Prescribing Disordered Eating to Teens as a Weight-Loss Plan

POSITION STATEMENT

F.E.A.S.T, an international organization supporting parents and caregivers of eating disorder patients, joins advocates and colleagues around the world in asking for reconsideration and withdrawal of a research proposal that prescribes fasting to young people as an “obesity” intervention. Fasting is a high-risk behavior especially for developing teens.

The “Fast Track to Health” Trial is a randomized controlled trial with “alternate day fasting diet on weight loss and well-being in adolescents with obesity.” The study, to be recruited out of The Children’s Hospital at Westmead and Monash Medical Centre, is designed to involve 186 Australian children between 13 and 17 years old.

We call on the Principal Investigator, Dr. Louise Baur, and Sydney Children’s Hospital Network Human Research Ethics Committee, to suspend this trial for safety reasons before enrollment begins in December 2018:

  • The behaviors in these treatments would be considered dangerously disordered eating in any other context
  • Data collected over the study period does not begin to monitor the possible long-term harm to the participants or their peers and siblings
  • Basing inclusion by BMI definitions of “obesity” puts significant numbers of participants at risk for malnourishment and metabolic harm as it fails to take their individualized growth curves into account
  • Adolescents who are weight-suppressed or in energy deficit are at grave risk of triggering disabling, lifelong, or fatal eating disorders
  • There are no known weight loss interventions known to be safe and effective for adults or for children over the long term

We note that this trial has a follow-up period of 12 months after end of treatment. As an organization of families, we find this painfully ill-conceived. The long-term risks of weight suppression are over decades of our loved ones’ lives, not in a few years.

We are tragically aware of the health risks of malnourishment in a developing adolescent, but also the abdication of responsibility inherent in “prescribing” disordered eating patterns like fasting. The potential harm to these young people of intermittent nutritional deprivation is grave: to their bodies, to their thinking, and to public health messaging.

When children are “treated” for their body size this has an effect on how these individuals think of themselves and others, and how their peers treat them. Weight stigma is an insidious and pervasive harm that we as caregivers and as health professionals cannot afford to encourage without strong and well-grounded evidence.

Fasting, in particular, is a risky and irresponsible recommendation for developing bodies. It represents the far end of restrictive eating and thinking about food. The eating disorder community quite rightly is stepping forward to decry this direction in research, not because of an objection to scientific progress but because of known harms to children.

“I am dismayed to learn that a restrictive diet / regime of nutritional restriction is to be imposed upon vulnerable young people. Experts tells us that negative energy balance is a gateway to an eating disorder, further, studies have shown that restrictive diets are frequently the start of a life of weight cycling.” – Nicki Wilson, EDANZ, F.E.A.S.T. Chair

“We are in a unique position, based on our knowledge of eating disorders, to provide some balance to the current social and biomedical rush to reduce the weight of a population with little to no consideration of harms. If not us, then who?” – Chevese Turner, CEO & Founder, Binge Eating Disorder Association (BEDA)

“I think it is beyond time for us to decide we are not going to promote intentional weight loss – not just because it’s not sustainable: weight cycling is harmful, and dieting in any form contributes to eating disorders.“ – Rachel Millner, Psy.D. Psychologist, The Children’s Hospital of Philadelphia

“It should not fall to those of us who know personally the deadly cost of eating disorders to alert the medical world of the risk of medical authorities prescribing the very same thinking and behaviors.” – Laura Collins Lyster-Mensh, F.E.A.S.T. CEO

F.E.A.S.T. calls on all healthcare and mental health advocates and professionals to speak up about this proposed research trial and make your voices heard. To normalize this kind of radical, risky approach to healthcare is to risk untold harm. Let’s remember “do no harm” is the foundation of medical care and a principle of research.

Signed,

The Board of Directors of F.E.A.S.T.