Something incredible has happened since I last wrote to you. I started a change.org petition to bring attention to the Fast Track trial and its dastardly plan to starve our teenagers. And it went viral – as I write, the signatures stand at almost 20,000 people – and the numbers are still growing.
People are angry. Hurt. Incredulous that in 2019, kids can be starved in the name of ‘research’. I have been inundated with messages from people all over the world. Health professionals. Parents of teens who have died from eating disorders. Researchers. Paediatricians. Many people shared their experiences of dieting as a teenager and losing years of their lives from the eating disorder that ensued.
The trickle of interest in this trial has grown into a tsunami. And I am so incredibly grateful to everyone who signed and shared the petition. For everyone who cares about the welfare of these young people and for the rights of all kids in larger bodies, I want you to know that the collective roar of your voices is being heard. The pushback is happening, and I have absolute faith that change can happen from this!
The petition attracted the attention of journalist Kasey Edwards, who wrote this article about the Fast Track complaint. More media attention ensued, with this article appearing in kidspot. Bloggers wrote impassioned pieces, including these heartwrenching accounts from dad Steven Dunn, who lost his daughter to an eating disorder. The incredible fat activist Ragen Chastain also wrote about it. Another major Australian news outlet wrote an article slamming the trial.
People gathered together, rolled up their sleeves, and pitched in to help organise a protest. A Facebook group called “Stop The Fast Track Trial” was formed. People began writing more and more letters of complaint to the Human Research Ethics Committee (HREC) who approved the Fast Track. They also wrote to politicians and professional organisations, asking them to step in and help stop this madness. An extremely detailed complaint, which specified the extreme potential for harm, was prepared by a group of medical professionals, and was sent to the HREC, with 35 co-signatures.
The pushback gathered such an incredible amount of attention that eating disorder organisations began to release public statements condemning the trial. This is truly a massive step – these are extremely conservative institutions, not ones to rock any boats! The eating disorder community is much less funded and powerful than the ‘ob*sity research’ community, and it takes absolute guts to take a stand. But stand they did:
- The Australian & New Zealand Academy for Eating Disorders (ANZAED) released their statement calling for the trial to be stopped, a phenomenal stance for a very conservative organisation.
- Health At Every Size (HAES) Australia released a statement, also demanding a stop to the trial.
- A joint statement made by The Butterfly Foundation, Eating Disorders Victoria, Eating Disorders Queensland, and ANZAED came out expressing “strong concerns about the safety of the young people involved in the trial.”
Outrage about the Fast Track trial has spread around the world. In the UK, FEAST released a second statement calling for the trial to be stopped (they had already released one back in October, when my complaint first went into the HREC, and they were astounded when the complaint was rejected). The Japanese Association for Eating Disorders released a statement opposing it. And one of the world’s largest and most conservative eating disorders organisations, the Academy of Eating Disorders (AED) released a position statement calling for the trial to be stopped, concluding that:
“research that promises few to no reasonably anticipated benefits alongside serious risks in a vulnerable population, such as appears to be the case in this study, should not proceed.”
I can’t tell you how good it feels to have the concerns that have been raised by this protest validated by such big organisations. It feels like through this process, the voices of all of us will be heard. It might be a case of David vs Goliath, but power structures can be shaken. Change is possible.
Amidst this immense roar of protest, I sent in an appeal to the CEO of the Sydney Children’s Hospital Network, Dr Michael Brydon, dutifully following the correct ‘procedures’ when a HREC complaint gets overruled. And he basically told me to bugger off. I then sent a letter of complaint to the Fast Track Trial’s funding body, the NH&MRC. The CEO, Professor Anne Kelso, also told me to bugger off, stating that she believed this trial is ‘high quality’ and that it ‘may provide a long term solution to the health issues’.
So, I decided to take a closer look at this Fast Track team’s ‘high quality research’. That’s where I have been for several weeks now: down a rabbit hole, reading back through all of the Fast Track researcher’s previous publications. And I have detected a pattern:
- They like to publish meta-analyses which support their own opinions.
- The conclusions of their research often conflict with what the data actually show.
- They ignore the long-term failure of dieting.
- Over the years, their weight loss interventions are getting more & more extreme.
In 2013 a research team including many of the Fast Track researchers published a meta analysis on the effectiveness of diets in larger kids and teens. Fifteen studies were reviewed, most of them were very short term: only 2 of the studies followed the kids up for longer than 1 year. Even so, the results showed that:
“weight regain, and the subsequent regression in metabolic profiles to baseline levels, is common” (p767).
The researcher’s own investigations show that teens who diet lose a little bit of weight temporarily, but put it all back on again. Health markers improve slightly for a short period of time, but then return to what they were before the diet. But rather than saying that diets don’t work, the researchers concluded that their review:
“provides support for the importance of dietary interventions as an essential component for managing childhood obesity” (p767).
In 2014, a group including many of the Fast Track researchers published another review, looking at whether or not tweaking macronutrients (ie, % of carbs, protein, or fat) had an impact on weight loss or metabolic outcomes in kids and teens. The data showed no evidence that tweaking macros did anything to improve on the kids’ dismal weight losses or secondary markers of health.
Not to be deterred by their own findings, the fearless Fast Track researchers then ran the RESIST study, and published the results in 2016. In this trial, teens with diabetes or deemed ‘pre-diabetic’ were made to tweak their macronutrients. They found that regardless of macronutrient composition, neither of the diets ‘worked’:
“At 24 months BMI95 was not significantly different from baseline”(p4).
That’s right – 2 years later, all of the kids had regained the weight. The investigators tried desperately to deflect attention from this fact, and focussed on how ‘early weight loss’ was a predictor of ’weight loss success.’ They ignored the experience of the majority of the teens, instead applauding the weight loss ‘success’ of the 7 kids who lost slightly more weight early on. But then ignored the fact that even those 7 kids were regaining weight!
Here’s an actual graph from their paper which demonstrates the good old “Nike tick” of weight regain:
Losing a lot of weight through dieting didn’t happen for the vast majority of kids. And the ‘successful’ kids are showing a FASTER RATE OF WEIGHT REGAIN.
The paper also ignored the huge number of kids who dropped out. Less than half of the teens came back after 2 years. I suspect that these were kids who had regained even more weight than they had lost in the first place, developed disordered eating, or, in my fondest fantasy, met a non-diet dietitian and became empowered enough to sack the Fast Track team.
So I kept trawling through the other studies which were published from the RESIST kids dataset. And in a paper by – you guessed it – some of the same Fast Track researchers, I found some more information on the weight changes these kids had experienced. But for some reason, these were completely different from the numbers reported above. It reported that “After 6 months, 43 participants had lost weight (median loss 3.7kg), 11 remained weight stable, and 44 gained weight (median 4.9kg).” (p2121).
Curiouser and curiouser, right? Which numbers are correct? What on earth is going on here? I intend to follow up this riddle with a letter to the researchers. I invite anyone else who is interested to do the same. Here is Louise Baur’s email address.
But regardless of which numbers are correct, it’s apparent that these are some seriously lacklustre results. But our ever-optimistic Fast Trackers conclude that:
“This study provides evidence that, even in adolescents with obesity and clinical insulin resistance, early weight loss is a strong predictor of long-term obesity treatment outcome.” (Gow et al., 2016, p9)
It is difficult to have faith in this group of researcher’s conclusions, when they evidently don’t match the data.
It’s clear that calorie controlled dieting is totally ineffective for lasting weight loss or improved health. It is this high failure rate that has lead many researchers and health professionals to recommend much less invasive interventions, such as weight-neutral approaches, but for the Fast Trackers, the message seems to be: let’s go harder.
In 2016 the Fast Track researchers released a review paper on diets to ‘reduce the risk of diabetes’ in youth. And it’s here that we see them introduce the idea of extreme diets, including:
“very low-carbohydrate diet, a very low-energy diet…and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes.” (Gow et al, 2016, p1)
And then they sow the tiny, evil seeds of the Fast Track itself:
“Daily modest caloric restriction can be difficult to sustain and it may be very difficult to adhere to a VLED. Therefore, a viable alternative may be intermittent modified fasting, popularised as the 5:2 diet, which has gained recent media interest and celebrity endorsement.” (Gow et al, 2016, p5).
Words cannot express how awful it is to read the phrase ‘celebrity endorsement’ in a scientific journal. What’s next – “Beyonce’s maple syrup diet trial for adolescents”?
The Fast Track researchers have already run two pilot studies of starvation diets in teens. Neither have been published, but I found a poster presentation on one of them from the Asia-Pacific Conference on Clinical Nutrition, held in 2017. In this pilot (which wasn’t completed), 18 kids aged 12-17 were starved on a shakes-only diet (just 500 calories a day) for 3 months.. After this, the kids were allowed to ‘choose’ either an intermittent fasting diet or a ‘continuous calorie restriction’ diet, for another 3 months.
After 3 months, the average weight loss among 18 kids was 3.5kg. At 6 months, the average weight loss was 2.1kg, showing that the kids had already regained 1.4kg – the weight regain had already begun. Psychologically, their ‘restraint’ scores had also significantly increased. Restraint is an eating disorder symptom, indicative of a disordered relationship with food.
But here’s what the researchers concluded:
“Intermittent fast diets appear to be safe and may be an effective dietary intervention in adolescents with obesity. A randomised controlled trial is required to compare IFD with continuous energy restriction.”
Is it??? Is it REALLY NEEDED.
So this is what’s justifying the Fast Track To Health experiment, in which 186 unsuspecting teens are going to be put through an intervention which has been shown to be just as useless as other weight loss diets in adults, and to lead to quick weight regain and an increase in disordered eating scores in their pilot study of teens.
High quality research, or a Fast Track to Hell?
True to form, the Fast Trackers have whipped up yet another meta-analysis to ‘prove’ that starving kids is actually 100% safe, and A Jolly Good Idea. This paper hasn’t been published yet but was recently presented at the International Congress for Eating Disorders (ICED) in New York. In their paper, the Fast Trackers claimed that if teens diet ‘under the supervision’ of hospital-based weight loss teams, dieting is actually completely safe and does not cause eating disorders!
To say that dieting is harmful unless it’s done by a team of ‘experts’ is breathtakingly arrogant. It’s like saying taking heroin is bad, but if a guy in a labcoat gives it to you, it’s totally legitimate. It smacks of ‘experts’ in a failed paradigm, desperate to hold onto a sense of legitimacy. The Fast Track researchers are narrative makers who are hell bent on re-writing the entire field of eating disorder knowledge. To which I say, no thank you.
Because there’s no actual paper for me to dissect, I can’t dive in and show you exactly how the team have come to this delusional conclusion that dieting is suddenly safe, but after trawling through their previous work, my bullsh*t radar is going off. I promise to bring you a detailed dissection once it’s published. People who heard the talk reported that the researchers said that although expert-supervised dieting is apparently very safe, it’s also important to ‘monitor’ eating disorder pathology during weight loss trials ‘to identify people who might be at risk’. Which is an interesting statement to make, considering that they are also saying that there is not a risk from these interventions. Apparently, it is important to monitor the risk that does not exist. Let that sink in!
The Fast Track trial protocol is packed with eating disorder measurements. Which is utterly screwed up when you think about it, because no matter what comes out, it’s awful. If they find that the kids have developed eating disorders from the starvation diets, that’s just sick making. But if they find that there was no increased risk (and we know they’ll do their damn diddly best to massage the stats until it looks safe as houses), then the results of the Fast Track trial will increase their credibility and allow them to push starvation regimes on even more teens.
The Fast Track trial has pulled back the veil to reveal the appalling lengths people will go to in order to ‘tackle’ childhood ob*sity. Folks in the ob*sity research world see people in larger bodies as an ‘epidemic’, little more than ticking time bombs for future health problems. Once you hold that world view, it’s easy to push the envelope further and further, until really extreme and unproven ‘treatments’ are seen as normal and reasonable.
But starving teenagers is just not ok. It’s not hard to see that. And as we have seen from this global protest, people are not going to put up with the terribly ineffective and harmful ‘treatments’ on offer.
The Fast Track trial is still going ahead, and it is imperative that we keep on pushing back. Because the Fast Track is a train straight to hell. Please join our facebook group, and help us stop it!
