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

Figures & data

Table 1 Description of Published Very-Low-Energy Diet Intervention Trials for Young People with Obesity and/or Type 2 Diabetes

	Food-Based VLED Interventions, n=17	Formula-Based VLED Interventions, n=6	VLED Type Not Stated, n=1
Year of publication	1980s (n=2), 1990s (n=12), 2000s (n=2), 2010s (n=1)	1980s (n=5), 2010s (n=1)	1997
Country of study	USA (n=12), Italy (n=3), Austria (n=2)	Austria (n=4), USA (n=1), Australia (n=1)	Italy
Study type	Chart review (n=2); pre-post (n=12); non-randomised comparison (n=2); RCT (n=1)	Pre-post (n=4); non-randomised comparison (n=2)	RCT
Sample size (range of included studies)	6 to 87	8 to 16	103
Participant age (range of included studies)	5 to 18 years	7 to 16 years	mean ± SD: 15.4 ± 0.2 years
Inclusion criteria	Obesity/severe obesity (n=16); obesity and type 2 diabetes (n=1)	Obesity/severe obesity (n=5); obesity and type 2 diabetes (n=1)	Severe obesity
Intervention duration; follow-up from baseline (number of studies including follow-up)	3 weeks to “up to” 26 weeks (until goal weight achieved); 20 weeks to “up to” 5 years (n=10)	3 weeks to 5 months; 34 week (n=1)	2 months; no follow up
Range of retention rates post intervention; follow up	75–100%; 50–70%	63–100%; 63%	NR

Note: Data from Andela et al.²⁷ Abbreviation: NR, not reported.

Table 2 Evidence and Knowledge Gaps for the Use of Very-Low-Energy Diets in Youth

What is known about VLED use in obesity?	Leads to short-term weight loss
What is known about VLED use in type 2 diabetes?	Improves glycemic control, including potential remission Can reduce the need for medication
Areas for future research	Long-term studies Larger studies Studies that include a control group Collection and reporting of safety data including side effects, growth, cardiac function, psycho-behavioral outcomes and acceptability of the diet

Figure 1 (A) Meta-analysis of weight loss immediately following a very-low-energy diet intervention. (B) Meta-analysis of weight loss at latest follow-up following a very-low-energy diet intervention. Reproduced with permission from Andela S, Burrows TL, Baur LA, Coyle DH, Collins CE, Gow ML. Efficacy of very low-energy diet programs for weight loss: a systematic review with meta-analysis of intervention studies in children and adolescents with obesity. Obes Rev. 2019;20(6):871–882; © 2019 World Obesity Federation.²⁷

Table 3 Potential Barriers to and Facilitators of the Use in Clinical Practice of Very-Low-Energy Diets to Treat Youth with Obesity and/or Type 2 Diabetes

Barriers	Facilitators
Difficult to adhere to calorie restriction Potential safety concerns not adequately addressed in research to date Diet acceptability, ie limited food options and taste of meal replacements Perceived unaffordability of meal replacement products Difficulty attending social events	Frequent contact with health professional Provision of VLED products Support from family and peers Technology, ie calorie counting phone applications Well thought out meal plans High water consumption Planning for social outings

Andela S , Burrows TL , Baur LA , Coyle DH , Collins CE , Gow ML . Efficacy of very low-energy diet programs for weight loss: a systematic review with meta-analysis of intervention studies in children and adolescents with obesity. Obes Rev . 2019;20(6):871–882. doi:10.1111/obr.12830 30734459

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