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All Fired Up


May 22, 2019

The “Fast Track to Health” trial is a year long semi starvation experiment aimed at Australian teenagers. Protest against the trial has been immense, with 20,000 people signing a petition to stop it, multiple complaints lodged to the Ethics Committee who approved the trial, numerous protest statements from eating disorder organisations, and substantial media attention. But the protest has fallen on deaf ears, and the trial looks set to go ahead. This week on All Fired Up, I speak with Emma Hagan, who was 10 years old when her parents took her to a paediatric “O” clinic to help her lose weight. Within a year, Emma was hospitalised with Anorexia, and 13 years later, she is still battling to find recovery. According to the Fast Track team, stories like Emma’s simply don’t happen - they believe that any risk is ‘minimal and manageable’. To which we say: BS. Stories like Emma’s need to be heard. Don’t miss this important conversation!

 

Shownotes

  • The “Fast Track to Health” trial is a weight loss experiment running out of 2 childhood obesity clinics at Children’s hospitals in Sydney and Melbourne, Australia. The trial is aiming to recruit 180 larger bodied teenagers aged 13 -17. In the trial, teenagers will be placed on a very low calorie diet (less than 800 calories a day) for a month, and then subjected to 3 days per week of fasting (less than 700 calories a day) for 11 months. The severity of calorie restriction on kids in growing bodies over such a prolonged period of time has alarmed thousands of health professionals around the world.
  • We know that intermittent fasting is very trendy right now, but the research shows that in the long term, this kind of diet produces no different results than any other diet. On this type of diet, people lose a little bit of weight in the short term, and then the weight comes back.
  • When Louise heard about the trial, she was horrified, and submitted a group complaint to the Ethics Committee who approved the trial which was co-signed by 29 health professionals and 2 organisations. The complaint detailed the lack of research evidence to suggest any efficacy for intermittent fasting, and called for the trial to be stopped on the grounds that it is dangerous and risked the physical and mental health of the teenagers.
  • Dieting in adolescence is the number 1 risk factor for development of an eating disorder. And the more restrictive the diet, the higher the risk. There is a huge body of longitudinal research in the eating disorders literature to show that this risk is significant. Eating disorders health professionals spend a lot of time trying to prevent eating disorders. In teenagers, we really try to emphasise helping kids of all shapes and sizes to take pride in the bodies, to develop a relaxed and attuned relationship with food, and to discourage crash dieting. This trial flies in the face of all known advice usually given to kids.
  • Of course, this intervention is being justified by saying that well, these kids are in larger bodies, they ‘need to lose weight for their health’.
  • So suddenly, something that is extremely dangerous for an adolescent is ok if your body is above a certain number?
  • Louise’s complaint was ultimately rejected by the Fast Track trial’s Ethics committee. They consulted with an anonymous panel of ‘experts’ who agreed that the risk was there, but said that the risk was worth it in the hope that the kids might lose a bit of weight.
  • Louise then started the change.org petition, which has been signed by 20000 people. This petition is calling for the trial to be stopped. This is unprecedented - a weight loss experiment really hasn’t had this level of protest against it before.
  • Numerous complaints to the Fast Track Trial's Ethics committee (more than 60) have been submitted, in groups and by individuals, and all of these complaints have been rejected.
  • Unfortunately, all of these complaints have been dismissed, with the research team consistently justifying their trial. They have even claimed that the risks of eating disorders are ‘minimal and manageable’, which is an extraordinary statement. Anyone who has experienced an eating disorder, or works with young people with eating disorders, knows how absolutely serious and difficult to manage they can be.
  • There’s no such thing as ‘minimal risk’ when you put someone on a crash diet, and there’s no such thing as ‘manageable risk’ when you look at an adolescent with an eating disorder.
  • Dr Louise Baur has said that she is ‘not aware of any studies of hospital based weight loss programs for adolescents which show evidence of harm’. This is a very reductive way of looking at the research and accumulated knowledge of eating disorder development. Dieting, body dissatisfaction and eating disorder development in adolescence go together, and to say ‘look, it doesn’t happen on our watch’ is irresponsible. It’s like looking at the data and saying ‘yes, we know that smoking causes lung cancer, but it wasn’t our packet of cigarettes and we’ve never seen a study to prove it was our cigarettes’.
  • A number of eating disorder organisations in Australia and around the world have called for the trial to be stopped, and posted statements protesting against the trial. There has also been a lot of media attention, some of it recognising the harm, and some of it quite weight biased, centring the ‘need for weight loss’ above all else.
  • We’re not getting anywhere in stopping the Fast Track trial, and our concern is that parents and teenagers are not being adequately informed of the risks, dangers, research, and lived experiences of dieting as a teenager. So we have launched a website to help the general public better understand the issues and the protest. In the website, we go through the research on the efficacy of weight loss for teenagers, particularly intermittent fasting, and of course the risk of developing eating disorders.
  • The website is www.fasttracktrial.com.au
  • Please visit this site, and share it. We don’t believe the gravity of the risk is being adequately shared right now.
  • One aspect which has been erased by the researchers is the stories and lived experience of people whose lives have been scarred by medically supervised dieting.
  • According to the Fast Track team, these stories don’t happen. But they do. These stories need to be heard, and heeded.
  • Today we meet Emma Hagan, and she is here to share her experience. Her eating disorder was directly caused by a paediatric ‘o’ intervention.
  • Emma is still undergoing treatment for her eating disorder, and it is difficult for her to talk about these issues. We are very touched that she is willing to stand up and tell her truth.
  • TW: those with eating disorder or in recovery, the following information may be triggering, as Emma discusses her illness and symptoms in detail.
  • Emma is fired up, because of the way the media have treated this story - ie centring weight loss above her story.
  • A media story just released about the Fast Track trial and the push back against it featured Emma and her experience. However, the article really didn’t pay adequate attention to Emma’s experience, instead favoring a weight loss story from one of the Fast Track participants.
  • Emma found out about the Fast Track trial when she was on the train to Day program for her eating disorder treatment. She was horrified, and thought how did it get past ethics?
  • Many people expressed this reaction - how did it get through ethics? Because the diet is so extreme, and so prolonged, and the target age is the highest risk age group for developing an eating disorder.
  • Emma grew up in a larger body, and experienced teasing and bullying because of her weight. At the age of 10 she ‘practically begged’ her parents to help her to try to lose weight. At the time it was self preservation, she was tired of being picked on.
  • Emma’s parents were aware of the risks of dieting, and wanted to be responsible, so they took her to a childhood ‘o’ clinic. They consulted with the paediatritian to design a safe weight loss program for Emma.
  • Emma’s family did all the ‘right’ things.
  • Emma was taught the difference between ‘safe’ and ‘unsafe’ foods. Early on they instilled the idea that weight loss is good, weight gain is bad, certain foods were good or bad.
  • Emma said it was hard to lose weight when she was at school, with her friends, just trying to be social and a normal 10 year old. That’s not compatible with weight loss.
  • Emma loved food. Over the Christmas holidays, she ‘gained weight’. When she returned to the “o” clinic, she was lambasted for it.
  • This pushed her to increase exercise, decrease food intake, and it became very obsessive. She got to the point where she had lost ‘enough weight’, was told by the paediatritian to stop, but by then she couldn’t. The eating disorder had taken hold.
  • The clinic taught Emma that restriction was a good thing. And the level of restriction she was on was less severe than the level required in the fast Track trial
  • This happened over a period of around 1 year. By the age of 11 she was diagnosed with Anorexia, was hospitalised, and fed on a tube.
  • Emma was sick for many years. Her hospitalisations did not stop at the age of 11. There is a culture of eating disorders in adolescence, which Emma’s parents shielded her from. But still the disorder had her in its grip.
  • Emma is now 24, and still in treatment.
  • Emma blamed herself, not the diet or the ‘o’ clinic, for her illness. She thought she’d taken a good thing ‘too far’. She never questioned the whole paradigm of ‘weight loss is a good thing’, she did not know of HAES or the impact of diet culture or weight stigma.
  • The paediatritian visited Emma in hospital when she was 11, and pretty much told her it was her fault. She seemed surprised that Emma had developed an eating disorder.
  • In retrospect, this was very unfair of her, but at the time it made sense to Emma.
  • One of the repeated messages we are hearing from the Fast Track team researchers is that the risk of an eating disorder is ‘minimal and manageable’. Emma thinks this is dismissive and idealistic. Eating disorders are not ‘managed’. They have their own life. They are obsessive and possessive, and not able to be placated by a professional.
  • Professional oversight did not prevent Emma’s eating disorder.
  • For 13 years, Emma has had a supportive eating disorder treatment team, but if has only been the last 6 months she has been able to embrace recovery.
  • Emma has a team of professionals: a psychiatrist, psychologist, dietitian, and a supportive family. Eating disorders don’t just affect one person, it’s the whole family.
  • It’s surprising in this day and age that we even need to be talking about the risks of dieting - that people like Emma need to stand up and say, this happened to me.
  • It seems pretty obvious that starvation, even if it’s ‘clinically approved’, will lead to an eating disorder. It’s not rocket science!
  • But there is a real push at the moment to erase stories like Emma’s. The Fast Track team even presented a paper at the International Congress for Eating Disorders (ICED) which said that hospital based weight loss programs for teenagers and kids did not cause eating disorders, were safe, and actually ‘beneficial’.
  • The paper hasn’t been released yet, but as soon as it is, Louise will report on it! Because often in their research, the Fast Track team’s conclusions don’t match their data.
  • The Fast Track teams’ prior research shows very little benefit to people in bigger bodies, and yet they’re pressing on with this experiment which is so precarious…..
  • In years to come, we are likely to see a real push back in the form of legal action against programs like these.
  • Emma was interviewed by Melissa Cunningham, the health reporter from The Age newspaper. Emma found it challenging to go through the interview process, she is very insecure about her eating disorder and it was difficult to talk about. She had thoughts like the article wouldn’t go ahead because she wasn’t ‘anorexic enough’. The reported also wanted photos of Emma at her most emaciated, which Emma refused to supply. So they took photos of her now.
  • Reading the article, Emma was genuinely surprised. She even thought - maybe it wasn’t the right one? Because it centred around a dad who had a 14 year old daughter in a larger body, she was active and healthy but always compared herself to her ‘rake thin’ sister. So the dad decided to enrol his daughter in the Fast Track trial, and now the daughter is 8 weeks in, a few kilos lighter and is ‘so happy’.
  • This trial is supposedly for teens in larger bodies who have ‘health complications’ - this girls health status is never mentioned - it’s all about weight.
  • Emma’s story, and the whole story of the protest and the complaint, was sandwiched between this ‘feel good’ weight loss story. Revolting!
  • Considering that it was Emma writing an email to the journalist to raise awareness of the concerns about the trial, to have the whole thing spun into a weight centric erasure of Emma’s story - sucks.
  • The article also minimised the protest against the trial, it only mentioned Louise’s complaint, it did not name the petition, the eating disorder organisation warnings - it really downplayed the push back.
  • Emma emailed the reporter with some ‘Frank feedback’. Her whole experience was washed, erased, by diet culture.
  • There is no good outcome from this trial. There will be minimal and short term weight loss, but the kids won’t be followed for long enough to capture the regain.
  • Failing to pick up eating disorder risk factors, the trial will likely result in ‘interventions’ like this being rolled out to more and more teens in larger bodies. This is a terrifying normalisation of extreme dieting.
  • This trial is the opposite of body acceptance.
  • If they find evidence of eating disorders developing, this means that these kids have been guinea pigs, exposed to known risks even after we have raised the alarm.
  • The researchers might say if they catch it early enough - it’ll be good. But Emma’s WAS caught early - in fact, Emma’s was created by the intervention itself. Early intervention did not save her from a 13 year nightmare.
  • If I was a journalist and heard Emma’s story, I can’t imagine then preferencing a small weight loss story above hers. This speaks to the magnitude of weight bias in our culture.
  • There is such a danger in unexamined weight bias. We have unexamined weight bias in the clinic, in the researchers, in the reporter investigating the story, in the politicians and NHMRC who we are appealing to - weight bias impacts everywhere, it is significant and difficult to undo.
  • We need to listen to the voices of people like Emma. This can happen. It could happen to you too. Please - visit the website, and get across the information about the risks and research.
  • We really need to heed the lessons of 70 years of weight loss research, and make major changes. Weight loss dieting does not work.
  • Big changes need to happen, we can’t keep doing the same thing over and over again & expect a different result.
  • Non-diet approaches to health help people to learn wonderful and health sustaining behaviours which can stick, without harming. Look for HAES Australia, or visit the Ellyn Satter website.

Resources:

The Fast Track parents information website

The Age article where Emma’s story was erased

The HAES Australia website

The Ellyn Satter Institute

Join our fb group - Stop the Fast Track Trial