Comparison of two hypocaloric diets in obese children

R. Figueroa-Colon, T. K. von Almen, F. A. Franklin, C. Schuftan and R. M. Suskind
Department of Pediatrics, University of Alabama, Birmingham.

OBJECTIVE--To examine whether a protein-sparing modified fast diet and a hypocaloric balanced diet are safe and effective for children in an outpatient weight reduction program. DESIGN--Randomization of two groups to either diet, with follow-up at 14.5 months. SETTING--Physician or parent referral to outpatient program at Children's Hospital of New Orleans, La. PARTICIPANTS--Nineteen children, ranging in age from 7.5 to 16.9 years, weighing 45% to 131% more than the mean weight for age, sex, and height. INTERVENTION--During the first 10 weeks, 10 children were placed on a protein-sparing modified fast diet (2520 to 3360 J), and nine children and adolescents were placed on a hypocaloric balanced diet (3360 to 4200 J). Subsequently, all participants were placed on a hypocaloric diet; calories were increased from 4200 to 5040 J in a 3-month period and maintained for 1 year. SELECTION PROCEDURES--Children were assigned to one of two diets for the first 10 weeks according to their time of enrollment. MEASUREMENTS/MAIN RESULTS--Both diets produced significant weight loss during the first 6 months. However, the protein-sparing modified fast diet produced significantly greater changes in the percentage of overweight at 10 weeks (-30% vs -14%) and at 6 months (-32% vs -18%). At 10 weeks, a significant loss of adipose tissue with preservation of lean body mass occurred in the protein-sparing modified fast group. A transient slowing of growth velocity was noted at 6 months in both dietary groups compared with values at 14.5 months. Growth velocity approached normal levels at 14.5 months compared with standards for North American children. When dietary groups were combined, the initial mean blood pressure decreased significantly at all points in the study. The initial mean serum cholesterol value also decreased significantly at 10 weeks. No biochemical or clinical complications were observed. CONCLUSIONS--These hypocaloric diets appear to be safe and effective in the short-term management of pediatric obesity. However, these diets should not be used without close medical supervision.

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