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Adolescents (13\u201317 years) with obesity and \u22651 obesity-related complication were Fast Track to Health 52-week randomized controlled trial participants. Adolescents undertook a 4-week micronutrient-complete VLED (800 kcal\/day), with weekly dietitian support. Anthropometric data were recorded at baseline and week-4 and side-effects at day 3\u20134, week-1, -2, -3 and -4. Adolescents completed an acceptability survey at week-4. A total of 134 adolescents (14.9 \u00b1 1.2 years, 50% male) had a 5.5 \u00b1 2.9 kg (p &lt; 0.001) mean weight loss at week-4: 95% experienced \u22651 and 70% experienced \u22653 side-effects during the VLED program, especially during the first week. Hunger, fatigue, headache, irritability, loose stools, constipation and nausea were most common. Reporting more side-effects at day 3\u20134 correlated with greater weight loss at week-4 (r = \u22120.188, p = 0.03). Adolescents reported \u2018losing weight\u2019 (34%) and \u2018prescriptive structure\u2019 (28%) as the most positive aspects of VLED, while \u2018restrictive nature\u2019 (45%) and \u2018meal replacement taste\u2019 (20%) were least liked. A dietitian-monitored short-term VLED can be implemented safely and is acceptable for many adolescents seeking weight loss, despite frequent side-effects. Investigating predictors of acceptability and effectiveness could determine adolescents most suited to VLED programs.<\/jats:p>","DOI":"10.3390\/nu16183125","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T10:56:57Z","timestamp":1726484217000},"page":"3125","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy, Safety and Acceptability of a Very-Low-Energy Diet in Adolescents with Obesity: A Fast Track to Health Sub-Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Megan L.","family":"Gow","sequence":"first","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8623-6174","authenticated-orcid":false,"given":"Hiba","family":"Jebeile","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Institute of Endocrinology and Diabetes, The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eve T.","family":"House","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Institute of Endocrinology and Diabetes, The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley","family":"Alexander","sequence":"additional","affiliation":[{"name":"Weight Management Services, The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise A.","family":"Baur","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Weight Management Services, The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Paediatric Endocrinology and Diabetes, Monash Children\u2019s Hospital, Clayton, VIC 3168, Australia"},{"name":"Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3298-756X","authenticated-orcid":false,"given":"Clare E.","family":"Collins","sequence":"additional","affiliation":[{"name":"School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia"},{"name":"Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris T.","family":"Cowell","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Kids Research, The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3846-8568","authenticated-orcid":false,"given":"Kaitlin","family":"Day","sequence":"additional","affiliation":[{"name":"School of Agriculture, Food and Ecosystem Sciences, University of Melbourne, Melbourne, VIC 3010, Australia"},{"name":"Department of Nutrition, Dietetics & Food, Monash University, Melbourne, VIC 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7552-0789","authenticated-orcid":false,"given":"Sarah P.","family":"Garnett","sequence":"additional","affiliation":[{"name":"Sydney Medical School, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Kids Research, 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