title: The Protein-Sparing Modified Fast Diet: An Effective and Safe Approach to Induce Rapid Weight Loss in Severely Obese Adolescents.
abstract: OBJECTIVE
  The protein-sparing modified fast (PSMF) is a rigorous way of rapidly losing a large amount of weight. Although adult studies have shown the PSMF to be effective, data in adolescents are lacking. The aim of this study was to determine the efficacy and safety of the PSMF in severely obese adolescents.
  
  
  METHODS
  12 subjects who were evaluated in the Obesity Management Program at the Cleveland Clinic from 2011 to 2014 were included. The subjects were initiated on the PSMF after failing other conventional methods of weight loss. Once the goal weight was achieved, subjects were transitioned to the refeeding phase for weight maintenance.
  
  
  RESULTS
  Follow-up was scheduled at 3-month (11 patients) and 6-month (6 patients) intervals. At the 6-month follow-up visit, the average weight loss was 11.19 kg (95% confidence interval = -5.4, -27.8, P = .028), with average of 9.8% from baseline. Fifty percent of subjects had >5% weight loss and 20% had >10% weight loss. Four patients were lost to the follow-up (40%). An improvement was noted in total cholesterol and high-density lipoprotein. Due to a small sample size these results were not statistically significant. Side effects reported by subjects were mild dehydration due to nausea (2 patients), decreased energy (1 patient), and transient labile mood (1 patient). No life-threatening side effects were reported.
  
  
  CONCLUSIONS
  Our results show that the PSMF diet can be used as an effective and safe method in the outpatient setting for rapid weight loss in adolescents with severe obesity.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Marwan
authors.initials: M
authors.lastname: Bakhach
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Vaishal
authors.initials: V
authors.lastname: Shah
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Harwood
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Lappe
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Bhesania
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Sana
authors.initials: S
authors.lastname: Mansoor
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
keywords: protein-sparing modified fast; safety; severely obese adolescents; weight loss