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

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.

Obesity in children and adolescents: epidemiology, causes, assessment, and management

“… 160 Data on VLEDs in the treatment of youth with early onset type 2 diabetes are limited to a small pilot study 161 and a medical chart review, 162 however, they have shown early short-term success and the possibility of reducing the requirement for medication, including insulin, and inducing remission of diabetes. 163 However, there is need for further research. 163 Variations in macronutrient distribution have been widely studied due to hypothesised effects on satiety, particularly higher protein (20–30% of energy intake from protein) approaches and very low carbohydrate diets (<50g per day or <10% energy from carbohydrate) aiming to induce ketosis.…”

Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement

“…Box 4 provides summary recommendations for nutrition management, noting that there is little evidence for one specific macronutrient approach in young adult type 2 diabetes. Of interest, the very low energy diet approach has shown benefit among adolescents with obesity and newly diagnosed type 2 diabetes, but evidence for long term effects is lacking at present 26,27 . Similarly, in adults using a weight management program incorporating a low energy formula diet, the DiRECT trial achieved remission of diabetes in almost half of the patients randomised to this intervention 28 .…”

“…Of interest, the very low energy diet approach has shown benefit among adolescents with obesity and newly diagnosed type 2 diabetes, but evidence for long term effects is lacking at present. 26,27 Similarly, in adults using a weight management program incorporating a low energy formula diet, the DiRECT trial achieved remission of diabetes in almost half of the patients randomised to this intervention. 28 Although young adults with type 2 diabetes were not well represented in this trial and evidence for durability of effect is still limited, the approach merits further consideration given the potential pre-conceptual, occupational and other benefits of inducing remission in this age group.…”

On the nutritional and therapeutic effects of ketone body d-β-hydroxybutyrate

“…It is also linked to other cardiovascular diseases such as atherosclerosis which leads to life-threatening situations (Kachur et al 2017). Lifestyle alteration is a key strategy used to tackle obesity and long-term KDs or verylow-energy diets have already been explored as a promising treatment strategy (Gow et al 2021;Kumar et al 2021).…”