Diabetes, Metabolic Syndrome and Obesity (Jan 2021)
Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth
Abstract
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, AustraliaCorrespondence: Megan L GowThe University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, AustraliaTel +61 2 9845 0000Fax +61 2 9845 3170Email [email protected]: 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
