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Randomized Controlled Trial
. 2024 Oct 1;178(10):1006-1016.
doi: 10.1001/jamapediatrics.2024.2869.

Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial

Natalie B Lister  1   2 , Louise A Baur  1   3 , Eve T House  1   2 , Shirley Alexander  3 , Justin Brown  4   5 , Clare E Collins  6   7 , Christopher T Cowell  1   8 , Kaitlin Day  9   10 , Sarah P Garnett  1   8 , Megan L Gow  1 , Alicia M Grunseit  11 , Maddison Henderson  2 , Mary-Kate Inkster  4   10 , Cathy Kwok  1   3 , Sarah Lang  10 , Susan J Paxton  12 , Helen Truby  13   14 , Krista A Varady  15 , Hiba Jebeile  1   2
Affiliations
Randomized Controlled Trial

Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial

Natalie B Lister et al. JAMA Pediatr. .

Abstract

Importance: Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management.

Objective: To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity.

Design, setting, and participants: This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included.

Interventions: Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52).

Main outcomes and measures: The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed.

Results: A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups.

Conclusions and relevance: These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice.

Trial registration: http://anzctr.org.au Identifier: ACTRN12617001630303.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lister reported receiving grants fron the National Health and Medical Research Council of Australia (NHRMC) during the conduct of the study. Dr Baur reported receiving speakers’ fees from Novo Nordisk and funds directed to the hospital cost center, and serving as a member of the Eli Lilly Advisory Committee outside the submitted work. Dr Baur also reported receiving grants from the NHRMC during the conduct of the study. Dr Day reported receiving personal fees from Nu-Mega Ingredients outside the submitted work. Dr Gow reported receiving grants from an NHMRC Early Career Fellowship during the conduct of the study. Dr Kwok reported receiving a University of Sydney Postgraduate Awards scholarship during the conduct of the study and travel support from Novo Nordisk to attend and present the ACTION Teens study (a survey study funded by Novo Nordisk) at the Australian and New Zealand Obesity Society (ANZOS) Annual Scientific Meeting 2023 in Adelaide, Australia, outside the submitted work. Dr Truby reported receiving grants from the NHMRC during the conduct of the study and funding from the Commonwealth Department of Health and Aged Care, Medical Research Future Fund, Preventive and Public Health Research Initiative Maternal Health and Healthy Lifestyles initiative, and NHMRC Ideas grants outside the submitted work. Dr Varady reported receiving author fees from Pan MacMillan Publishing for the book The Fastest Diet outside the submitted work. Dr Jebeile reported receiving grants from the NHMRC during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram Showing Participant Flow in the Study
BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); CER, continuous energy restriction; IER, intermittent energy restriction. aTwo participants withdrew from IER treatment but returned for the next measurement visit (1 at 16 weeks and 1 at 52 weeks).
Figure 2.
Figure 2.. Change in Body Mass Index (BMI) z Score (BMIz) between Baseline and Week 52 and BMI Expressed as a Percentage of the 95th Percentile (BMI95) at Week 52 Compared With Baseline
For BMIz, data are from 141 adolescents. The shaded area represents the 4-week very low-energy diet phase of the trial. Error bars indicate 95% CIs. For BMI95, data are from 94 participants who had BMI data at week 52. Body mass index was calculated as weight in kilograms divided by height in meters squared. CER indicates continuous energy restriction; IER, intermittent energy restriction.
Figure 3.
Figure 3.. Change in Body Mass Index Expressed as a Percentage of the 95th Percentile (BMI95) at Week 52 Compared With Baseline
For the intermittent energy restriction (IER) group, data are from 40 participants with BMI data at week 52; for the continuous energy restriction (CER) group, data are from 54 participants with BMI data at week 52. Body mass index was calculated as weight in kilograms divided by height in meters squared.
See this image and copyright information in PMC

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