A little while ago I posted about the horrendous “Fast Track to Health” trial, where plans are being finalised to make Australian teenagers intermittently starve themselves in the name of research. These unfortunate kids will be compared to another group of teens who’ll be undergoing constant calorie restriction. All of the kids will kick off the experiment with gruelling MONTH on a ‘very low calorie diet’ of just 800 calories a day. And the whole ugly process will drag on for an entire year.
I want you to imagine doing this to your growing child. What it would be like to literally not feed them, day after day, for an entire month. Sending them to school without any lunch. Leaving them out of dinnertime while the rest of the family chows down. Watching them go hungry, and still not letting them eat. Sending them to bed with an empty tummy. And then to follow that up with 11 more months of intermittent torture…. hoping that their school PE lesson doesn’t happen on a ‘fast day’. Thinking of them at recess, at lunch, twiddling their thumbs while watching all of their friends enjoying a normal relationship with food.
I don’t know about you, but this just breaks my heart.
I told you that I was planning to do my damnedest to stop this trial going ahead. I submitted a complaint to the Human Research Ethics Committee (HREC) at Sydney Children’s Hospital, who had approved it in the first place. While I really wanted to send in a letter saying simply ‘what the actual F***K!? are you thinking!’, I was able to articulate what I thought were some pretty compelling arguments on why this trial was a terrible idea.
I reminded them that diets don’t work for the vast majority of people, that indeed the long term net impact of dieting is weight gain, not loss. I reminded them that the evidence against dieting for weight loss is so strong that prominent medical institutions such as the Royal Australian College of Physicians and the American Academy of Paediatrics are recommending that we stop trying to force people to lose weight and start looking after their health behaviours instead.
I then reviewed the shitty research evidence on intermittent fasting in adults. There have been only 3 human trials which reviewed outcomes at one year post diet. And all of them showed that intermittent fasting produces results which are NO DIFFERENT to those found in any other type of diet intervention. People are literally doing all of this extra starvation work, needlessly. So why would the results be any different in children? Why would researchers subject kids to a really extreme intervention if they already know it’s of no benefit??
Since I submitted my complaint, another 12 month outcome trial on intermittent fasting was published, and guess what? Yep: intermittent fasting for a year gave these poor people exactly the same results as standard, garden variety, depressing dieting: both groups lost a little bit of weight to begin with, and one year later the weight was creeping back on again. There were zero differences in either weight loss or secondary health markers. What a giant waste of time and energy!
I popped in a reminder to ethics board about the staggering amount of evidence that points to dieting as a major predictor of developing an eating disorder, and how adolescence is the absolute highest risk time to expose a kid to such a risk factor. This fact is being increasingly ignored by researchers hell bent on ‘tackling the obesity crisis’ in kids.
I also talked about weight bias, and how studies like this which basically tell our teenagers that fat bodies are illnesses waiting to happen are by their very nature incredibly biased. And about the devastating impact that weight bias can have on people’s physical and mental health.
Please, I asked the ethics board, don’t subject these poor kids to this horrendous trial. If you can’t bring yourselves to stop running it, at least change the experiment. Replace the intermittent fasting kids with a non-diet group, and let dieting be compared to weight neutral approaches. At least let the kids have half a chance at actual wellbeing*.
I’m not the only one who thinks this trial is batshit. My complaint was co-signed by no less than 28 health professionals from a diverse array of professions. It was also endorsed by the Association for Size Diversity & Health (ASDAH) and the National Association to Advance Fat Acceptance (NAAFA). I also linked the HREC to a position statement released by FEAST, who have also expressed their horror at such a trial and are calling for its suspension. I wanted the committee to know – and I want the world to know – that health professionals are really opposed to this kind of treatment being normalised in modern health care. There is a LOT of dissension, particularly from health professionals who work at the coal face of eating disorders – because we know that far from being a ‘fast track to health’, restrictive dieting in adolescence has disaster written all over it.
When the HREC received the complaint, they paused the trial’s recruitment drive while the committee and an ’independent panel of experts’ investigated it. I was happy to hear that recruitment had stopped, and that a panel would review it, but was also suspicious that any ‘expert panel’ which didn’t include at least one weight-neutral expert or someone who knew the first thing about weight bias was fated to find in favour of letting the kids starve. So I wrote back and asked them if the panel would include someone who is weight neutral. But they wouldn’t tell me. Apparently the panel member’s identity ‘cannot be exposed to respect their privacy and confidentiality’.
Call me cynical, but this reads as a ‘We did not include any of you crazy non-diet people, we have consulted with our own weight-centric peeps so there’. So finally, just before Christmas a response came back. And it was pretty much a very polite “fuck you”.
They led with the obligatory “kids are getting fatter and fatness leads to disease and don’t you get it we need to DO SOMETHING” rhetoric, which pretty much outs the entire panel as weight-centric and fatphobic.
They straight up ignored the strong evidence presented in the complaint about how ineffective dieting is. Instead of acknowledging the fact that there is Level “A” scientific evidence to show that diets don’t work (as stated by the NH&MRC), they limply said that “there is currently no gold standard weight management intervention and there are differing views on the effectiveness of diet-based interventions.”
Differing views. Yep, just like there are ‘differing views’ on climate change.
They totally ignored the detailed information in the complaint about how ineffective intermittent fasting is. This is literally all that they said about it:
“The Committee noted however that the Fast Track trial’s aim is to determine if MADF is effective, safe and acceptable to adolescents compared to a standard weight control diet. The current study design was considered to be scientifically valid in answering this research question.”
So basically, the fact that this diet has been proven to be ineffective in adults isn’t important. They want to spend a million more dollars researching an ineffective adult diet…to see if it’s just as useless in teens?!
Excuse me while I throw a piano out the window.
The next bit was the most disturbing, where they responded to the risk of eating disorders:
“The HREC recognises that there is a risk for a young person to develop an eating disorder with exposure to restrictive diets, and in particular very restrictive diets .”
Let’s take this in for a moment. THEY KNOW THERE IS A RISK. So what makes them think it’s a risk worth taking?
“The SCHN HREC was advised by the expert panel that these risks can be justified by the likely benefits of the trial provided that the trial is adequately monitored with an appropriate risk management plan to minimise and communicate the risks associated with eating disorders.”
Let’s unpack this a bit. The risk is apparently worth it because of the ‘likely benefits’ reaped by semi starvation. According to the evidence in the adult research, these ‘benefits’ are likely to be: temporary, small weight losses (people tend to lose @5% of their body weight during the ‘intervention’ phase – usually early on ie the first 12 weeks or so – then their weight starts to creep back up again, there is a clear trend in all of the studies for weight to be returning, if not completely returned, by 12 months). And what of the ‘health benefits’ of dieting? Well, improvements in health from long-term diet studies have been found to be very small, and not actually related to weight loss. In fact, it seems that improved health indicators come from behaviour changes (like increasing exercise, improving diet variety and quality, social support, and taking care of stress) even without weight loss. And we haven’t even touched on the risks to metabolic health caused by dieting, but there’s another consequence of this type of trial that’s being stubbornly overlooked at by these researchers.
So here’s the risk/benefit analysis as I see it:
The HREC know it’s risky, but their solution isn’t not to do it at all, it’s to implement a fancy schmancy ‘risk management plan’, which basically means they’re going to collect more data as the harm is being done. That’s like saying “yes, we know there are crocodiles in the water, and lots of these kids will get eaten. Our plan here is to construct more viewing platforms in the river, so that our team of experts can get a better look.”
This is not a risk management plan. This is lunacy.
Actual footage of Fast Track researchers preparing their risk management plan
One more note on this topic: research just published by Stice and Ryzin (2018) on the temporal sequencing of risk factors in the development of eating disorders found that among adolescents, getting an eating disorder usually follows this pathway:
- Pressure to be thin
- Internalisation of the thin ideal
- Body dissatisfaction
- Getting an eating disorder
As we know, people in larger bodies are developing eating disorders at very high rates. And when you look at this model, it’s easy to see why: larger adolescents are under ENORMOUS pressure to lose weight in diet culture. And ‘trials’ like this simply reinforce this idea that it’s really important to be thin. Stice and Ryzin also found that:
“eating disorders emerged a full 27 months on average after disorder-predictive levels of dieting or negative affect emerged, implying that the risk from these latter two risk factors accumulate over a very extended period before eating disorder emergence.”
The Fast Track trial is only planning to follow up the kids for 12 months – not enough time to pick up the significant proportion of them who will go on to develop an eating disorder. So the researchers will be able to publish data which looks like the kids are just coming up roses, blissfully ignoring the damage that they’ve done.
Just to put a final nail in my complaint coffin, the HREC and their absolutely anonymous and totally not in cahoots with the researchers expert panel decided that my “complaint of weight bias in this clinical trial is not supported.” This was entirely due to the fact that they ignored my definition of weight bias, and insisted that they’re following guidelines on reducing ‘weight stigma’ in their trial. Their logic is basically this: because they are being nice to the fat kids, they’re not weight biased. The HREC even had the nerve to commend the Fast Track trial team’s “commitment to reducing weight stigma”.
I’ll say it again. By its very nature, a trial which centres a child’s body as wrong, and seeks to change it to fit into a cultural norm, IS BIASED. They are wilfully ignoring what I am saying, because they just can’t wrap their thinking around the idea of not seeing everything through a weight-centric lens. It’s like defending gay conversion therapy on the basis of using ‘respectful language’ and being ‘welcoming’. The fact remains, no matter how nice they try to be, they are still trying to eradicate these kids.
I was then told that their decision here is “final”, and to please fuck off. Once they’ve finished building their crocodile viewing platforms, this trial will be going ahead.
So that’s about the size of it.
What can be done now? Not much I’m afraid, certainly not by going through these closed off official avenues. I should not be surprised that Sydney Childrens Hospital are defending their own. An objective review was never going to come from a committee who approved the whole mess in the first place, nor from a mysterious panel of anonymous cronies who apparently definitely have no vested interest in any of this.
Grassroots objection is all we have available, so I am asking for some help! Please sign this petition asking the CEO’s of the hospitals involved, MP’s and the Health Minister Greg Hunt to stop the trial.
And if any readers of this blog live near the vicinity of this trial, I ask that you help me to spread the word about what the likely outcomes of this trial really will be. I would like to reach the attention of the parents being enticed into this trial. I want each parent to read this blog, and my last one on this topic, and decide then if they really want to enrol their kid in the Fast Track to Hell. Call me cynical (again), but I seriously doubt that the parents are truly being told the full story of the risk, or the ‘likely benefits’.
Here are the areas: in Sydney, the trial is being run out of Westmead hospital. Surrounding suburbs are: Parramatta, Northmead, Greystanes, Merrylands, Toongabbie, Northmead, Baulkham Hills, Girraween, and Seven Hills.
In Melbourne, they are running out Monash children’s hospital in Clayton, and at Monash University. Surrounding suburbs there are Oakleigh, Mount Waverley, Mulgrave, Wheelers Hill, Clarinda, Murrumbeena, Chadstone, Ashwood, and Glen Waverley.
If you know people who live in these areas, please share this blog on their social media and ask them to share it with their communities. Think of local area mothers groups, high school facebook groups, any places where the mothers of teenagers in these areas are likely to see it. If the ethics committees won’t protect these kids, let’s galvanise the most powerful people in the world: the mums! And parents, if you are reading this and thinking “but my child really needs help”, please visit the HAES Australia website where you can access a database of weight-neutral health professionals. There is LOTS of support out there, and weight loss is definitely not the only path to improved health!
Thanks for making it through this epic post.
*If you’d like to read my entire complaint, or the response to it, please email me at firstname.lastname@example.org and I’ll send you a copy.