Pediatric Weight Management (PWM) Using Protein Sparing Modified Fast Diets for Pediatric Weight Loss
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
PWM: Protein Sparing Modified Fast Diets: Short-term Treatment
If children and adolescents are >120% of ideal body weight, have serious medical complications and would benefit from rapid weight loss, then a Protein Sparing Modified Fast Diet (PSMF) could be utilized in a short-term intervention (typically 10 weeks) under the supervision of a multidisciplinary team of healthcare providers who specialize in pediatric obesity. Research shows that short term use of a PSMF brings about short term and longer term improvement in weight status and body composition when part of a medically supervised, multicomponent program.
PWM: Protein Sparing Modified Fast Diets: Long-term Treatment
The Protein Sparing Modified Fast Diet is not recommended for long-term weight management for obesity in children or adolescents. There are few well designed studies to support the use of this intervention for longer than 10 weeks.
Risks/Harms of Implementing This Recommendation
- Electrolyte imbalance, especially hypokalemia, can be a side effect of the PSMF,
- Electrolytes should be monitored and potassium should be supplemented through dietary supplements when this diet is implemented,
- A daily multivitamin supplements containing 100% of the DRI should be prescribed with the diet to ensure adequate vitamin and mineral intake especially since fruit, vegetable and dairy consumption may be limited,
- Adequate fluid intake should be encouraged to prevent dehydration.
Conditions of Application
Parents/caregivers of obese children and adolescents need to participate in the counseling process.
The Protein Sparing Modified Fast Diet should not be used in obese pregnant adolescents. Prior to implementing PSMF, screen for pregnancy and provide anticipatory guidance to avoid pregnancy while on this diet.
PSMF stage of intervention should be followed by a less restrictive diet intervention.
Potential Costs Associated with Application
Additional medical and laboratory monitoring may incur increased healthcare costs.
The purpose of using a PSMF diet is to bring about rapid weight loss in obese children during the initial phase of treatment (10-20 weeks) while minimizing the negative effects of a very low calorie diet. Even though studies utilizing the PSMF diet showed significant short term weight loss (Figueroa-Colon, von Almen, et al 1993 Brown R, Sothern M et al 2000, Brown R, Sothern M et al 2000, Sothern and Hunter 1999, Sothern, M., Loftin, M. et al 2000, Sothern, M., Loftin, M. et al 2000) it is unclear if the weight loss can be solely attributed to the macronutrient content of the diet or a result of a hypocaloric intake. Only one study, Figueroa-Colon, von Almen, et al 1993, compared the PSMF to a hypocaloric balanced macronutrient diet. However, the PSMF intervention arm still consumed a mean of 200 kcal/day less than the hypocaloric balanced nutrient control group.
Long-term treatment outcomes (>=1 year) for PSMF studies show that subjects initially treated were able to maintain some weight loss at one year. However, the data is limited to 4 studies with neutral ratings and a majority of the data was from the same treatment program. The one study (Figueroa-Colon, von Almen, et al 1993) that compared the PSMF diet with a hypocaloric balanced macronutrient diet showed some weight regain at one year compared to their post-treatment weight but, the children remained below their pre-treatment weight. Only 2 studies provided data on short term growth velocity but long-term effects on growth have not been studied. Data of hunger and satiety implications of the PSMF is very limited.
Recommendation Strength Rationale
Conclusion Statements are Grade III and V
- One received a positive rating, three received a neutral rating, and one received a negative rating,
- All studies present results from the same treatment program (thus, no variation across settings),
- Only one of the studies compared the use of a protein sparing modified fast diet with a control diet (balanced macronutrient diet)--and this study had subjects on the PSMF diet on a lower energy intake than the control group,
- Four of the studies report outcomes at one year (or greater) post treatment,
- Only two studies report on growth velocity,
- Only one study provided information on self reported hunger "side effects" of PSMF versus balanced macronutrient diet.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Does short term (no more than 20 weeks) use of protein sparing modified fast diets compromise fat free body mass in obese children?
Do protein sparing modified fast diets bring about greater weight loss in children than macronutrient balanced diets of the same level of energy intake?
Are children on protein sparing modified fast diets less hungry than children on balanced macronutrient diets at the same level of energy intake?
Do protein sparing modified fast diets preserve fat free body mass in children better than balanced macronutrient diets at the same level of energy intake?
What evidence is there that short-term use of protein sparing modified fast diets for childhood weight loss may compromise the growth velocity of children?
Brown R, Sothern M, Suskind R, Udall J, Blecker U. Racial differences in the lipid profiles of obese children and adolescents before and after significant weight loss. Clinical Pediatrics 2000; 39: 427-431.
Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
Sothern, M., Hunter, S., Suskind R., Brown, R., Udall, J. and Blecker, U. Motivating the obese child to move: the role of structured exercise in pediatric weight management. Southern Medical Journal 1999; 92: 577-584.
Sothern, M., Despinasse, B., Brown, R., Suskind, R., Udall, J. and Blecker, U. Lipid profiles of obese children and adolescents before and after significant weight loss: differences according to sex. Southern Medical Journal 2000; 93: 278-282.
Sothern, M., Loftin, M., Udall, J., Suskind R., Ewing, T., Tang, S., & Blecker, U. Safety, feasibility and efficacy of a resistance training program in preadolescent obese children. American Journal of the Medical Sciences, 2000; 319: 370-375.
Sothern, M., Schumacher, H., von Almen, T., Carlisle, L., & Udall, J. Committed to Kids: an integrated, four level team approach to weight management in adolescents. Journal of the American Dietetic Association 2002;102:S81-S85.
Sothern, M., Udall, J. Suskind, R., Vargas, A., & Blecker, U. Weight loss and growth velocity in obese children after very low calorie diet, exercise and behavior modification. Acta Paediatrica, 2000; 89(9): 1036-43.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process