Time-Restricted Eating Combined With Progressive Personalized Lifestyle Modifications for Adolescent Obesity: A 12-Month Case Series

Four adolescents, first cousins (three male, one female) residing in a joint family household, of age 11-18 years, reported with lifestyle-related obesity (established from the Z-scores for age and gender). Eleven out of 12 members of the joint family were suffering from overweight or obesity. One male adolescent (17 years, seven months) had pre-diabetes as evident from the values of fasting plasma glucose and HbA1c. Due to the young age of the patients, the parents were not in favor of initiating pharmacotherapy. A detailed study of the lifestyle of the four patients revealed unhealthy eating habits, a long duration of the eating window, short sleep duration, and a lack of physical activity. Laboratory investigations revealed elevated levels of fasting glucose, total cholesterol, triglycerides, triglyceride-glucose index (TyG), and liver enzymes, indicating insulin resistance. This case-series (without any control subjects) of one year's duration involved subjects habituated to an unhealthy lifestyle. Lifestyle modifications (LSMs), including time-restricted eating (TRE), were implemented in a slow and progressive manner over a period of two months. Physical measurements and laboratory parameters were noted at zero, six, and twelve months. Care was taken to avoid nutritional deficiencies and to ensure optimum growth. Anthropometric parameters, fasting glucose, lipid profile, and liver enzymes showed marked improvement after 12 months. All four patients reduced their BMI from the obese to the overweight category. The BMI reduced from 26.4+/- 2.8 kg/m² to 23.5 +/- 0.8 kg/m². The extent of weight loss was different in all four individuals, as they had not observed equal adherence to the recommended LSMs. Development of healthy lifestyle is crucial for children to avoid weight-related issues when they are older. Unrestricted food intake and long eating windows can lead to weight gain and obesity at an early age. This study shows the importance of early interventions with LSMs in adolescent patients with obesity.