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Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth

Authors Gow ML, Pham-Short A, Jebeile H, Varley BJ, Craig ME

Received 30 October 2020

Accepted for publication 6 January 2021

Published 18 January 2021 Volume 2021:14 Pages 215—225


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ming-Hui Zou

Megan L Gow,1 Anna Pham-Short,2 Hiba Jebeile,1 Benjamin J Varley,1 Maria E Craig3

1The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia; 2Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW, Australia; 3School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia

Correspondence: Megan L Gow
The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
Tel +61 2 9845 0000
Fax +61 2 9845 3170

Abstract: In both developed and developing countries, pediatric obesity and type 2 diabetes are an increasing public health concern: globally 5.6% of girls and 7.8% of boys aged ≥ 5 years have obesity. The incidence of type 2 diabetes has increased in youth in recent decades and disproportionately affects those from ethnic/racial minority groups and disadvantaged backgrounds. For the treatment of both conditions, conventional lifestyle intervention is frequently ineffective, access to bariatric surgery is very limited and many young people are unsuitable or unwilling to undergo surgery. A very-low-energy diet (VLED) provides a viable alternative and may be effective for weight reduction and improved glycemic control in youth, based on one systematic review. In particular, in the treatment of type 2 diabetes, a chart review and a pilot study both demonstrated that a VLED can reduce the requirement for medications, including insulin, and lead to the remission of diabetes. However, long-term follow-up and safety data remain limited and therefore a VLED is inconsistently recommended by clinical practice guidelines for the treatment of pediatric obesity and type 2 diabetes. In clinical practice, VLED use in children and adolescents is uniquely challenging due to intolerance of expected side effects, difficulty adhering to the highly restrictive diet and difficulty with behaviour change within the current social context and environment. Ultimately, more research, including larger, longer-term trials with comprehensive safety monitoring are required to strengthen the evidence base. This would inform clinical practice guidelines, which may facilitate more widespread utilization of VLED programs in the management of obesity and type 2 diabetes in youth.

Keywords: pediatrics, obesity, type 2 diabetes, very-low-energy diet, youth

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