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Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial
Natalie B Lister1,2, Louise A Baur1,3, Eve T House1,2
1Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia.
JAMA Pediatrics
|August 26, 2024
Summary
Intermittent energy restriction (IER) and continuous energy restriction (CER) effectively reduced BMI z scores in adolescents with obesity. Both dietary approaches offered similar benefits for weight management and metabolic health in this population.
Area of Science:
- Pediatric Endocrinology
- Metabolic Health
- Obesity Treatment
Background:
- Adolescent obesity is a growing concern requiring effective and accessible treatments.
- Intensive dietary interventions can supplement behavioral weight management strategies.
- Metabolic complications associated with obesity in adolescents necessitate tailored therapeutic approaches.
Purpose of the Study:
- To evaluate the efficacy of two distinct dietary therapies, intermittent energy restriction (IER) and continuous energy restriction (CER).
- To assess these therapies as components of an intensive behavioral weight management program for adolescents with obesity and associated metabolic issues.
Main Methods:
- A 52-week, multisite randomized clinical trial involving adolescents aged 13-17 years with obesity and metabolic complications.
- Participants received intensive behavioral interventions comparing IER and CER, including very low-energy diet, intensive, and maintenance phases.
- Primary outcome was body mass index (BMI) z score at 52 weeks, with secondary assessments of anthropometry, body composition, and cardiometabolic health.
Main Results:
- Both IER and CER groups achieved significant reductions in BMI z scores and BMI percentiles at 52 weeks, with no significant differences between the groups.
- While both interventions initially reduced insulin resistance, this effect was sustained in the CER group only at 52 weeks.
- No significant differences were observed in body composition or dyslipidemia between the IER and CER groups; a small improvement in hepatic function was noted.
Conclusions:
- Intermittent energy restriction (IER) can be integrated into behavioral weight management programs for adolescents with obesity-related complications.
- IER offers a viable alternative to continuous energy restriction (CER), potentially increasing participant choice and adherence.
- Both dietary strategies demonstrate effectiveness in improving key weight and some metabolic parameters in this population.
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