Wednesday, February 18, 2009

Why We Need to Regulate the Weight Loss Industry

Wow, the editorial sure made a splash.

Of course editorials are brief and points always need to be limited so I just wanted to take a few moments and flesh this out some more.

Plainly put we need to protect consumers from weight management fraud, but where weight management differs from other areas is that the problems are more real and the people, more vulnerable. No one would care if you bought a shammy from Vince from Sham-Wow and it didn't work - $19.99 (or whatever it is) and no harm done. Here there's harm.

Obesity and overweight contribute dramatically to morbidity, mortality, reduced quality of life, social stigma and bias and both direct and indirect health care expenditures. Media, governments, physicians all hammer home the notion that weight has major risk and it would be healthy to lose it. Of course by not telling people where to go, consumers may find themselves in programs or buying products that they purchased due to overtly fraudulent or misleading claims.

The harm is not only in consumers being swindled into non-evidence based and likely non-sustainable approaches, not just to their pocket books that in many cases will end up much, much lighter, the harm is that those same individuals who are clearly in a state of change involving readiness, likely won't be at that same state once they've failed a program that itself was a failure - they'll blame themselves and be less likely to trust or seek out further help.

The call to action in the Journal is simple and it's a no brainer really - if you're going to make a claim about a product, pill or potion to treat obesity, if you can't back up your claim with evidence you shouldn't be allowed to make it.

With allied health professionals I'll go one step further. While Vince from Sham-Wow might be able to get away with outlandish claims, allied health professionals are not, or at least should not be able to. Physicians, dietitians, chiropractors etc., are all governed by the Heath Care Act and as such we are not allowed to make claims that are fraudulent or misrepresent the evidence base. Consequently I'll throw down my gauntlet to the Colleges of various health care professionals and state that it is their immediate and direct responsibility to protect the public from the myriad of health professionals currently sullying the good names of their respective Colleges and preying on the public that in too many cases trusts them too much.

Unfortunately doctors too can be unscrupulous.

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  1. Dr. Freedhoff – While I fully agree with your editorial on the need to regulate the weight loss industry, I would like to point out that some Regulated Health Professionals may be more of the problem than the solution. It is funny that you mentioned chiropractors in your post today, because when thinking about unethical nutrition practices, that is exactly the group of ’professionals’ I was thinking of.

    Although chiropractors are not actually qualified to counsel patients on matters of diet and nutrition, all most all of them do. Their education is not based in mainstream medicine, however, and unfortunately, the nutrition recommendations that they relay to their patients are unscientific, unproven and, in many cases, designed only to make money.

    Two years ago I visited a chiropractor for relief of back pain. Five minutes of the one hour appointment was dedicated to reviewing my ‘nutritional history’ and, to my surprise, the appointment ended with the “doctor” recommending I take several different supplements to correct my nutritional ‘imbalances’ and ’deficiencies’. Coincidentally, all of the supplements he recommended were available for sale right in his office. How convenient!

    Walk in to almost any chiropractic office and you will find the same selection of supplements for sale. Are these supplements proven? Are they evidence-based? Are the claims they make valid? Highly unlikely.

    I was amazed that this person could diagnose ‘imbalances’ and ‘deficiencies’ with 5 minutes of questions about my diet, and then think I was naïve enough to purchase the supplements he recommended. I never returned.

    This incident caused me to further investigate chiropractors and their practices, especially in the area of nutrition. I came across an organization, founded by an MD, called Quackwatch which is dedicated to combating health frauds, myths and fallacies.

    According to this organization, in the US, at least 50 companies are marketing irrationally formulated supplement products exclusively or primarily through chiropractors. Some of these companies sponsor seminars at which chiropractors are taught pseudoscientific nutrition concepts-including the use of supplements to treat disease. Supplement manufacturers provide information on alleged therapeutic uses that would not be legal to place on product labels. Some companies issue newsletters and/or product literature that provide dubious advice.

    My appointment with a chiropractor led me to question the knowledge base and ethical standards of the entire chiropractic profession. Who is regulating the education of chiropractors? Why are they allowed to sell supplements at all, let alone those that are ineffective? Why is nutrition even within the scope of practice of someone who is supposed to help relieve my back pain? These are the questions I ask.

    I hope that any Physician who refers patients to a chiropractor understands that there are some serious ethical issues with this profession and that their education is not fully grounded in evidence-based medicine.

    Where is their College in all of this? Why is the College of Chirpractors not protecting the public from these fraudulent practitioners?

  2. If you would like further evidence of the fraudulent nature of the chiropractic profession, I recently read a press release from a company (ironically called Evidence Based Nutrition Inc.) that manufactures “personalized genetics test kits” specifically for chiropractors to use with their patients.

    From a swab of the check and a lab analysis, the test miraculously spits out nutritional and lifestyle recommendations, and the chiropractor meets with the patient to discuss these recommendations and an appropriate supplement regimen.

    To me, the part of the press release that was most telling was this: “The use of our (test kits) will assist chiropractors in attracting new business and bringing clients back for continued care and purchase of nutritional supplements - as most of these individuals are seeking optimal health."

    Optimal health or optimal revenue? Does this sound like quality care from a ‘regulated health professional’?

  3. Thanks for the thoughtful comments Eric.

    I'm indeed a big fan of Quackwatch - since day 1 of this blog have included them in my links section.

    Certainly were you to have concerns about any healthcare professional writing their College's registrar is the way to voice those concerns.


  4. Anonymous3:09 pm

    Congrats Yoni (& Dr. Sharma) on your study of the diet industry! I was out at lunch and was pleasantly surprised to hear the CBC featuring your study on their "talk back" program. Lots of people were calling in to discuss and most felt that they indeed had been mislead and disappointed with diet programs.


  5. Dr. Freedhoff,

    I am a little conflicted on this issue.

    I agree with you that the the stench of snake oil permeates the weight loss industry.

    Most companies make promises that even they must know to be unrealistic.

    I also agree that these companies should be forced to back up their claims.

    However, I disagree with your call for increased regulation.

    For a variety of reasons.

    1. In our recent history, the biggest health problem associated with the weight loss industry didn't come from the snake oil salesmen - it came from the pharmaceutical industry - Fen-Phen

    2. For the past 50 years, the medical establishment has been telling overweight patients that fat is bad, that carbs are good, and that all you need to do to lose weight is to decrease calories - and we are fatter than ever. Why should we listen to a medical establishment that obviously has no idea how to help people lose weight?

    3. And who is going to determine what weight loss advice has been proven correct? Gov't bureaucrats, medical professionals who want to eliminate non-professionals from the very lucrative weight loss market? Scientists who cling to the dogma of carbs good/fat bad?

    4. Who is going to control the lobby groups that currently shape our national dietary recommendations and influence gov't subsidization of corn/soy/etc...?

    Instead of regulation, maybe the public should assume that a company that makes outrages claims about the success of their weight loss pill/gadget/service is lying in order to make lots and lots of money.

    Ask for a reference.

    My business is based on word of mouth. When I deliver what I promised, they tell their friends. And their friends call me and engage my service.

    Conversely, if I couldn't deliver on my promises, my business would dry up without the referrals.

    And with the internet, there is no reason anyone should be buying those pills and potions anyway. There are more than enough bloggers out there willing to complain about bad products and services

  6. You are right about the need for regulation, but there is also a massive need for education. American physicians, especially, seem no more qualified to give nutritional advice than Eric's chiropractor. My mom is physically disabled by arthritis and 150+ pounds overweight. She was seeing an orthopedic specialist as she was gaining many of those pounds, and the arthritis was worsening. He told her toward the end to lose weight, but never specified HOW or recommended a dietician. Now he has done many, painful, expensive surgeries she could have avoided or postponed. I go to a chiropractor for the same joint problems she has, but he takes a physical therapy/ healthy living (no selling supplements) approach. We just happen to have lax joints that dislocate in ways a well-trained chiropractor can successfully treat- and putting extra weight on them is disastrous. I wish mom had known how painful it would be before she gained the weight, and had met some kind of medical specialist who could have helped her.

  7. Yoni Freedhoff,

    Could you comment on the developing situation in British Columbia, where the government has proposed that naturopaths be given the right to call themselves Doctors, to prescribe medicines and treatments, and perform surgeries?

    I think this is a regressive step. What about you? I imagine you would have some thoughts on the matter, although not a British Columbian, since your area of medicine is one where "alternative" treatments are common.

  8. Hi crf,

    I'm an empiricist, and hence when it comes to matters of science, if you can't prove what your saying to be true, you shouldn't say it (or do it, or prescribe it).

    While there may be empirical, evidence-based practitioners of naturopathy, I would imagine naturopaths themselves would agree that many of their therapeutic choices lack robust evidence bases. That's not to say I look down my nose and suggest it would be impossible that those remedies work but rather than they are yet to be scientifically proven to be both safe and efficacious and for me therefore, remedies that it would be irresponsible for anyone to prescribe.

    All that said, I don't worry tremendously about the utility of the term "Dr." as I believe that over the years, its attribution to multiple young and/or belief based disciplines has to a degree diluted the title and folks now look for the clarifying term (medical, naturopathic, chiropractic, etc.) so I don't think that part worries me too much. What would worry me has to do with treatment as I certainly would not want any sort of doctor (medical, naturopathic or otherwise) to be given the right to prescribe medicines and treatments, and perform surgeries that don't fall within the boundaries of a well delineated evidence base.