PMID: 39339725

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Plain Language Summary

Paediatric obesity is linked to various health issues, emphasising the need for effective treatment. When obesity-related comorbidities are present, weight loss becomes a key goal. Guidelines recommend lifestyle programmes focusing on nutrition, physical activity, and sustainable behaviour change. This study aims to explore the efficacy, safety and acceptability of a 4-week very-low-energy diet (VLED) for adolescents with obesity and co-morbidities seeking weight loss treatment. This research (Fast Track to Health) was a two-arm multi-site randomised controlled trial which enrolled adolescents aged 13–17 years with obesity. Participants were randomised to one of two dietary interventions: intermittent energy restriction or continuous energy restriction. Results showed that the dietitian-monitored VLED programme was safely implemented in adolescents with obesity, though side effects were common and acceptability varied. Participants lost an average of 5.5 kg over four weeks, lower than the 10.1 kg average in longer VLED studies. Most achieved ketosis at some point, showing adherence is possible without inpatient care, but sustained ketosis was limited, indicating potential for greater weight loss. Authors concluded that a dietitian-monitored VLED can be implemented safely in the short-term and can be effective for achieving rapid short-term weight loss in adolescents with obesity.

Abstract

The aim of this study was to determine the efficacy, safety and acceptability of a 4-week very-low-energy diet (VLED) program for adolescents with obesity. Adolescents (13-17 years) with obesity and ≥1 obesity-related complication were Fast Track to Health 52-week randomized controlled trial participants. Adolescents undertook a 4-week micronutrient-complete VLED (800 kcal/day), with weekly dietitian support. Anthropometric data were recorded at baseline and week-4 and side-effects at day 3-4, week-1, -2, -3 and -4. Adolescents completed an acceptability survey at week-4. A total of 134 adolescents (14.9 ± 1.2 years, 50% male) had a 5.5 ± 2.9 kg ( < 0.001) mean weight loss at week-4: 95% experienced ≥1 and 70% experienced ≥3 side-effects during the VLED program, especially during the first week. Hunger, fatigue, headache, irritability, loose stools, constipation and nausea were most common. Reporting more side-effects at day 3-4 correlated with greater weight loss at week-4 (r = -0.188, = 0.03). Adolescents reported 'losing weight' (34%) and 'prescriptive structure' (28%) as the most positive aspects of VLED, while 'restrictive nature' (45%) and 'meal replacement taste' (20%) were least liked. A dietitian-monitored short-term VLED can be implemented safely and is acceptable for many adolescents seeking weight loss, despite frequent side-effects. Investigating predictors of acceptability and effectiveness could determine adolescents most suited to VLED programs.

Address: Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia.; Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia.; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.; Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia.; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.; Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, VIC 3168, Australia.; Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia.; School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.; Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.; Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia.; Kids Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.; School of Agriculture, Food and Ecosystem Sciences, University of Melbourne, Melbourne, VIC 3010, Australia.; Department of Nutrition, Dietetics & Food, Monash University, Melbourne, VIC 3004, Australia.; Nutrition and Dietetics, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.; Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, VIC 3168, Australia.; Department of Nutrition, Dietetics & Food, Monash University, Melbourne, VIC 3004, Australia.; Department of Nutrition, Dietetics & Food, Monash University, Melbourne, VIC 3004, Australia.; School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia.; School of Primary and Allied Health Care, Monash University, Melbourne, VIC 3004, Australia.; School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia.; Department of Kinesiology and Nutrition, University of Illinois, Chicago, IL 60612, USA.

DOI: 10.3390/nu16183125

Patient Centred Factor

Mediators: Adolescents with obesity

Clinical Imbalances

Immune and inflammation Structural Integrity and Musculoskeletal

Laboratory Testing

Blood

Modifiable Lifestyle Factors

Diet

Jadad Score

Allocation Concealment

Yes

Nutrition Evidence Keywords

Obesity Body mass index Weight loss Ketosis Micronutrient Low-energy diet

Link outs

Free resources

Full Text Sources:

Medical:

https://medlineplus.gov/weightcontrol.html

MeSH Terms: Humans, Adolescent, Male, Female, Pediatric Obesity, Weight Loss, Diet, Reducing, Caloric Restriction, Treatment Outcome, Patient Acceptance of Health Care