In summary, we found that the HPLC diet resulted in significantly greater reduction in BMIZ
(and trend for greater weight loss) compared with the LF diet over the 13 week intervention,
and was found to be without serious adverse effects. Markers of cardiovascular risk and insulin
resistance improved in both groups, with the HPLC having a more potent beneficial effect on
markers of insulin resistance. We thus conclude that a high protein, carbohydrate restricted
diet should be considered a safe and effective option for medically supervised treatment of
severe obesity in adolescents. The fact that the BMI-Z for both groups was still significantly
lower at 6 months follow-up compared with baseline, with no intervening contact, argues for
on-going, perhaps less intensive, support to achieve further benefit. With the unprecedented
prevalence of severe obesity and its co-morbidities in the pediatric population, the important