Introduction and Objective: Adolescents with severe obesity are at high risk for insulin resistance and youth-onset type 2 diabetes (Y-T2D). Intensive weight-loss interventions are increasingly used to prevent progression to Y-T2D and enable remission in early disease; however, their impact on health-related quality of life (HRQoL) has not been characterised. Methods: Adolescents aged 15-17 years with severe obesity (BMI ≥35 kg/m²) completed a 12-week very low-calorie diet (VLCD) using the Optifast® program. HRQoL was assessed using the Short Form-36 (SF-36) at baseline, post-VLCD, and follow-up (6-36 months). After VLCD completion, eligible participants were offered bariatric surgery. SF-36 domain and total scores (0-100) were analysed using linear mixed-effects models including time, surgery status, and interaction terms. Clinically meaningful change was defined as ≥3-5 points. Results: At baseline, participants (45% Y-T2D, 40% pre-diabetes) demonstrated HRQoL impairment (mean SF-36 total 50.0±12.9), particularly in role physical, role emotional, and mental health domains. Following VLCD, SF-36 total score increased by ~9 points (p=0.005). Significant improvements were observed in physical functioning (+18.1), role physical (+29.8), role emotional (+32.1), and social functioning (+21.5) (all p0.05). Vitality (−13.8) and mental health (−11.7) declined during VLCD (both p0.05). During follow-up, surgery was associated with higher physical functioning and lower pain burden, while vitality and mental health improved over time in both groups. The proportion with Y-T2D dropped from 43% to 0% after surgery but was unchanged with VLCD alone (46% vs 46%). Conclusion: Among adolescents with severe obesity targeted for Y-T2D prevention and potential remission, VLCD produced rapid, clinically meaningful improvements in physical and role-based HRQoL despite transient reductions in vitality and mental well-being. Bariatric surgery conferred sustained functional advantages during longer-term follow-up. Disclosure K. Perera: None. J. Baker: None. K. Smallman: None. K.A. Pickering: None. P.J. Harry: None. D.J. Anderson: None. B. Orr-Walker: None. R. Babor: None. D. Simmons: Speaker's Bureau; Ended; Novo Nordisk. Other - Educational grant; Ended; Abbott Diabetes. Research Support; Current; Novo Nordisk. Consultant; Ended; Dexcom, Inc.
Perera et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: