Pediatric Weight Management (PWM) Very Low Carbohydrate Diet
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: Very Low Carbohydrate Diet - Adolescents
If a low-carbohydrate diet is selected for use in adolescents, then it is recommended for short-term (up to 12 weeks) use. The use of an ad libitum very-low-carbohydrate diet, which is defined as a diet containing 20g to 60g of carbohydrates to treat obese adolescents has shown short-term improvement in weight status. However, due to the lack of evidence, it is not recommended for long-term treatment of pediatric obesity.
Risks/Harms of Implementing This Recommendation
- Electrolyte imbalance, especially hypokalemia, can be a side-effect of the diet, especially when an adolescent is in a state of ketoacidosis
- Electrolytes should be monitored and potassium should be supplemented through dietary supplements when this diet is implemented
- Constipation may occur secondary to inadequate fiber and fluid intakes
- A daily multi-vitamin supplement 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.
Conditions of Application
- Adolescents with a positive family history of premature atherosclerosis or an LDL-cholesterol level above 130 should not be prescribed this diet
- The very-low-carbohydrate diet has not been studied in children under the age of 12 years and therefore should not be used in this population
- The very-low-carbohydrate diet should not be used in obese pregnant adolescents. Prior to implementing a protein-sparing modified fast diet, screen for pregnancy and provide anticipatory guidance to avoid pregnancy while on this diet.
Potential Costs Associated with Application
There is only a single study, Sondike SB, Copperman N et al, 2003, that reports that adolescents on ad libitum, low-carbohydrate diets lose weight and improve BMI in the short term. Even though this study received a positive rating, there is too little research to be able to determine whether calorie unrestricted low-carbohydrate diets would be effective longer term (one year or more).
Recommendation Strength Rationale
Only one study with a positive rating available.
- 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).
What is the evidence to support using an ad libitum, low carbohydrate diet as a way of treating obesity in adolescents?
What is the evidence to support using an ad libitum, low carbohydrate diet as a way of treating obesity in children (ages 6-12)?