EDiTing The Risk Of Childhood Dieting: The Fast Track Team’s Big Play

It was a tough time to be in the child diet game. Flailing weight loss company WW had recently launched the Kurbo app, targeting kids as young as eight. Kurbo promoted the ‘traffic light’ diet, dividing foods into red (bad) and green (good) categories. WW’s move attracted media criticism for promoting restrictive dieting and disordered eating in children. More than 100 000 people had signed a petition calling for Kurbo’s removal. Clinicians and researchers warned that Kurbo contravened the 2016 American Association for Paediatrics (AAP) guidelines, which advised against dieting and weight loss focus in such a vulnerable population.

By the mid 2010’s, the world was turning against the weight loss industry. A well established body of research had demonstrated that dieting was largely ineffective, producing only small, short term weight loss followed by regain. The same applied to kids: a 2017 review of 70 programs found similar results.

The physiological and psychological harm from dieting was also of concern. Weight cycling from dieting drove metabolic slowdown, increased hunger, and was linked to higher risk of cardiometabolic disease and death. Psychologically, dieting was well established as the strongest risk factor for eating disorders in young people, with teen dieters up to 18 times more likely to develop an eating disorder than non-dieting peers.

Jebeile was no stranger to the growing backlash against dieting. Back in Sydney, she was running the Fast Track trial – a teen weight loss experiment which had also attracted intense criticism. Targeting larger bodied kids aged 13-17, the Fast Track regime began with a month-long crash diet of 800 calories per day using liquid meal replacements, followed by 11 months of either constant calorie restriction or intermittent fasting. For 3 days a week, “fasting” teens were allowed 600-700 calories: less than a quarter of a growing human’s daily requirements. Those in the constant restriction group were limited to 1400-1700 calories a day, similar to that in the infamous Minnesota Starvation Experiment.

The severity of the Fast Track regime sparked an outpouring of concern from eating disorder organisations, clinicians, and people with lived experience of developing eating disorders from teen weight loss programs. 20 000 people signed an online petition calling for it to be stopped. Formal complaints to the Sydney Children’s Hospital’s research ethics committee had resulted in a six-month pause in recruitment.

Global condemnation of child dieting was reaching a crescendo. But in Sin City, a place synonymous with high-stakes gambling, the child obesity field’s response was defensiveness. Even the title of the panel discussion – “Hold ‘Em or Fold ‘Em? Treating Pediatric Obesity in the Era of Outrage” – epitomised the fields’ disdain for dissension, fuelling more anger from those whose lives had been negatively impacted by child obesity “treatment.”

Despite the panel’s catchy title, there was never any serious exploration of folding. All three invited guests presented variations on the same theme: how to keep the industry going. Michelle Cardel, from WW, was adamant that this was not the moment to “fold.” Ania Jastreboff, a drug company funded obesity doctor, pushed to “draw,” suggesting that weight loss drugs be added to the mix. Jebeile spoke last. “Hold,” she advised, and let’s “take stock.”

Jebeile had a masterful play up her sleeve. She and her colleagues hadn’t been idle during the Fast Track’s 6 month enforced hiatus, using the time to publish a meta-analysis claiming that if they were “professionally supervised,” weight loss interventions did not increase paediatric eating disorder (ED) risk. In fact, they concluded,

‘structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms’.

This paper was exactly the kind of ammunition the field needed to push back against the tide of anger. WW were already using it to defend the Kurbo app.

But the Fast Tracker’s “ace” was a card trick. The meta-analysis pooled 30 studies and 2,589 adolescents, but most were low quality and short-term. Only three papers followed participants for two years or more after the diets ended. Long term eating disorder outcome data was available for 195 adolescents – a measly 7.5% of the original participants.

Of these, between 5–9% had developed disordered eating during or following weight loss interventions, although these figures were not reported in the paper itself – they had to be calculated by yours truly. Whether or not this level of risk was “acceptable” – particularly balanced against the marginal and temporary nature of weight loss, was a question left unexplored.

The scientific shakiness of the meta analysis was virtually irrelevant, because the Fast Track team represented the elite of Australia’s research power structure. Professor Louise Baur, principal investigator of the Fast Track Trial and Jebeile’s PhD supervisor, was a National Health & Medical Research Council (NHMRC) Leadership Fellow, a top-tier award that provided a hefty government-funded salary and the resources to lead large-scale research programs. Research money flowed like a swollen river to this team. The Fast Track trial alone had received over $AUD1 million in funding.

With such powerful backing, Jebeile’s “hold” strategy was the opening play in a much larger game, in which the outrage from the eating disorders field, and the lived experiences of those harmed by child dieting, would be transformed into fodder for obesity research empires.

The Fast Trackers were soon awarded a 3 year, $AUD600 000 NHMRC research grant entitled “Bringing fields together: Identifying individuals at risk of eating disorders in weight management programs.”

The project was framed like this:

“A major barrier in improving obesity and eating disorder care is the hotly debated issue of eating disorder risk following weight management.”

Here, eating disorder risk was positioned not as a well-established harm, but as a “hot debate” getting in the way of continuing to run weight loss trials.

And they had a plan:

Using ‘big data’ methods and international collaborations, we will analyse individual-level data from weight management trials with eating disorder assessments, and deconstruct these complex interventions into their smallest ‘active ingredients’. We will translate findings into recommendations so that treatment approaches can be tailored to individuals.”

There are many ways the problem of eating disorder risk from weight loss trials could be approached. Deep engagement with eating disorder research, clinical practice, and lived experience would have been an obvious starting point. Instead, their plan was to trawl existing weight loss trials, break them into their smallest components, and generate “tailored recommendations” for future weight loss programs.

Imagine if, in the face of growing evidence about climate change, the response from the fossil fuel industry was not to reduce emissions- or even to examine climate scientists’ evidence- but to simply analyse their own industry research to identify “less harmful” emissions, and explore which populations might be most “resilient” to pollution. It’s preposterous !

The Fast Track team are leading a research juggernaut that has quietly shifted focus from the overall harms of weight loss research, to how it can be managed. Rather than “bringing fields together,” the Fast Trackers, backed by deep funding and academic clout, risk burying the eating disorder field altogether.

Because there is no equivalent eating disorder research juggernaut. In Australia, between 2009 and 2021, eating disorder research received $AUD28 million in total, while over a comparable period, $AUD778 million was poured into obesity research. The eating disorder field are the poor relatives of a giant weight loss industry, seemingly destined to keep mopping up their casualties.

Flush with NHMRC funding, the Fast Track team soon launched a new project: the Eating Disorders In WeighT Management (EDiT) Collaboration.

“EDiT” was an unnervingly apt title. Eating disorder risk was becoming the new domain for career-building obesity researchers. In this diabolical “collaboration,” risk was recast as something that could be “managed” within the same weight-centric system that produced it.

And the concerns of a community long fighting to be heard would be quite literally, EDiTed out.

In the next instalment, I’ll take you on a deep dive of the EDiT “Consensus” paper, in which 84% of respondents agreed that weight loss interventions increase eating disorder risk. I can’t wait to share how they EDiTed that one!

Stay strong diet culture drop outs!

*Over the years I have written about the Fast Track Trial in excruciating detail. You can find Part 1 here, Part 2 here, Part 3 here, Part 4 here, Part 5 here (this one is about WW using Fast Track to defend Kurbo), Part 6 here, Part 7 here, Part 8 here (starting from here is when the results of the trial are ‘in’), Part 9 here, and Part 10 here​