All Fired Up

The Fast Track researchers have just published the results of their pilot study, and they are VERY excited about it! But does this optimism match the actual data? Don’t miss an explosive episode of All Fired Up, as I walk you through this paper step by step, breaking down into plain English what actually happened when 21 teenagers were starved three times a week for 6 months, all in the pursuit of short term weight loss. My guest is the incredible Ruth Leach, whose eating disorder began at the age of 9, when her whole family started fasting for ‘health’. Ruth not only survived her eating disorder, she is now a fierce advocate for everyone at the coal face of this deadly illness. We are LIVID about the lack of information being given to parents and kids who are being introduced to a lifetime of metabolic damage, weight cycling and disordered eating. The Fast Track trial is STILL GOING AHEAD, and we need to keep pushing back against this antiquated, weight biased, dangerous approach to teen ‘health’. Share this one far and wide!!

ShowNotes

• This week we bring you Part 2 of The Fast Track Trial, where we dig into the results of the newly published Fast Track Pilot Study. A pilot study is a mini-version of a larger trial, a practice run for ‘the real thing’, and the results can give you a pretty good idea of what kinds of results we can expect from a larger trial.
• I really wanted to get a ‘plain English’ summary of what happened in this trial out there.
• An article in The Age newspaper about the Fast Track controversy stated that:

"While the trial is the first of its kind, Professor Baur said it had come off the back of a successful pilot program in which 25 teenagers followed a similar model and saw benefits in their cholesterol, blood pressure, liver and heart function."

• Which is interesting, because Louise was reading the results of the pilot study at the time, and was noticing that in fact the trial results showed no changes in blood pressure, overall cholesterol, or liver function, and only 1 small change out of 9 measures of heart function. This is quite different to what the media was saying!
• It is so important to go back to the source and have a look at the scientific studies behind the media soundbytes, so you can fact check and see what actually happened.
• This should be easy, but in reality it’s not. Reading a study is actually quite complicated, and even when you have degrees and training in science, it can still be quite difficult to make sense of what happened. This is why I am here to unpack it for you!
• It is important for parents and teenagers who may be being targeted to participate in this trial to clearly understand what is likely to happen as a result of taking part. This is why I am doing this podcast.
• The article has just been published in the Journal of Nutrition, and the title is “Intermittent Energy Restriction is a Feasible, Effective and Acceptable Intervention to Treat Adolescents With Obesity”. What an impressive and optimistic title!
• But does the optimism match the data?
• The pilot trial took place at Sydney Children’s Hospital at Westmead, kids were recruited from the adolescent  “O” treatment clinic. 45 kids aged between 12 and 17 were approached, and 30 said yes. There were 25 girls and 5 boys, and the average age of the kids was 15.
• All of the teens were supposed to have a BMI of 30 or more. In fact, they ranged from a BMI of 27.7 to 52.4, so at least one was well below the weight threshold.**
• 3 of the kids were from Aboriginal or Torres Strait islander background. 6 of them were born overseas. We don’t know more about the cultural background of the rest of the kids.
• The experiment ran for 6 months under a dietitian. There were no psychologists or eating disorder specialists involved. For the first 12 weeks all of the kids were placed on Optifast (shakes) and allowed just 600-700 calories a day for 3 days of the week. The rest of the week the kids were told to follow ‘healthy eating guidelines’.
• After 12 weeks teens were ‘invited’ to either keep starving for 3 days a week, or they could change to starving for 2 or 1 day a week, or they could swap to a ‘continuous prescribed healthy eating plan’ for the next 3 months.
• 7 of the kids didn’t make it past the 8 week mark. These tended to be ‘heavier’ kids. We don’t know what happened to them after that. 2 more dropped out before the experiment ended, so overall just 21 teens finished the whole 6 months.​
• The kids were given a Fitbit, but were not given any instructions about physical activity. Mysteriously, the pilot paper never discusses the fitbit results.
• The primary measure they were looking at was weight loss at 12 weeks, with secondary interest in weight loss at 26 weeks, and they also did a range of health marker measures and one 20 item questionnaire which asked about eating disorder symptoms.
• 28 of the kids were categorised as ‘insulin resistant’ at the beginning of the study.
• At 12 weeks, and 26 weeks, the study reports weight change, but it’s actually quite difficult to figure out what that means. This is quite common: weight change in scientific papers can be reported in a huge variety of ways, eg BMI change, z score change, % excess weight loss change.
• Weight change was primarily reported as ‘percentage point change in BMI 95th%ile’, a very confusing statistic which stops everyday people from figuring out what the actual average change in weight was. A researcher can tell you something is statistically ‘significant’ even if it’s not that meaningful in real life.
• In the paper, it was reported that at 12 and 26 weeks the kids demonstrated a reduction in the percentage point change in BMI 95th%ile. But what does this actually mean in terms of real life weight change? It is impossible to tell.
• Luckily, the lead author presented her data at a conference where she did talk about the average kg weight loss for 19 of the 21 study completers.
• At this conference, she reported that after 12 weeks of intermittent starvation, the kids had lost on average 3.5kg.
• But by 26 weeks, these changes were not maintained; the teens had regained 1.4kg, so in total after 6 months of regular starvation, they were @2kg less than when they started, and they are likely to keep regaining.
• That’s not a big change, especially given the huge effort, and we know weight will keep coming back. We know this is the norm for most people who diet: dieting triggers a metabolic defence response, and our bodies fight to regain any weight loss. This is not a failure or a problem, it is the body’s built in response to dieting.
• What a difference between the raw data at a conference and adding the statistical wizadry in the published paper!
• There’s more to this story: in the paper,” Figure 3” is a graph which represents each of the kids percentage point BMI95th%ile change at 12 and 26 weeks. There’s a cute little diamond which represents each kid. And when you look at Figure 3, you can clearly see that one kid really stuck out from the rest of them: this kid lost WAY more weight at 12 and 26 weeks than the others, who really didn’t lose much at all. And it seems that this kid - this ‘statistical outlier’ - is responsible for changing the story of this data from concluding that weight loss between 12 and 26 weeks was ‘not maintained’ to saying that it was maintained, all because of one child who may in fact be developing an eating disorder right in front of us.
• Instead of removing this outlier (which is what a lot of researchers would do, because one person’s unusual results are skewing the data, and this isn’t what science is all about), it was left in. The fact that one person had an unusual response was not discussed in the paper.
• This is why it’s important to read the studies! To see what actually happened.
• We can also see in the Figure that at both time points, several of the kids had GAINED weight above the starting point - 3 at week 12 and 5 by 26 weeks. This is normal when we look at it from the perspective of the body’s response to starvation, but weight gain was not discussed in the paper.
• If you have almost a quarter of your sample over shooting with weight gain, it should be discussed!!
• Worryingly, the results show a significant reduction in height between 12 and 26 weeks. This was not discussed in the paper. This means that the teens' growth cycle is being interrupted. If a growing body is not getting adequate nutrition, the body will stop growing in order to compensate.
• Any impact of starvation on the teens’ menstrual cycle was not investigated. Given that 25 of the 30 were girls, this is staggering.
• Metabolic impact of starvation on the teenagers’ growing bodies was not measured or discussed in the paper.
• 28 of the 30 kids were reported to be ‘insulin resistant’ at the outset of the experiment. This was exactly the same after 6 months of semi starvation.
• Measures of cardiometabolic risk including cholesterol, blood pressure, and insulin resistance did not change after 6 months of intermittent starvation. Small changes in plasma triglycerides were reported, but these were in the normal range to begin with. A small increase in fasting plasma glucose occurred at 6 months, but overall no changes in insulin resistance occurred.
• Expensive and complicated vascular structure and function (heart) measures were taken, of 9 vascular measures only one was significantly changed by 6 months - arterial wall thickness. Measures of these factors were not taken for all of the completers.
• The comments made to The Age newspaper regarding the effectiveness of the Fast Track pilot are not true. The teenagers in the pilot study did not see "benefits in their cholesterol, blood pressure, liver and heart function". At best, one aspect of a secondary marker of heart function improved at 6 months, but the majority of bio-markers were unchanged.
• Dietary restraint - a measure which can indicate disordered eating and presence of an eating disorder - was significantly increased by 26 weeks. These scores were elevated to start with and became even higher as the starvation diet progressed.
• The paper does not discuss this at all.
• Although the paper reported ‘improvements’ in emotional eating and eating for external reasons, these scores were not unusual to begin with, therefore any reductions do not reflect a real life improvement, they are likely just reflecting the fact that the teens were eating less overall.
• Of 7 measured areas of quality of life, only 2 showed improvement by the end of the 6 months. Interestingly, the results showed that improvements in quality of life were more likely to happen for those kids who did manage to maintain their weight loss at 6 months, the ones who didn’t maintain their weight loss were worse off. Given that we know that all of these kids will continue to regain weight, it seems likely that their quality of life measures will worsen. However, the researchers will not follow them up long enough to find out.
• So they’ve just reinforced the idea that their self confidence is based on their weight.
• These outcomes are not great, yet their conclusions are effusive!
• I am sorry (not sorry) but the conclusions do not match the data.
• This Pilot study is being used to justify the Fast Track trial, and there is no plain English version out there.
• My guest Ruth Leach is an eating disorder survivor, her whole family suffered with eating disorder thanks to her dad’s obsession with fasting and his subsequent eating disorder.
• Ruth is tenacious, she organised a group complaint co-signed by 35 health professionals and people who have experienced eating disorder (many of whom attributed the cause of their disorder to teenage dieting).
• In the 1960’s Ruth was a ‘fussy eater’ - this would now be labelled as ARFID but back then there was no definition.
• When Ruth was 9, her dad went on a ‘wacky diet’ to prevent cancer - a fasting diet.
• The whole family began fasting. Ruth’s sister was 12 when they started fasting, and her growth was impacted - she didn’t grow very tall - Ruth is 8 inches taller than her - and she did not get her period until she was 17.
• Ruth developed childhood Anorexia, and then developed Bulimia as a teenager. She attributes the fact that she was able to grow taller to the binges she engaged in - they allowed her body the nutrition it craved in order to allow growth.
• Ruth follows the work of Gwyneth Olwyn, who talks about the concept of ‘extreme hunger’.
• A lot of people see bingeing as negative, but Ruth’s ‘extreme hunger’ was just her body trying to recalibrate after years of starvation.
• In Ruth’s early 50’s Ruth’s dad died, from complications of cancer. Even throughout his illness, he kept on fasting - he had an eating disorder. He was hospitalised repeatedly for re-feeding syndrome, and eventually this killed him.
• At this point Ruth’s eating disorder flared up, and she has been battling Anorexia again.
• Ruth’s dad did everything ‘right’, but still died of the cancer that fasting was meant to prevent. This is part of the reason the Fast Track study affected Ruth so much.
• It was only when Ruth’s dad was dying and her symptoms were returning did Ruth realise that it wasn’t just her, but her dad who was eating disordered.
• Ruth went through years of hell, but is out of her eating disorder now.
• Ruth became involved in peer support and online eating disorder support networks. Through the process of her recovery, Ruth learned about weight science and the ‘BMI lie” and how the ‘war on obesity’ is a complete beat-up.
• So much weight bias rampant in the field of ‘obesity’, and also the multi-billion dollar diet and weight loss industry that keeps the beat-up going.
• One of the reasons the industry is so huge is because our bodies have a built in mechanism to regain weight if we fall below our set point. This theory of set point is well established in science. This ‘war’ against obesity is really a war against biological reality.
• Ruth is concerned that the Fast Track trial will launch kids into either an eating disorder or a lifetime of disordered eating.
• The kids will also be introduced to a lifetime of weight cycling, and all of the health issues that come from that. The metabolic impact of repeated dieting causes a lot of the health damage that is attributed to higher weight itself.
• Ruth’s own life experience, and the experience of everyone in her peer to peer support networks, is that adolescent dieting ‘cost us dearly’.  For some, it has cost their lives: Ruth knows of at least 18 people in the last 2 years who have died from their eating disorder. And as teenagers, many of these people did the same thing that the kids in the Fast Track are being told to do.
• The Fast Track model is utterly a model of anorexia nervosa being sold to larger kids.
• Ruth’s complaint to the Fast Track ethics committee went into great detail about weight cycling and the risks to metabolic health, and also the risk of eating disorders. It was a very detailed complaint.
• We already have so many studies which demonstrate this risk. One study mapped out the pathway to developing an eating disorder. This starts with a child feeling dissatisfied with their body and experiencing bad body image, stigmatisation based on weight, and then dieting. So many of these kids have already crossed 3 out of the 4 stages of development of an eating disorder. So when the head researcher says there is no risk, Ruth asks how can you say that when there is good, consistent science based on thousands of people to say otherwise?
• The study the Fast Track is based on relies on just 21 kids’ results. And there was no follow up so we have no idea what happens to them a few years down the track.
• The study talks about the kids being placed on a healthy diet, but also says they were drinking Optifast shakes. On what planet is a shake an example of a healthy diet, especially for growing kids!
• This is an extreme intervention, but to realise in plain English that this means in all likelihood, your child will lose @3.5kg and then put it back on again, and not see any major health improvements - why on earth would you do this to your impressionable teen?
• This weight cycling aspect is not something the Fast Track parents or kids are being told about.
• The Fast Track has also been designed to stop following kids up at one year. At year 2 they have the option of reporting in again, but not a lot of effort is going into seeing what happens longer term. We really need to stop doing these short term studies and to design weight loss trials (if we do them at all) to have a 5 year follow up period - this is the only way we’ll be able to see the patterns of eating disorder development.
• What will the kids do when they overshoot in weight? Why isn’t anyone following people up?
• This research is already established - The Minnesotta Semi Starvation experiment showed clearly what happens to a starving body when it re-feeds. We really don’t need to keep ‘proving’ the risks, we need instead to stop exposing people to them.
• Out of the complaints that were lodged and following meetings with eating disorder organisations like the Butterfly, the Fast Track researchers said they would update the parent consent forms to better inform parents of the risks. That was back in February, and still we’ve heard nothing.
• In 2019, if you’re going to go into a weight loss experiment, you need to know what the science says about what you can reasonably expect in terms of weight loss and regain, and what to expect in regards to risk. This isn’t rocket science, it’s a basic human right!
• If they wrote down exactly what to expect, I wonder if anyone would sign their kid up!
• The increases in restraint are concerning, this is a marker of eating disorder development. Regardless of weight, this is a worry.
• In Ruth’s networks she advises parents to look at sudden weight losses in their kids, regardless of BMI - look at the disordered relationship with food, not the size of the child’s body.
• The fast Track researchers are saying that their adjustments to the study protocol - as in, checking more frequently for eating disorder markers - will increase safety, but how on earth can you detect an eating disorder behaviour if the study itself encourages disordered eating and rewarding restriction?
• If we put together the diary of someone with an eating disorder and a journal of the Fast Track kids, they would look almost identical.
• If someone was getting really sick, they won’t see it ! They will look like weight loss ‘success’ stories.
• People with eating disorders feel really good, and positive, when they are restricting. They can feel calm, clear headed, and energetic when they are starving.
• This is not a normal response to starvation, and it’s a deadly response. The Fast Track researchers will not be able to view this as troubling, and the kid will fall through the cracks.
• How do you get $1.2 million to fund a study with such unimpressive results? The data do not match the conclusions.
• Even the title of the pilot study is seriously overblowing their actual findings.
• We need to listen to the American Academy of Paediatrics - where it specifically says discourage dieting, and skipping meals, and encourage healthy eating. It’s not hard.
• This experiment is unacceptable. It only makes sense through the lens of weight bias. If we’re worried about people’s health, there’s better ways than risking the metabolic damage that comes from weight cycling from crash diets.
• At this point the Fast Track trial is still continuing, in spite of the enormous global protest.
• Please sign the petition!
• Emerging news this week - the Fast Track researchers have published another paper, a meta-analysis which claims or concludes that hospital based weight loss programs for kids and teens definitely doesn’t cause eating disorders. The team have now told the Butterfly Foundation that they are planning to post this study and the pilot study up on the Fast Track website as a way of communicating risk to the parents and teens who might be enrolling.
• I will dive into this paper & let you know - is there a difference between the data and the conclusions? Spoiler alert: they’re doing it again…..
• Informed consent is everything, and this is a serious problem with the researchers slapping up their own research as a way of getting around presenting potential participants with straightforward risk information. This brings up the very issues we’ve talked about today - how on earth are parents supposed to be able to read and understand this dense data?
• That’s why we need the plain English website where we clearly tell people about the risks and likely outcomes.
• Visit the Fast Track parents information website!

** Via a letter from a legal firm, the Fast Trackers informed me that this statement is incorrect, and that in fact the kids all had an 'age and sex adjusted' adult equivalent of a BMI over 30. No other aspects of my interpretation of the paper (including the interesting tweakery between the presentation figures and the addition of the outlier which changed the results) were challenged by the team.

Resources Mentioned:

Ruth’s complaint

My complaint

The Fast Track parent information website

Gwyneth Olwyn

Sign the Petition

Join our fb group

Connect with Ruth on Twitter

Ruth’s tumbler post

The ‘experts in the room’ blog

What’s wrong with ‘obesity prevention’ ?

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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

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Wellness influencers are everywhere; our social media is littered with shiny haired, sparkly toothed, spray tanned gurus eager to sell us a 'better version' of ourselves. Wellness is just diet culture in organic recyclable wrapping, and my guest Virginia Sole-Smith, feminist author, has had ENOUGH already. Who is responsible for this epidemic of commercialised wellness? WELL, ACTUALLY, our cultural obsession was engineered by thin white men! That's right, back in the late 1990's a bunch of privileged white dudes created a whole new way of gaslighting women! No longer content with the simplistic demand for thinness, wellness culture has added extra layers of guilt - not only MUST we be thin, we must also care about the environment, never eat processed foods, recycle, and remain ZEN. It's exhausting, confusing, and we've had enough! Join us for an epic rant!

Show Notes

• My guest is the fierce and fabulous Virginia Sole-Smith, journalist and author of “The Eating Instinct: Food Culture, Body Image and Guilt in America”.
• Virginia is enormously cheesed off with privileged, thin white men who get off on telling us what to do with our bodies and how big/small we need to be.
• I found a brilliant article that Virginia had written entitled “Well, Actually...The thin white men who rebranded dieting as “wellness”” - and just HAD to talk to her more about this.
• There are a truckload of ‘mansplainers’ in the wellness space. And in her article, Virginia is tracing back the timeline of our current wellness saturation.
• Virginia points out that currently, wellness ‘influencers’ are often thin white women, and they cop a fair amount of criticism for their messaging - RIGHTLY SO - but when we look at where they’re getting this world view of wellness from, it does tend to go back to thin white men who really think they know how everybody should eat.
• Back in the 1980’s diet culture was heavily influenced by thin white men like Dr Atkins (Atkins Diet) and Dr Agatston who invented the South Beach Diet. We’ve had men telling us what to eat for decades!
• This trend dovetailed with women entering the workforce since the 1970’s. If we can keep women focused on our bodies, on trying to stay as small as possible, that saps a lot of energy when we could be out dominating the world.
• In the 1990’s Naomi Wolf wrote in The Beauty Myth that dieting is the most potent sedative in women’s history, it keeps us focused in a really narrow way and not participating in the world.
• We can trace this trend of the Thin White Men back even further, back to Kellogg, to Banting, to these thin white men who dominated and create the narrative of deprivation for us to follow.
• Even Jenny Craig launched her business with her husband Sid who was really the driver of the business model, while she was ‘the face’. This often happens - a woman is the front of house but a man is powering everything.
• Guys often take credit for their thinness when in reality they’re born on 3rd base - they have bodies that are genetically programmed to be a smaller size. Others are programmed differently, theirs just happens to fit a cultural ideal. It’s not really through anything they did, it’s just biology & genetics that set them up this way.
• The ‘bootstrapping’ mentality - if you have success, that’s definitely down to you, but concepts like adversity, hardship, oppression - none of that really applies to the Thin White Men.
• In the mid 2000’s, Thin White Guys got more subtle, and more overtly political than their diet peddling forefathers In the 1990’s and even early 2000’s, we knew when a diet was a diet. But when Thin White Men like Michael Pollan (In Defense of Food) and Michael Bittman (Vegan Before 6) came along, they talked about food with an environmental and political agenda, this whole other mission of reducing meat consumption and embracing organic farming. Concepts like this - having a more sustainable food supply, or eating more plant based foods, - are fine, and useful ideas, but the Thin White men turn these concepts into dogma, and take it into communities who just don’t have access to this way of living and to be honest have bigger problems to face than the quality of the food they’re eating, and say hey, you should eat like me and the “o*esity crisis’ will be solved.
• For many people, it’s hard to connect with organic farmers, but if it is framed in terms of the weight issue, this becomes something that really grabs people’s attention.
• This is where the groundwork for our modern concepts of wellness came from - now it’s not about dieting, now it’s about wellness and healthy eating and sustainability. Except it’s not, it’s still about weight!
• We’ve really lost the environmental agenda but we’ve still attached this morality to these food choices.
• This is where it gets really elitist and classist and racist, in addition to the misogyny that’s been there all along. I’m better than you because of how I eat.
• Louise admits that early on in her anti-diet career, Michael Pollan’s book was for sale in her practice! He was so convincing. It took her a while to recognise how elitist and snobby (and white) it was to tell people that a certain way of eating was morally superior to another, without taking consideration of the multiple layers of disadvantage and inequality people experience.
• Michael Pollan did one great thing - he called out the ‘fake’ diet foods (especially low fat yogurt, how gross) which were very unsatisfying for people. The problem was he replaced it with another diet and did not empower people to trust their bodies.
• Pollan never questioned the thin is good rhetoric, he even talks about his way of eating as a way to solve the ‘problem’ of larger bodies.
• Pollan’s second book, “The Rules of Food”, is like a women’s dieting magazine article, but it’s written by a man. Ewwwww.
• The mansplaining of wellness is not just an American Thin White Man thing. In the UK, Jamie Oliver also talks up the power of unprocessed foods as a way of solving the apparent ‘crisis’ of larger kids.
• At first, approaches like Oliver’s seemed exciting, and Louise had his cookbooks as well, it was fun to enjoy cooking again with lots of fresh foods. But as time progressed it seems that his message has increased in fervour, that the reason to eat like this is to change the problem of fat bodies.
• Jamie’s habit of lunch box shaming drives Virginia crazy, as kids don’t really have a lot of choice as to what’s in their lunch box. It’s particularly stigmatising to poorer and disadvantaged kids, which is evil!
• Here in Australia, the King of the Humans when it comes to Thin White Men mansplaining wellness is Pete Evans or ‘Paleo Pete’, a celebrity chef from Masterchef who owned a pizza restaurant and was normal until he discovered the Paleo diet, lost 300 grams, and became an absolute zealot. He’s gone really extreme, totally rogue, anti-fluoride, anti-vaccination etc.
• The amount of moralising and dressing up wellness as a disguise for thinness is really awful with Pete. It seems he is everywhere right now as well.
• It’s really dangerous the way people like this use flimsy arguments or bring up totally shit studies to support their extreme views. And we are vulnerable to these people and these messages.
• In her article Virginia writes that celebrity influencers like Gwyneth Paltrow have been ‘simultaneously inspiring and terrorising their audiences”, and this works well for Paleo Pete too. It’s 5% inspite and 95% terrify and gaslight, introducing this distrust in our bodies. Don’t trust yourself, you need to outsource everything to this guru or expert.
• This was the foundation for Virginia’s book The Eating Instinct, that as humans, we generally know when we are hungry, what we feel like eating, and when we are full. We can trust this.
• Virginia is a journalist, who used to be a ghost writer for celebrity “lifestyle’ books, and used to cover ‘wellness’ for women’s magazines - right in the thick of it! As a feminist it was really hard and Virginia struggled with the messages women were being given around food.
• For a long time, Virginia looked for the ‘right’ diet - one that would work. And Michal Pollan offered that, or so it looked, so for a long time Virginia was on that bandwagon.
• In 2013 when Virginia’s daughter Violet was born, everything changed. Violet was born with a congenital heart condition and she almost did. As a result of this, she stopped eating completely and was dependent on a feeding tube for the best part of 2 years.
• Virginia had done everything ‘right’ - really trying to look after her prenatal nutrition, exercise etc, and now her baby would not eat and no-one knew why.
• There are no experts, there are no plans here. There’s just me and this kid and we’ve got to figure this out!
• When Violet was too scared to eat, it really brought home the reality of food as a basic instinct. It’s not about finding the right ‘plan’, it’s about figuring out our own relationship with food.
• Virginia realised it wasn’t just about nutrition: food needed to provide comfort.
• In order to get Violet to eat, she needed to teach her that food was safe, comforting and pleasurable.
• In diet culture emotional eating is viewed as a ‘bad’ thing, when in fact this is what we’re programmed to do. Babies eat emotionally!
• The act of feeding a baby raises our oxytocin levels - the hormones associated with love, safety and comfort. And this is breast or bottlefeeding!
• Diet and wellness culture views eating as something to get ‘right’ nutritionally, and ignores all of these other important aspects of our relationship with food.
• Even in some non-diet spaces, there’s a message that if you learn the principles of mindful eating you’ll stop comfort or emotional eating.
• This is different to eating to numb difficult emotions - which we may call comfort eating, but it’s not really providing comfort, it’s more a habit of eating to escape or check out from difficult emotions. It’s more accurately described as ‘distress’ eating.
• At the heart of this kind of eating is restriction, and you can’t get away from this type of pattern unless you have full permission to eat.
• Once this sense of permission and safety is established, a beautiful self-regulation can appear, so you feel safe eating whatever you feel like, and you also know when you’ve had enough. That’s pretty radical, and something a lot of adults struggle with in diet culture!
• Many people who come to the non-diet approach arrive because they want to stop the binge or comfort eating. But establishing a safe foundation of food safety needs to happen first - not elimination of binge eating.
• When you start the process of permission and food safety, often you will eat more than you might be used to while everything is settling in. This can be scary for people, but it is necessary to keep embracing full permission, as it’s only when we feel truly safe that we can start to feel more in contact with physical signals.
• Going through the process of eating more is not pathological - you are healing from this deprivation induced trauma. It can take time & can be messy!
• In diet culture the restriction mindset is so dominant, particularly for women we are taught that we should always want less. It’s so difficult to eat, especially in public.
• This is this patriarchal message about food that we’ve really internalised.
• It’s a very radical thing to reject that, and to say I embrace my hunger, my appetite, my body, my right to take up space in the world.
• We’re fighting not just for ourselves, but for others, and for future generations.
• During Virginia’s experiences with Violet, she got to know a lot about paediatric feeding problems and how they are treated. In the USA, babies are treated at feeding centres, not eating disorder clinics.
• It’s behaviour therapy - kids are encouraged to push through their fears, and get rewards for eating a bite of food.
• Virginia was horrified - knowing that her daughter was going to grow up in diet culture, with so many messages already there to not listen to her body - and the programs would really strongly reinforce this.
• Virginia believed that Violet’s response to the trauma was logical, and that treatment needed to honour that.
• She researched & found out about the child lead model, a longer process but one which really allows the trauma to heal and for the child to re establish a sense of safety and comfort around food.
• The behavioural approach is quicker, it’s a kind of boot camp model. But for Virginia, it was like looking at dieting versus intuitive eating, and she wanted to do the intuitive model.
• Virginia began to realise that it is the loss of the eating instinct - the loss of knowing hunger, fullness, and a sense of safety and comfort - that underpins many eating struggles. So she wrote a book about it!
• The book has many stories of how people get disconnected from their instincts, and how this impacts their lives.
• Virginia’s experiences with Violet have really helped her with her second daughter, to navigate things like appetite fluctuation without panic.
• The feeding philosophy which underpins Virginia’s approach to Violet is called “The Division of Responsibility in Feeding” developed by Ellyn Satter, she’s been around for decades. This says that feeding is a relationship, that parents and kids have distinct roles. Parents are in charge of what, where and when to eat. Kids are in charge of how much to eat, and whether or not to eat everything on offer.
• With this model, food intake may not look ‘balanced’ at every meal, but over time, they tend to get everything they need.
• Also what appears is this ability to self regulate, for the kids to really know what they need, it’s so awesome.
• When you have kids who are intuitive eaters, things change all the time. And that’s ok. It’s about honouring the child’s instincts, not policing their nutrition intake.
• This is where the lunch box policing is not helpful! There are many other considerations than dietary quality.
• An awful news article came out recently comparing the lunch box contents of rich kids to poor kids, with the conclusion of look how much better the rich kids are eating…..tone deaf!
• It is a privilege to be able to think about dietary quality. It is ok to give your kids comfort food. And processed foods! Violet wouldn’t have learned how to get comfortable to eat without baby food pouches.
• Certainly, there’s something wonderful about improving our food supply. But we need to not shame people, and also to honour people’s individual relationships with food.
• Feeding kids is not easy! We need to honour the work parents are doing.

Resources Mentioned:

Virginia’s amazing piece for Bitch Media: “Well, actually…..”

More about Ellyn Satter & The Division of Responsibility model

The awful news article on school lunch boxes

Find out more about Viriginia Sole Smith

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Diet culture has a nasty habit of targeting women at vulnerable times in their lives, and this is particularly evident in pregnancy and birth. This week on All Fired Up!, I am venting with the incredible Hilary Kinavey and Dana Sturtevant from Be Nourished, who bravely walked into a medical conference and called out the rampant weight stigma which is hurting pregnant women. This is a not to be missed episode, how women in larger bodies are being treated by the medical profession is just NOT OK. Women are being told that their vagina is “too fat to give birth”, that they won’t live to see their babies grow up, that they need to lose weight! The fact is, most women in larger bodies have healthy pregnancies and births, but are having the bejeezus scared out of them with some seriously odious threats. Reclaiming your body and your power is possible. It’s time to take your body sovereignty back!!

Show Notes

• Hilary and Dana, anti-diet health professionals from Be Nourished, are utterly fired up about the never ending pressure that diet culture puts on women at vulnerable times of our lives, particularly with regards to fertility, pregnancy, and birth.
• They were invited to speak at a conference where they could talk about body positivity and managing risk in pregnancy. Whilst an awesome and much needed topic, they were the only speakers to talk about weight stigma.
• In the medical community there is some acknowledgment that weight stigma impacts health, but the vast majority of professionals are seeing weight stigma as a barrier to losing weight, which is just not reflective of a deep understanding of these issues.
• Stigma itself affects health, greatly, and this is not being researched nearly enough.
• Multiple sources of oppression intersect in pregnancy. Women are of course oppressed in general in a patriarchal society. Women of colour, and women in larger bodies who are of colour, suffer the most from these structural oppressions.
• Women who experience stigma can have a harder time giving birth, because of the stigma, not their weight alone.
• The history of gynaecology is implicitly racist and sexist. Early experiments in gynaecology were performed on Black women without anaesthetic, as it was believed they could not feel pain as much as white women.
• although we own the bodies that are giving birth, we are often told that we are ‘not qualified’ to make choices about our births.
• The concept of ‘weathering’ is when multiple levels of stigma impact on our bodies.
• Serena Williams’ experience of birth is reflective of this impact of stigma and the inherent disregard for women’s agency in pregnancy and birth.
• Higher rates of caesarian sections occur in women with higher BMI’s. But why? How much of this is due to the belief that as a woman in a larger body, you can’t deliver safely?
• This idea of ‘colouring’ - that when we internalise weight stigma, it colours our decisions and choices.
• The midwifery model is to view birth as an event, not an emergency.
• The vast majority of women in larger bodies have successful pregnancies and births. And if something goes wrong, this can be managed most of the time.
• The actual risks of complications in birth are being exaggerated by statistical buggery.
• Women are facing systemic discrimination in the area of birth. Women are often told they can’t give birth in their local hospital, in rural & remote Australia they are being flown to hospitals in capital cities. Imagine the impact of this. We are so vulnerable at this time and we need our support networks.
• Physicians are frequently scaring women and telling them that their weight means they are automatically a high risk pregnancy. This is because many health professionals receive training which views a larger body as a problem or a risk factor.
• If we believe we are not capable of a birth, this will reflect on outcomes.
• Once women pick up the idea that the medical professionals will judge their bodies, they will avoid pregnancies in order to avoid judgement, or choose to avoid medical care altogether.
• Society is messed up and your body is not, medical providers have been given a biased education.
• It is ok to grill your health professionals in order to assure that you are safe.
• If you do have a complication during birth, it doesn’t mean you’re a bad person or a bad mother.

Resources Mentioned:

• Find out more about Hilary & Dana at Be Nourished
• Watch the Being Serena Documentary
• Nothing dear, you’re not qualified!
• The article about risks of birth defects in larger women and how statistical buggery is being used to inflate the risk.
• Fantastic article about how the medical community fat shames mums. This is the one where the woman was told her vagina was ‘too fat’ to give birth. And the awesome comment from Dr Shah.
• The Australian study on weight bias in maternity care.
• Awesome FB group for ‘plus size pregnancy’
• Help with diabetes through a weight inclusive lens - Megrette Fletcher

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It’s the 50th episode of All Fired Up! and we are delving into the Keto Diet craze!! Join me and my fabulous guest Jessi Haggerty, RD and nutritionist, as we set the record straight on all of this ketosis nonsense. As Keto fever sweeps the planet, we really need to stick on our critical thinking hats. Just what is ketosis, and why is everyone trying to do it? Is it really the answer to life, the universe, and everything, or is it just another fad? (Spoiler alert: the answer begins with the letter F).

Show Notes

• Urgent call for action - In Sydney and Melbourne, the “Fast Track to Health” trial is about to kick off, and researchers are planning to subject adolescents to a starvation diet for an entire year. Please sign the petition to get this stopped!
• Jessi Haggerty, RD and nutritionist, has had a gutful of all of the ‘hot diets’ around in January. She has a special pet hate for the Whole 30, which she talked about on her podcast recently. The sister diet to the Whole 30 is the Keto diet! Keto is THE hot diet right now.
• Jessi wrote a great blog on this topic - a Dietitian’s take on the Keto diet - which is really awesome. Jessi’s intern did a lot of the writing and heavy lifting for this blog, so a shout out to her.
• The Keto diet has taken the low carb movement to the next level. It’s not like going low carb/high fat is new - we saw it in the 90’s with the Atkins diet. Well, the Keto diet is Atkins 2.0, but it’s even harsher than Atkins!
• Keto started as a medical solution for children with epilepsy. Paediatric dietitians help kids with epilepsy follow a very high fat, medium protein & very low carbohydrate diet. Dietitians typically recommend that 40-50% of our intake be carbohydrate based, on a keto diet this goes way down to about 5%. The primary reason for doing this for kids is seizure prevention. It is an extreme measure that is only used when the medications don’t work. Because doctors and parents know how difficult it is to stick to such an extreme diet. But this is a last ditch effort in a very difficult situation. And for these kids, the keto intervention only works about 50% of the time. The mechanism of why this type of intervention might work to reduce epileptic seizures is unclear.
• Somehow, this diet was adopted by the mainstream as a way to lose weight. Go figure!
• Some people talk about using Keto for disease management, but overwhelmingly people are using it as a weight loss/fat loss tool.
• Like any weight loss diet, keto has major downsides. Restriction like this is not fun for people, and can lead to disturbed eating patterns and even eating disorders. Metabolic disturbance is also a serious consequence of dieting.
• How on earth did this diet get so popular! It’s really big in gym culture in Australia - it’s just so popular.
• We just keep going for fewer and fewer carbs - what’s next!
• There is a difference between ketoacidosis and ketosis. Ketoacidosis can happen if you are diabetic and your blood sugars get very low. Ketosis is when your body doesn’t have enough sugar in your system to keep everything running efficiently, so your liver creates ketones to keep your body going. Ketones are your bodys’ ‘back up’ mechanism which makes sure you can survive, and find food again. Ketones are not your bodys preferred source of energy, they are a back up system to take care of you when you don’t have enough carbohydrates.
• ...And this is being sold as a ‘healthy diet’ for people!?
• We literally hear people bang on about ketosis as if it is a superior way of living.
• Just because our body can use alternative sources of fuel, doesn’t mean that we should or need to be aiming for it! You’re just putting stress on the body in the name of weight loss.
• What is the impact on the brain of starving it of glucose and carbohydrates? Brains love these!
• Jessi’s blog post brought the ire of people who have tried Keto and say that it has ‘worked for them’. Jessi challenges them - what do you mean by ‘worked’ - (it’s going to mean weight loss!).
• A lot of people told Jessi that it helped lower their blood sugar levels. Which if course will happen, because you’re not eating any carbohydrates!
• Fiona Willer talks about the concept of ‘metabolic austerity’, where when your body is really deprived of food, it isn’t even well enough to be sick…It doesn’t mean that the underlying health condition has improved, it’s just being suppressed.
• For every negative response to her blog, Jessi got 10 messages from people who said the Keto diet had major side effects - they couldn’t think clearly, couldn’t concentrate in classes etc. It chips away at you little by little.
• Of course, not being able to poo is a problem because not enough fibre! This is a big deal!
• People are voluntarily not pooing? No thanks!
• Plus, the bad breath thing. It’s a side effect of the ketones having that specific smell. Gross!
• Keto diets have become so popular in Australia, that in some rural and remote areas the pharmacies have sold out of urine strips, so people with actual health condition can’t monitor themselves. Because gym dudes want to check they’re in ketosis!
• To be so obsessed with wee and to forget all about poo, doesn’t seem right to me.
• This diet is so unsustainable. Getting and staying in ketosis is really difficult. A lot of people who are doing this are torturing themselves and not even getting into this ‘glorified state’. It’s a lot of work for very little benefit. We have no solid research that this diet is helpful at all, aside from the evidence for kids with epilepsy. We don’t even do this treatment for adults with epilepsy.
• The research is only short term. And we know from 70 years of weight research that weight loss is likely to be temporary only, and the impact on metabolism is quite scary potentially.
• Although Jessi wrote the blog a while ago, she is still getting comments! One comment said that Jessi is “drowning in carb-tard cognitive dissonance”! WTF!
• The Keto people are a bit us and them - what is a carb-tard! If they’re saying there is something wrong with people’s brains because they eat carbs - that’s the pot calling the kettle black!
• If this diet makes you feel restricted and you’re struggling, it’s probably not for you. If it works for you, that doesn’t mean that the entire body of science is wrong. If the majority of people aren’t doing well, that means something - go elsewhere! Selling this as if there is no risk is the real cognitive dissonance.
• Won’t it be nice when we can go back to the high carb fads again! There will always be a fad to talk about.
• Louise tells her story about being scammed out of $300 with a ‘keto ultra diet’ pill!
• There is a lot of privilege involved in selling ketosis. It’s paying a lot of money to starve yourself.
• If you are tempted to diet, take a step back and ask yourself - what is the problem I am trying to solve here? Is there even a problem? A lot of the time, nothing is wrong. And these weight loss ‘solutions’ create a whole world of problems. And take a close look at the science. And always go non diet!!!

Resources Mentioned:

• Starving Our Teens - Update on the Fast Track to Health” blog
• Sign the petition to Stop The Fast Track Trial
• The A Current Affair story about the Keto Diet pill scam
• A Dietitian’s Take on “Going Keto” by Jessi Haggerty - blog and podcast and Instagram

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Welcome to the All Fired Up Second Annual Crappy Awards! In this nail biting episode, we hear rants from people all over the world who are letting us know their thoughts on the sh*ttiest diet culture trend for 2018. Hilary Smith, social justice warrior, pole dancer AND winner of last years’ Inaugural Crappy awards, is here to judge the contestants, and my goodness it’s a stiff competition! Pour yourself a drink and get ready to be utterly gobsmacked by the utter diet culture bullsh*t delivered in 2018!

Show Notes

• It’s time for the 2nd annual Crappy Awards show! Thank you to everybody who submitted their audio rants, we have a very high standard of entries this year! And it is fantastic to have applications from listeners as well as non-diet health professionals.
• What was the worst, most irritating diet culture trend for 2018? I am joined by last year’s Crappy Award winner, Hilary Smith, who has kindly agreed to come on the show to judge this years entrants and crown the new winner!
• Hilary will judge each nomination according to Creativity, Quality of the Argument, Passion, and Number of Swear Words.
• Louise needed to have a little rant about her pet peeve for 2018, the f*cking intermittent fasting craze, with a special mention to Michael Mosely for expanding the spread of such bullsh*t. And to all of the health professionals and researchers pretending that this stupidity is the key to long lasting, effective weight loss, Louise says SCREW YOU!
• Crappy Award Nominee #1, from New Zealand’s Tania Vincent from Thrive Nutrition: A horrific facebook ad for a fat shaming phone app, using cute little cartoon characters to sell calorie control.
• Crappy Award Nominee #2, from listener Jade Pettersen: After having gastric surgery, it seems like your body becomes public property! And the support groups online are like breeding grounds for eating disorders!
• Crappy Award Nominee #3, from listener Ava: Louise reads a heartfelt email about how the weight loss surgery business model is targeting vulnerable people. A good friend of Ava’s was encouraged to take out her superannuation to pay for the surgery, even though her friend has significant mental health issues. Ethics anyone?
• Crappy Award Nominee #4, from Mind Body Well psychologist Janet Lowndes: The incredibly unethical “Fast Track to Health” trial being run here in Sydney and Melbourne, where adolescents are being  put on intermittent fasting diets for an entire year, in spite of the lack of efficacy for this type of diet. This is just a recipe for an eating disorder, and it is equally heart breaking and enraging that it’s allowed to proceed!
• Crappy Award Nominee #5, from Heather Eisman all the way from Alaska!: The “Bright Lines Eating” program by Susan Peirce Thompson, a horrendous example of monetising the 12 step programs and increasing restrictive thinking in people who already have eating issues.
• Crappy Award Nominee #6, from UNTRAPPED member Alyssa: Unsolicited health advice from thin people who think they are doctors.
• Crappy Award Nominee #7, also from Alyssa: The Cookie Diet - almost no words!
• Crappy Award Nominee #8, from Anna Hearn from Haven Wellness: The entire diet culture and its relentless toxicity, in particular this idea (incorrect) that we can all ‘choose’ our own body weight. Not supported by science!
• Crappy Award Nominee #9, from Sona, member of Haven Wellness: Policing people who speak about HAES beyond the idea of body acceptance/body love.
• Crappy Award Nominee #10, from Natalie Haider, psychologist and yoga instructor from Haven Wellness: Placing the pursuit of health on a pedestal while ignoring all of the other ways humans can be absolute shits to each other.
• Crappy Award Nominee #11, from listener Mia in California: “WW” and the awful Mindy Grossman, planning to get WW into every home on the planet. Please bugger off Mindy.
• The Second Annual Crappy Award Prize is a Bullshit Button!
• The Crappy Award winner is Alyssa, nominee #6, for unsolicited health advice!
• Unbelievably well delivered sarcasm means Alyssa wins, with 4 equally amazing ties for second place!

Resources Mentioned:

• Hilary Smith’s award winning Crappy rant from last year’s show:
• The incredibly fatphobic ad for the Huawei mobile phone calorie counter app, thank you to Tania Vincent from Thrive Nutrition for this entry!
• Find out more about the amazing anti-diet psychologist Janet Lowndes
• Find out more about Anna Hearn & Haven wellness here

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Hosted on Acast. See acast.com/privacy for more information.

Strap yourself in for a wild ride on the rollercoaster of yo-yo dieting! My guest is utterly fierce HAES psychologist and eating disorder specialist Deb Burgard @BodyPositivePhD who is DISEMBOWELLING a new study which claims that yo yo dieting is actually really good for you. You will not believe how shaky this science is, or the lengths that Deb went to in order to sniff out the truth! Join us for a fabulous rant about the evils of the weight cycling industry, mouse research, dodgy science, cake icing, white supremacy, and more!

Show Notes

• The fabulous Deb Burgard is fired up about the weight scientists desperately trying to legitimise the failure of dieting by using mouse research to justify weight cycling.
• The vast majority of people who diet put the weight back on. The evidence to support this is extremely robust - Level “A” evidence according to the National Health & Medical Research Council. We are as sure that people will put weight back on as we are that smoking causes lung cancer. The evidence just doesn’t get any stronger in research!
• But the weight loss industry has profited from selling the hope of long term, permanent weight loss, and it has even convinced us that when we fail, it’s us that’s the failure, not the product itself!
• It’s probably one of the largest gaslighting industries in the world.
• It’s hard wired in us to regain weight, it’s a normal process of our bodies returning to homeostasis. We are supposed to have size diversity.
• Weight suppression is a pathology, not an achievement. But we only recognise it as a pathology in thin people, and we completely miss it in larger people.
• Higher weight people with exactly the same illness (AN) won’t get the diagnosis as easily (or at all!) as a thin person with AN. We prescribe for fat people what we diagnose as eating disordered in thin people.
• Deb is renowned for standing up and calling things as she sees them. She’s not afraid to call out the weight cycling industry and challenge the paradigm!
• Deb has seen people for 30 years, she’s seen how people suffer at the hands of diet culture. Larger people with lives worth living, the casualties of this idea that they’re supposed to spend their life pursuing thinness. For Deb, pursuing diet and weight loss is a giant waste of time which we can’t get back. No-one should have to lose years of their lives dedicated to this project of weight loss, which science shows us won’t work.
• Deb wants everyone to divest from the weight cycling industry, because it’s a death industry. We need all hands on deck to dismantle weight-centric business models. It’s a white supremacy model, based on oppression.
• Deb has been around for a long time, she grew up absorbing the atmosphere of the women’s movement and the civil rights movement, and for a long time she has fought for social change. Getting together and fighting battles really does and can change the world.
• When we wake up and realise that it’s not us, but the world that is wrong, and we come together as a community, we become strong.
• Looking at diet culture nowadays is kind of like the story of the Emperor’s New Clothes, where you’re standing there looking around for the other people who can see that he’s naked! We need each other. We need to know that other people think like this!
• Deb has a big community of people, both locally and online, and this community has helped her to find and use her voice, and to gallop the HAES movement forward.
• This is how we got started on today’s topic: in a chat room, a new study came out on mice which showed that mice who weight cycled - ie the mice who went off and on diets - lived longer than mice who stayed fat. The paper concluded that people should still try to diet, even if they will put it back on, because presumably the same effect would generalise to humans.
• It’s a really irritating way to interpret the failure of dieting - that even though diets don’t work, we should just put up with weight cycling and yo yo diet all of our lives, because the less time spent being fat, the better.
• Weight science history - at first, it started out aiming to make fat people not fat anymore. But when that didn’t work, the aim became 20% weight loss, that didn’t work, so they went to 10%, and that still didn’t happen, so now they’ve dropped the definition of weight loss ‘success’ to 5% and even less - not because science shows benefits there, but because humans just don’t lose that much weight in weight loss studies.*
• People like Paul Ernsberger have been turned away from studying weight cycling and actively discouraged.
• The Look Ahead study is often talked about as an example of ‘proof’ that people can lose weight & keep it off, even though that study was stopped early because it turned out that making people lose weight didn’t actually reduce their risk of having a heart attack. Deb talks about how people in this study were older, and even the control group were losing weight. Also, the people in the intensive lifestyle intervention group were subjected to intense pressure, and knew they would be weighed every year, so everyone made a big effort in the 6 months leading up to the weigh in. So this is actually a study of weight cycling, not a triumph of effortless lasting weight loss.
• Behind the scenes, people in these studies talk about how much bullshit goes on. When people are not weighed and just provide answers, they know what the researchers want to hear, and there's shame about weight regain too. Deb loves to really dig into the research studies, to go beyond the headlines and abstracts and really ask the question - what did they do here?
• In the mouse study, it is a particular strain of mice that were studied. Deb went & spoke to people who know more about mice research than she does, including the authors.
• The study concluded that weight cycling in mice was a good thing.
• There’s a few issues here. Paul Ernsberger speaks about the unique properties of species like mice. They are basically a food supply for predators. When there is a lot to eat, they don’t need to turn on their genes to make them live longer, because they’ll be able to quickly procreate and make lots of offspring. When there’s not a lot of food around, these genes in the mice switch on, allowing them to live longer and procreate later, ensuring that they will continue to exist as a species. As an apex predator, humans do not follow this pattern and do not display this type of change. So right there, there’s reason to doubt that whatever we see in mice when they are deprived of food will be similar in humans. So mice research in this area really doesn’t generalise well to understanding humans.
• The other interesting point here is how these mice were fed in order to produce ‘obesity’. The study says they were fed a high fat diet. Paul Ernsberger says that it is probably more accurate to say that the mice were fed the equivalent of cake icing! For breakfast, lunch and dinner. Even the most extreme human diets don’t mirror this type of diet.
• So interestingly, even when mainlining cake icing, ⅓ of the mice didn’t get fat, so they were eliminated from the study.
• As Deb points out, in humans, many of those at higher weights are not like that because they’re all eating fast food. They’re just larger people. So the mice who started small and became big through force feeding are really different to the human population who basically have multiple reasons that they may be larger.
• So of the ⅔ of the mice that were left, a huge number of them got a condition called ulcerative dermatitis and either died or had to be euthanised. This was more than 200 animals out of 500. But the authors are using their lifespans to argue for weight cycling?
• It is possible that the mice who were being fed only the cake frosting diet were getting sick and dying, so now we have a completely confounding factor here. How did this paper get through? Deb has asked the author but really didn’t get an answer, apparently another paper is coming out.
• Basically, the weight cycling mice were given a break from the relentless cake icing feeding, and it may very well be that break from a horrible diet which was related to their longer lifespan, not weight cycling.
• So Deb went to the company that bred the mice, and asked how long their lifespan was. The average lifespan of this strain of mice was apparently well below what all of the mice in the experiment lived for! So all of the mice in this experiment - including the ones who were always fat - lived longer than the average lifespan for this strain. This fact was not mentioned in the paper. New headline - “cake frosting prolongs life if it doesn’t kill you?!”
• A well fed population, a population with good nutrition, means we change - our puberty happens earlier, it also means we are heavier. And yes, this change brings different health challenges.
• There’s definitely a health disparity between higher weight people and lower weight people. This may be about fat cells driving things. But also, If you’re treated poorly it’s going to have an effect on your health. And we have very good evidence that larger people are not treated well. So it is plausible that there is an interaction between all of these factors - structural oppression, weight stigma, health care inequities - with our biology - and to ignore all of these factors and focus only on the narrow physiology is another case of the Emperor’s new clothes.
• Some people would argue that all of the rat and mice studies are impacted, because they are social animals but in experimental conditions they all live separately.
• Researchers really want to be doing research follow ups for longer than they are right now, but grant money and structures don’t support such models.
• We absolutely need more research to understand the whole phenomenon of weight cycling in humans, given that most of us will weight cycle. But it’s not an area which is heavily researched. Many weight loss studies don’t last long enough to cover a whole weight loss/regain cycle - they stop the research at the end of the weight loss period, and don’t look further.
• There is a real issue in research in weight science of not following people for a minimum of 5 years, which really should be the standard. Short term weight loss research really is a waste of time and money. We should do less research, but do it for longer time periods, to gather meaningful information.
• The harms of interventions are also not being captured in current research models, even though Stunkard was saying it back in 1959!
• Speaking of harms not being captured, researchers in the eating disorder field are planning to present at the ICED conference in 2019 saying that dieting in adolescents doesn’t lead to eating disorders! This will no doubt be based on research with flaws like we’ve mentioned.
• It’s really sad how the diagnostic criteria for binge eating disorder completely misses the restriction part. Those of us who work with people with binge eating issues know how restriction shows up - in a feeling of guilt after a binge, in experiencing thoughts about restricting food, and in restrictive behaviours - but it’s just been disregarded by the powerful people who were in charge of creating the diagnosis whose weight bias stops their ability to imagine that fat people could also be restricting!
• Our eating disorder criteria is tragically bound to weight biased understanding of eating disorders.
• It’s sad that the people in power had so little understanding of the phenomenon they were describing. It’s back to white supremacy again.
• The drive to make some bodies have more worth than other bodies is evil.
• If we don’t understand this history, we will repeat the mistakes.
• Food insecurity also impacts on all of this.
• People who publish research on binge eating disorder who trumpet about how their intervention not only led to a reduction in eating disorder symptoms but also to weight loss, are missing the point. They are embroiled with the eating disorder and not seeing the bigger picture. You’re just at the bottom of the diet cycle. But many researchers are so weight biased that they don’t understand that people with this disorder can not binge for months. They are capable of restriction. Restriction is part of the problem!
• If you’re too good at restriction you’re going to run into trouble one way or another.
• what we think of as success is actually part of the problem, if you just look at the psychology of this.
• Back in the days when homosexuality was considered an 'illness', Evelyn Hooker presented psych test batteries to psychiatrists and asked people to pick out who was gay from examining the tests. She showed them there was no difference between psych results based on sexuality. Here’s another way of thinking - if we presented eating disorder experts with a list of behaviours of something a client was doing, and asked them to determine if the person had an eating disorder. If people agree that it is an eating disorder if a person is thin, but not if a person is fat, this is a problem. It’s not ‘tips’ from the weight control registry, it’s a disorder!
• Science is supposed to be about stepping back from our presuppositions. We need more people who think critically, ask questions, and push back. We need to recognise our bias. It is part of science to come up with alternative hypotheses. It can be difficult to get access to the training in order to critique studies, but thinking critically is a time-honored tradition of all people resisting oppression.

Resources Mentioned:

The NH&MRC slide from the fabulous Fiona Willer:

*A really good study which talks about the history of % weight loss targets

The mouse study on weight cycling

The Look Ahead study

Find out more about Deb here and here

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This week I have an epic and inspiring mega-rant for you, with Dani Galvin, eating disorder survivor, insta influencer and fat activist from @iamdaniadriana. Dani is unapologetically HAPPY and embracing life, and because she dares to do all of this in a larger body, she’s a troll magnet. Trolling on the internet sucks, but trolling fat people for simply existing takes things to a new low. Join us for an awesome and fierce conversation about why the world needs fat activists, the psychology of troll mentality, what it’s like to have an eating disorder when you’re fat, and much, much more!

Show Notes

• Dani has had a gutful of trolls on her Insta account, who on a daily basis harass and threaten her via DM and public posts on her Insta account.
• The aim of trolling isn’t debate or healthy criticism – it’s bullying, and they want to scare people off the internet.
• Dani’s convinced that the trolls have some deep seated psychological issues. Happy people just don’t feel compelled to bully strangers on the internet.
• Dani believes that forgiveness is a powerful tool – it helps her to let go of the impact. That doesn’t mean she doesn’t speak out against it!
• Places such as Reddit are dark holes where the hatred is real. Dani gets a lot of DM’s with links to Reddit, which is always bad. Or messages from people accusing her of promoting obesity. These people aren’t even reading her captions, they just look at her body at make judgements.
• It pisses them off that Dani exists and doesn’t feel ashamed of her body.
• She’s had trolls say things such as they ‘wouldn’t even rape her’. As if rape is a privilege?
• Trolling like this reveals the multiple levels of hatred and misogyny underpinning this kind of behaviour. This is not normal.
• Louise used to work with sex offenders in gaol, and agrees with Dani that threats of sexual or other violence is all about control – not sex. It’s using sex as a weapon to intimidate and exert power and control over women.
• Louise’s hat is off to all fat activists on SM! This message is so needed, but to think about how dangerous it is because of the constant trolling – it’s another level of trauma.
• It doesn’t bother Dani as much anymore. She’s had so many micro aggressions against her body in the real world, that online doesn’t matter.
• It worries Dani that the level of aggression towards people like Dani will scare other people in larger bodies away from fat activism or even just being ‘out and fat’.
• It’s a huge process to wake up from diet culture, to reject the idea that something is wrong with you or your body, and to stand against diet culture. It takes a long time, and everyone ends up in different places. Not everyone will end up being a fat activist!
• It’s ok for people in the body positivity process to be in different places. We’re all different and we need to respect that difference of experience. We need to think of the concept of psychological diversity as well as body diversity!
• To get over the trauma of diet culture, we all need to go through the stages of grief in order to let it go. This can take time, and it’s not easy.
• Regardless of how far you move away from diet culture, it’s not realistic to wake up every day loving your body! It’s not about loving your appearance. It’s about finding peace and acceptance. It’s about honouring and riding the tough stuff. And the reason you feel like this isn’t your fault – it was taught to you by diet culture.
• The default is diet culture, and it’s easy to be performative in that. It’s harder to stand up and cognitively and emotionally work through this shit.
• Dani has been in LOTS of therapy, and has done a lot of work to get where she is now. She didn’t wake up one day glowing with body love.
• Many of us are expected to be ‘performative’ in diet culture, by which Dani means we are expected to perform certain social rituals to meet social norms. Such as, taking part in body shaming when we’re with a group of women, or taking part in conversations which encourage food guilt.
• Diet culture performances, like feeling bad for eating the office birthday cake, is so in-built and multi generational. It’s literally never questioned in diet culture.
• Why can’t we just go to the party and enjoy the cake?
• There’s this strong idea that we need to diminish ourselves in front of others in order to be a ‘good person’. We’re doing it to fit in, to be accepted by others.
• Diet culture emphasises that what we eat equals who we are. And that certain types of food consumption patterns make us better or worse people. This is monstrous and serves to further oppress marginalised groups.
• When you’re a fat person in diet culture, how does the performative stuff show up?
• Being performative in diet culture as a fat person means always trying to lose weight – being a ‘good fatty’.
• There’s this strong idea that you can’t start living your life until you meet the goal of being thin. Dani had a list of things on her computer that she’d never do until she lost weight. These included going on a holiday, falling in love, wearing a swimsuit and getting a tattoo – things she’s done now, in her fat body!
• Dani had an extreme eating disorder for many years. She is scared by statistics that show that 1 in 4 people who diet will develop an eating disorder.
• There’s a push in certain research circles to say that dieting doesn’t lead to eating disorders in fat people. For Dani, dieting was a ‘gateway drug’ to an eating disorder. Not the only factor, but definitely a big one.
• Dani thinks the reason eating disorder professionals are making these claims is because now that eating disorders in higher weight people are being recognised, they don’t feel comfortable not prescribing weight loss! Weight stigma anyone?
• Dani’s eating disorder was really vicious, and she remembers being given the seriously screwed up mixed messages – ‘you’re taking it a bit far…but you’re doing really well.”
• Comments and perceptions like this meant that for Dani, during the last 2 years of having her eating disorder, all she thought about was wanting to die.
• Eating disorders have the highest mortality rate of all mental illnesses, and a large proportion of these are suicides. How many people in larger bodies are dying because of weight stigma in eating disorder treatment?
• The DSM needs to stop using the BMI as a criterion for diagnosis. No other mental illness has a weight requirement. Imagine just how high the eating disorder rate in people in larger bodies is.
• Dani suffered terribly from her eating disorder, but because of her higher weight, she struggled for it to be recognised and properly treated. It was by chance that she stumbled across a therapist who finally saw her and what was going on. Without that, Dani might not be here.
• There’s a lot of evidence to show that the impact of weight stigma on health is just as impactful as BMI itself.
• Dani appeared on a tv show alongside some of the ex Biggest Loser contestants (who had put on all of the weight again) and a whole pile of people doing weight loss surgery. Dr Dixon was there, spruiking the fact that diets don’t work therefore give everyone surgery. Dani was the lone voice of body positivity!
• We’ve let weight and diets become our church and we’re now equating our appearance to something spiritually meaningful. Dieting is literally the new religion. It’s healthist and exclusionary.
• The ‘obesity epidemic’ rhetoric puts all fat people in the same category and labels them as diseased, AND pretends that body size is a choice.
• This rhetoric keeps us all imprisoned, as thin people are terrified of fat too.
• It's rare to come across a health professional that actually cares about your experience as a human on the planet, to see beyond your BMI.
• Dani’s wish is to continue to advocate for larger people via her Insta platform, and she won’t let the trolls stop her! Her hope is that if she has kids or grandkids and they’re fat, that their experience won’t be like hers was.
• Her Insta account is a safe haven for people in larger bodies.
• Find Dani on Instagram @iamdaniadriana

Resources Mentioned:

Dani’s website

The article which gives an overview of how weight stigma is potentially responsible for all of the health impacts usually attributed to higher BMI.

The TV segment we were talking about with Dani featured – this version has been edited by Dani, so it’s not triggering.

Where Dani gets all of these amazeballs bikinis! – on Insta:

@alwaysforme

@eloquii

@asos

@alwaysformellc

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As Health At Every Size becomes more popular, there’s also a truckload of controversy ! Is there such a thing as being “too fat” for a Health At Every Size Approach? Should we put a weight limit on weight inclusivity? Can we do Health At Every Size AND weight loss? Hell No!!, say my guests, the incredible Dietitians Unplugged Glenys Oyston & Aaron Flores. Join us for a fierce and fabulous rant about “health concerns” and fatphobia, paradigm straddling, and Aaron’s pet hate, splinterarsing!

Show Notes

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