Effective management of adolescents with obesity requires an understanding of the developmental and physiological issues faced at this developmental stage, as well as engagement of the young person, and usually the family, in a treatment program.
Dietary change is a key element, with energy restriction usually incorporated. Various dietary manipulations can achieve weight loss in adolescents, with adherence being the strongest predictor of weight loss.
Low carbohydrate diets are no more effective for long-term weight loss in adolescents than a low-fat approach, although they might provide short-term benefit. While increased protein diets are hypothesised to lead to greater weight loss, increasing protein (from ~15% to 20–40% of daily energy) has no demonstrated benefit for weight loss in free-living adolescents.
Intermittent energy restricted diets have gained popularity. The first RCT of intermittent energy restriction vs continuous hypocaloric diet in adolescents (The Fast Track to Health Trial) is underway in Sydney and Melbourne.
Very low energy diets (VLEDs) typically comprise <800 kcal/day, with micronutrients provided through meal replacements. VLEDs in adolescents lead to short term weight loss (4-15 kg over 3-12 weeks) while preserving lean mass and improving cardio-metabolic risk. VLEDs require intensive monitoring by health professionals.
Concern has been raised that dieting in adolescents can be associated with the development of disordered eating and other psychological harms. Two recent systematic reviews of treatment of obesity, with a dietary component, in children and adolescents have shown that structured and professionally run obesity treatment a) is associated with reduced eating disorder prevalence, eating disorder risk and symptoms, and b) is not associated with an increased risk of depression or anxiety, and may result in a mild reduction in symptoms.
More data are needed to examine prospectively the long-term effects of dietary interventions on psychological outcomes in adolescents.