The Protein-Sparing Modified Fast for Adolescents With Severe Obesity

Abstract

Background. Severely obese youth respond poorly to current conventional lifestyle interventions when compared with their overweight and obese peers. The protein-sparing modified fast (PSMF) intervention is a reduced-calorie, low-carbohydrate, high-protein diet that is thought to improve weight loss. The objective of this study is to describe 2 inpatient cases and 1 outpatient case that used the PSMF for adolescents. Methods. Three patients followed a PSMF for approximately 12 to 52 weeks, initially consuming 20 to 40 grams of carbohydrate per day for the first 12 weeks. Two of these patients were admitted as inpatients for the first 2 to 4 weeks of the diet. Results. The PSMF led to rapid weight loss and a decrease in body mass index. For 2 patients, there was an improvement in liver function tests or liver disease following the PSMF diet. All the patients demonstrated an improvement in some abnormal laboratory indices, for example, liver function tests and hemoglobin A1c, but had a clinically insignificant increase in total cholesterol. No serious complications were observed. Conclusions. With proper planning and adequate resources, PSMF or low-carbohydrate diets are a viable option for the management of severe obesity in medically complex adolescents. However, practitioners will need to be conservative with its application in the pediatric population. Further research is needed to assess the long-term outcomes from a PSMF.