In the Market for a Diet Plan? A Few Pitfalls to Avoid

Fri, 4 Nov. 2011 - 6:47 p.m. MT
Credit: ARA Staff - American Running Association

Physicians are enthusiastically joining the ranks of commercial weight loss plan (CWLP) entrepreneurs. The trend now extends beyond diet plans and books and into retail meals, supplements, medications, consultations, and other treatments.
 
The potential for conflicts of interest gives many physicians pause. Recommending or even prescribing a product or supplement that your office also sells has its complicating factors, ethically speaking. Yet these plans are not all to be dismissed as frivolous fads or onerous marketing ploys. There are certainly doctor-engineered and -endorsed programs out there worth the paper they are prescribed upon. Here we attempt to establish some guiding principles for choosing a CWLP should you decide to do so. What are some warning signs that your money is best spent elsewhere?
 
Immodest proposals. Always remember that extraordinary claims require extraordinary evidence. Examples of the former, which never seem to be followed by the latter, include: “No exercise necessary!” and “Lose five pounds a week!” Also dismiss recently discovered wonder drugs and other miracle products. True scientific advance is a slow process. A new product or cure may seem to be an overnight success, but a little research always reveals that it was a very long night indeed.

A heavy reliance on supplements. As mounting FDA warnings and consumer-led class action lawsuits attest to, the chains of manufacture and sale for thousands of readily available dietary supplements remain alarmingly sloppy, and the law policing their claims is even worse.

In 1994 Congress passed the Dietary Supplement Health and Education Act (DSHEA), which allowed manufacturers to sell them without first getting FDA approval. This shifted the burden of proof to the FDA to determine not that a product is safe before it is sold—as with prescription drugs—but to determine whether a product is unsafe before it can be removed from the market. Furthermore, The FDA website states that “Manufacturers must make sure that product label information is truthful and not misleading.” [Emphasis added.]
 
In December the FDA sent a stern letter to several supplement manufacturers asking for better policing of undeclared ingredients. Several supplement trade associations endorsed the letter. A spokesperson for the FDA declared that the FDA hopes the manufacturers “take the letter seriously.” That’s it?

Independent testing groups such as consumerlab.com do their best to test popular new supplements, but any claim that a supplement manufacturer is “FDA audited,” as many do, is false. And a high level of scrutiny is deserved for all supplements-focused weight-loss claims.

Note that in general the regulatory gray area in which supplements function gives way to alarming abuse of the system. Several criminally negligent manufacturers, mainly overseas but also stateside, have been caught making slight molecular alterations to powerful prescription drugs and remarketing them in the unregulated supplements category, therefore dangerously selling them to the public without prescriptions or any dosage restrictions.
 
 “Brazilian diet pills” for example, have been repeatedly found to contain a frightening array of stroke-inducing amphetamines and prescription-grade antidepressants. For a thorough, if by nature never comprehensive, warning advisory visit www.fda.gov/Food/DietarySupplements/Alerts/default.htm.
 
Doctor or doctorate? Weigh carefully whether a company is staffed, policed, or advised mainly by MDs or by PhDs. There are of course legions of well-credentialed PhDs out there researching, monitoring, and reporting at the highest level of professionalism with regard to diet, weight loss, health, and lifestyle. But there are PhD programs offered at every caliber of trustworthiness. Medical doctors have generally undergone a far more standardized and knowable process of evaluation before becoming board certified and active in a medical practice. In short, it’s easier to find a person with an obscure pseudoscientific doctorate from an unknown institute to endorse your unfounded weight loss claims than a practicing physician from an established medical school.

A lack of peer review. It’s worth a search of the PubMed database for clinical trials or other published research papers on as many specific aspects of a commercial diet plan as you can. Plans nearly always proffer cleverly packaged in-house data, some of which is passable as science and other of which is complete mumbo-jumbo—or at least P.R.-department generated and therefore highly questionable. A lack of any peer reviewed studies in medical journals is always troubling. This is a way of saying that good science means replicability, and therefore predictability. “Studies show” is a lot more reliable than “Our study showed.”

FDA conspiracy theories. Buyer beware of too much FDA bad-mouthing because it is convenient and disingenuous on a number of fronts. Contempt for all things federal is en vogue these days, making a body like the FDA an easy target. But why target? If your weight loss plan can’t prove its claims, the easiest thing to do is downplay any regulatory body’s relevance of opinion in the matter. FDA bashing is so tempting for the shadier supplement companies and weight loss plans because it capitalizes on a possibly legitimate complaint, deliberately confusing the two issues. This complaint stems from the belief that approval of prescription drugs is somewhat politicized, too slow, and often favors the pharmaceutical giants over generics that could be provided at much less cost to the consumer. As earlier noted, supplements by contrast are given freewheeling permission to enter the market, and so they remain utterly unrelated to the prescription drug-approval process.

Weak logic and vague language. Often you’ll find overreaching connections in the general literature of a CWLP. In a discussion of B12 injections, one website declared, “This injection is also referred to as being a lipotropic nutrient.” Note that the company stops short of saying definitely that the injection is a lipotropic nutrient.
 
Other hedging buzzwords and phrases include:
  • Doctor So-and-so “believes”
  • Doctor So-and-so is “renowned”—by whom?
  • The term “expert”
  • Saying something “just makes sense”
 
To this list we might add saying that this or that treatment or product is “exclusively available” at XYZ Clinic—although that might not make it ineffective. This statement just warrants an air of caution because it’s improbable that one clinic has access to something truly remarkable that no other clinic has, and so the statement likely means only that a specific brand is exclusively available. That may be ok too, but it certainly gives the clinic a great excuse to financially exploit its exclusivity.

Other considerations include whether the FAQs in the literature seem written with your questions truly in mind, or as a platform for the CWLP’s website to proffer selling points. Also beware of an anti-aging emphasis—there are no known anti-aging diets/creams/pills, strictly speaking. Some creams or dietary decisions can slow the process or even reduce wrinkles (at least in the short term), but anti-aging, which implies reversing the aging process, is an indefensible concept by current scientific standards.
 
A few plans worth mentioning. In May that trusty watchdog Consumer Reports evaluated some of the more popular weight loss plans using surveys and available scientific data. Jenny Craig came out on top, having had a 332-person, two-year study of the program published in the Oct. 27, 2010, issue of JAMA. Ninety-two percent of participants stuck with the Jenny Craig program for two years, which represents a remarkable level of adherence. At the end of that time folks weighed an average of about eight percent less than when they started. The key components that contributed to such a high level of adherence appear to be personal counseling, portion control through pre-packaged meals, and the incorporation of Volumetrics’ strategy to consume high-bulk, low-calorie food.

The idea that not all food calories are created equal has gained quite a bit of traction since Consumer Reports issued the same survey four years ago, when the Volumetrics plan in fact beat out the others. As we all know, regardless of your plan, to lose weight you must burn more calories than you consume. “The first law of thermodynamics still applies," says Dean Ornish, MD, whose nearly vegan plan was also rated high by Consumer Reports. In addition to a low-fat diet, Dr. Ornish’s program includes exercise, stress management, and group support, and has proven so effective that Medicare now covers it for cardiac patients.

Just because something is aggressively marketed or very expensive doesn’t mean it doesn’t work. But be sure you’re not simply entering into a compact to be prescribed an astonishing array of mandatory therapies, paid a la carte by you, without which you’ll be forfeiting any refund guarantee because they can say you went off the plan.
 
In June the USDA Food Pyramid was replaced by the USDA Food Plate. The new design emphasizes portion control, 50 percent fruits and vegetables, half or more of grains from whole grains, and being mindful of sodium. This reflects what many successful CWLP promote: smaller portions, low-fat substitutes, and an increased role of filling, high-fiber foods.
 
And not surprisingly, in the Consumer Reports survey, the most successful dieters combined restraint at the table with increased physical activity. Finally, do look for moral support in a plan. Mandatory checking in with a counselor works better for some people; others prefer a weekly support group. Ultimately, it is the small changes in the right direction that are sustainable—and therefore sustain us—in our fitness goals in the long run.
 
Adopted from “Weight Loss for Sale” by Jeff Venables, June 2011, www.americanrunning.org

(RUNNING & FITNEWS®  May / June 2011 • Volume 29, Number 3)


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