HealthTeacher

Fad Diets and Weight Loss Products

Approximately 8 million Americans a year, enroll in some kind of structured weight-loss program. Consumers need to be wary of claims that sound too good to be true. Almost all fad diets fail. Fad diets offer only a quick fix and not a solution to the problem. They do not attempt to change the behaviors of the person who is dieting. All too often, dieters are left with feelings of guilt and inadequacy because of their perceived failure to lose weight and maintain weight loss.

Doctors, dieticians, and other experts agree that the best way to lose weight is to eat fewer calories and increase your physical activity so you burn more energy. A reasonable goal is to lose about a pound a week. For most people, that means cutting about 500 calories a day from your diet, eating a variety of nutritious foods, and exercising regularly. i

Characteristics of Fad Diets:

promises of quick weight loss
limits on food choices
recommendations for expensive supplements or special products
claims to be better than recommendations from doctors and scientists
no requirements for physical activity

Be skeptical of any weight loss programs claiming to be:

effortless
guaranteed
miraculous
magical
breakthrough
new discovery
mysterious
exotic
secret
exclusive
ancient

The FTC's Response to Fad Diets and Weight Loss Products
1. Any claims that you can lose weight effortlessly are false. The only proven way to lose weight is either to reduce the number of calories you eat or to increase the number of calories you burn off through exercise. Most experts recommend a combination of both.

2. Very low-calorie diets are not without risk and should be pursued only under medical supervision. Unsupervised very low-calorie diets can deprive you of important nutrients and are potentially dangerous.

3. Fad diets rarely have any permanent effect. Sudden and radical changes in your eating patterns are difficult to sustain over time.

4. Some diet pills may help control the appetite but they can have serious side effects. (Amphetamines, for instance, are highly addictive and can have an adverse impact on the heart and central nervous system.) Some pills are completely worthless.

5. The FDA has banned 111 ingredients once found in over the counter diet products. The Federal Trade Commission and some Attorney Generals have successfully brought cases against marketers of pills claiming to absorb or burn fat.

Beware These Boasts:
When it comes to evaluating claims for weight loss products, the Federal Trade Commission (FTC) recommends a healthy portion of skepticism. Before you spend money on products that promise fast and easy results, weigh the claims carefully. Think twice before wasting your money on products that make any of these false claims:

"Lose weight without diet or exercise!"

Achieving a healthy weight takes work. Take a pass on any product that promises miraculous results without the effort. Buy one and the only thing you'll lose is money.

"Lose weight no matter how much you eat of your favorite foods!"

Beware of any product that claims that you can eat all you want of high-calorie foods and still lose weight. Losing weight requires sensible food choices. Filling up on healthy vegetables and fruits can make it easier to say no to fattening sweets and snacks.

"Lose weight permanently! Never diet again!"

Even if you're successful in taking the weight off, permanent weight loss requires permanent lifestyle changes. Don't trust any product that promises once-and-for-all results without ongoing maintenance.

"Block the absorption of fat, carbs, or calories!"

Doctors, dieticians, and other experts agree that there's simply no magic non-prescription pill that will allow you to block the absorption of fat, carbs, or calories. The key to curbing your craving for those "downfall foods" is portion control. Limit yourself to a smaller serving or a slimmer slice.

"Lose 30 pounds in 30 days!"

Losing weight at the rate of a pound or two a week is the most effective way to take it off and keep it off. At best, products promising lightning-fast weight loss are false. At worst, they can ruin your health.

"Everybody will lose weight!"

Your habits and health concerns are unique. There is simply no one-size-fits-all product guaranteed to work for everyone. Team up with your health care provider to design a personalized nutrition and exercise program suited to your lifestyle and metabolism.

"Lose weight with our miracle diet patch or cream!"

You've seen the ads for diet patches or creams that claim to melt away the pounds. Don't believe them. There's nothing you can wear or apply to your skin that will cause you to lose weight.

Factors to Evaluate if Considering a Commercial Weight Loss Program: ii
(1) the cost of the program and its duration,

(2) the qualifications and credentials of program staff,

(3) the risks associated with the program; and

(4) program outcomes in terms of both weight loss achieved and weight loss maintained short term and long-term.

Healthful Weight Control
Doctors, dieticians, and other experts agree that the best way to lose weight is to eat fewer calories and increase your physical activity so you burn more energy. A reasonable goal is to lose about a pound a week. For most people, that means cutting about 500 calories a day from your diet, eating a variety of nutritious foods, and exercising regularly. iii

According to a statement by the FDA, losing weight may not be effortless, but it doesn't have to be complicated. To achieve long-term results it is best to avoid quick-fix schemes and complex regimens. Focus instead on making modest changes to your life's daily routine. A balanced, healthy diet and sensible, regular exercise are the keys to maintaining your ideal weight. Although nutrition science is constantly evolving, here are some generally accepted guidelines for losing weight:

Consult with your doctor, a dietitian, or other qualified health professional to determine your ideal healthy body weight.
Eat smaller portions and choose from a variety of foods. See the slide show, Portion Distortion, athttp://hin.nhlbi.nih.gov/portion/
Load up on foods naturally high in fiber: Fruits, vegetables, legumes, and whole grains.
Limit portions of foods high in fat: dairy products like cheese, butter, and whole milk; red meat; cakes and pastries.
Exercise at least three times a week.

Recommended Diets
Adkins Diet, South Beach Diet, other proprietary weight loss centers… so many diets to choose from. Diets have become big news and big business. But it should not cost you a fortune or place your health at risk to lose weight. There are some solid diet plans that have been researched and follow generally approved principles of weight loss. Here are some examples of healthy weight management plans.

1. The DASH Diet. Initially, scientists studied individual food nutrients, but without much gain in understanding how they work to raise or lower blood pressure. In a key study, supported by the National Heart, Lung, and Blood Institute of the NIH, scientists tested nutrient groups as they occur in typical foods. The result was the knowledge that blood pressure can be lowered by changes in the diet. The diet plan that proved to reduce blood pressure is one that is low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and low-fat dairy products. It is called the DASH diet (Dietary Approaches to Stop Hypertension) and is summarized in the chart below.

Food Group	Single Servings / Day	Size / Single Serving	Food Examples
Grains and grain products	7-8	1 slice bread; 1 oz dry cereal;½ cup cooked pasta, rice or cereal	Whole wheat bread English muffin Pita bread Bagel Cereals Grits Oatmeal Crackers Unsalted pretzels Unsalted popcorn
Vegetables	4 - 5	1 cup raw leafy vegetable; ½ cup cooked vegetable; 6 oz. vegetable juice	Tomatoes Potatoes Carrots Green peas Squash Broccoli Turnip greens Collards Kale Spinach Artichokes Green beans Lima beans Sweet potatoes
Fruits	4 - 5	6 oz. fruit juice; 1 medium fruit; ¼ cup dried fruit; ½ cup fresh, frozen, or canned fruit	Apricots Bananas Dates Grapes Oranges Orange juice Grapefruit Grapefruit juice Mangoes Melons Peaches Pineapples Prunes Raisins Strawberries Tangerines
Low fat or fat free dairy foods	2 - 3	8 oz. milk; 1 cup yogurt; 1 ½ oz. cheese	Fat-free (skim) or low fat (1%) milk Fat-free or low fat buttermilk Fat-free or low fat regular or frozen yogurt Fat-free and low fat cheese
Meats, poultry, fish	2 or less	3 oz. cooked meats, poultry, or fish	Select only lean meat, Trim away fat, Broil, roast or boil Do not fry, Remove skin from poultry
Nuts, seeds, and dry beans	4 - 5 per week	1/3 cup or 1 ½ oz of nuts; 2 TBS or ½ oz of seeds; ½ cup cooked dry beans or peas	Almonds Filberts Mixed nuts peanuts walnuts Sunflower seeds kidney beans lentils
Fats & Oils	2-3 servings	1 tsp soft margarine; 1 TBS low-fat mayonnaise; 2 TBS light salad dressing;1 Tsp vegetable oil	Soft margarine Low-fat mayonnaise Light salad dressing Vegetable oil (olive, corn, canola or safflower)
Sweets	5 per week	1 TBS sugar; 1 TBS jelly or jam; ½ oz jelly beans; 8 oz lemonade	Maple syrup Sugar Jelly Jam Fruit-flavored gelatin Jelly beans Hard candy Fruit punch Sorbet Ices

Source: National Heart, Lung and Blood Institute. NIH.

More Information on the DASH STUDY

2. The TLC Diet. TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main parts of TLC include the diet, weight management, and physical activity.

The TLC Diet

Limiting the amount of saturated fat and cholesterol you eat.
Eating only enough calories to achieve or maintain a healthy weight.
Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber.
Adding cholesterol-lowering food such as margarines that contain plant sterol or stanol esters for some people.

Weight Management
Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).

Physical Activity
Regular physical activity is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

What about the Glycemic Index?

Eliminating sugars and starches from the diet is not by itself the answer to weight loss according to the ADA.

"The idea surrounding this popular belief probably relates to the Glycemic Index. The GI is used as a measurement of the impact individual foods have on blood sugar levels. The GI ranks foods against white bread or glucose according to their potential to raise blood glucose levels in the body. However, most foods are consumed with other foods, not by themselves, and eating combinations of foods can alter the GI for each meal component.

In addition, there is insufficient research to show that the GI of a food of a meal has any effect on weight loss or gain.

The best strategy for weight management still is to consume a variety of foods including whole grains and nutrient-rich carbohydrates in portions that are appropriate for your physical activity." v

What is a Supplement?

A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The FDA traditionally considered dietary supplements to be composed only of essential nutrients, such as vitamins, minerals, and proteins. The Nutrition Labeling and Education Act of 1990 added "herbs, or similar nutritional substances." Therefore the meaning of the term "dietary supplements" expanded beyond essential nutrients to now include such substances as ginseng, garlic, fish oils, psyllium, enzymes, glandulars, and mixtures of these. Dietary supplements are NOT intended to be used as conventional foods or as the sole item of a meal or diet.

Supplements Vs Healthy Eating
If a healthy variety of foods are eaten, supplements are not necessary. Our bodies need a total of 42 nutrients each day. Taking in more nutrients than our body needs does not provide added energy, added brainpower or greater protection against disease. Single nutrient supplements or high mineral combinations may be harmful to our health. Taken in high dosages, some supplements may produce side effects such as fatigue, diarrhea and hair loss. Other more serious side affects include kidney stones, liver or nerve damage, and birth defects.

Who Needs Supplements?
People who have chronic illness or who have very restrictive diets may need to take supplements. Otherwise, most people can receive adequate nutrition by eating a variety of foods and following the standard dietary guidelines.

Potential Risks of Supplement Use
Unlike drug products that must be proven safe and effective for their intended use before marketing, there are no provisions in the law for FDA to "approve" dietary supplements for safety or effectiveness before they reach the consumer. Also unlike drug products, manufacturers and distributors of dietary supplements are not currently required by law to record, investigate or forward to FDA any reports they receive of injuries or illnesses that may be related to the use of their products. Under DSHEA, once the product is marketed, FDA has the responsibility for showing that a dietary supplement is "unsafe," before it can take action to restrict the product's use or removal from the marketplace. vi

Many supplements contain active ingredients that can have strong effects in the body. Taking a combination of supplements, using these products together with medicine, or substituting them in place of prescribed medicines could lead to harmful, even life-threatening results. Also, some supplements can have unwanted effects before, during, and after surgery. It is important to let your doctor and other health professionals know about the vitamins, minerals, botanicals, and other products you are taking, especially before surgery.

Here a few examples of dietary supplements believed to interact with specific drugs:

Calcium and heart medicine (e.g., Digoxin), thiazide diuretics (Thiazide), and aluminum and magnesium-containing antacids.
Magnesium and thiazide and loop diuretics (e.g., Lasix®, etc.), some cancer drugs (e.g., Cisplatin, etc.), and magnesium-containing antacids.
Vitamin K and a blood thinner (e.g., Coumadin).
St. John's Wort and selective serotonin reuptake inhibitor (SSRI) drugs (i.e., anti-depressant drugs and birth control pills). vii

If you suspect that you have had a serious reaction to a dietary supplement, you and your doctor should report it to FDA Medwatch:

Phone: 1-800-FDA-1088
Fax: 1-800-FDA-0178
Internet: www.fda.gov/medwatch/how.htm

Tip-Offs to Rip-Offs
From the USFDA: How to Spot Health Fraud viii

Product No. 1: Pure emu oil

FDA determined that a pure emu oil product marketed to treat or cure a wide range of diseases was an unapproved drug. Its marketer had never submitted to FDA data to support the product's safe and effective use.

One Product Does It All

" ... extremely beneficial in the treatment of rheumatism, arthritis ... infections ... prostate problems, ulcers ... cancer, heart trouble, hardening of the arteries, diabetes and more. ... "

"completely eliminating the gangrene ...

"... antibiotic, pain reliever ... ."

Be suspicious of products that claim to cure a wide range of unrelated diseases--particularly serious diseases, such as cancer and diabetes. No product can treat every disease and condition, and for many serious diseases, there are no cures, only therapies to help manage them.

Cancer, AIDS, diabetes, and other serious diseases are big draws because people with these diseases are often desperate for a cure and willing to try just about anything.

Personal Testimonials

"Alzheimer's Disease!!! My husband has Alzheimer. On September 2, 1998 he began eating 1 teaspoon full of ... Pure Emu Oil each day. ... Now (in just 22 days) he mowed the grass, cleaned out the garage, weeded the flower beds, and we take our morning walk again. It hasn't helped his memory much yet, but he is more like himself again!!!"

Personal testimonies can tip you off to health fraud because they are difficult to prove. Often, says Reynaldo Rodriguez, a compliance officer and health fraud coordinator for FDA's Dallas district office, testimonials are personal case histories that have been passed on from person to person. Or, the testimony can be completely made up.

"This is the weakest form of scientific validity," Rodriguez says. "It's just compounded hearsay."

Some patients' favorable experiences with a fraudulent product may be due more to a remission in their disease or from earlier or concurrent use of approved medical treatments, rather than use of the fraudulent product itself.

Quick Fixes

"... eliminates skin cancer in days! ..."

Be wary of talk that suggests a product can bring quick relief or provide a quick cure, especially if the disease or condition is serious. Even with proven treatments, few diseases can be treated quickly. Note also that the words "in days" can really refer to any length of time. Fraud promoters like to use ambiguous language like this to make it easier to finagle their way out of any legal action that may result.

Product No. 2: Over-the-counter transdermal weight-loss patch

FDA issued a warning letter to the marketer of the weight-loss product described here because it did not have an approved new drug application. Because of the newness of the dosage form--skin-delivery systems--FDA requires evidence of effectiveness, in the form of a new drug application, before the product can be marketed legally.

'Natural'

"Healthy, simple and natural-way to help you lose and control your weight."

Don't be fooled by the term "natural." It's often used in health fraud as an attention-grabber; it suggests a product is safer than conventional treatments. But the term doesn't necessarily equate to safety because some plants--for example, poisonous mushrooms--can kill when ingested. And among legitimate drug products, says Shelly Maifarth, a compliance officer and health fraud coordinator for FDA's Denver district office, 60 percent of over-the-counter drugs and 25 percent of prescription drugs are based on natural ingredients.

And, any product--synthetic or natural--potent enough to work like a drug is going to be potent enough to cause side effects.

Time-Tested or New-Found Treatment

"This revolutionary innovation is formulated by using proven principles of natural health based upon 200 years of medical science."

Usually it's one or the other, but this claim manages to suggest it's both a breakthrough and a decades-old remedy.

Claims of an "innovation," "miracle cure," "exclusive product," or "new discovery" or "magical" are highly suspect. If a product was a cure for a serious disease, it would be widely reported in the media and regularly prescribed by health professionals--not hidden in an obscure magazine or newspaper ad, late-night television show, or Website promotion, where the marketers are of unknown, questionable or nonscientific backgrounds.

The same applies to products purported to be "ancient remedies" or based on "folklore" or "tradition." These claims suggest that these products' longevity proves they are safe and effective. But some herbs reportedly used in ancient times for medicinal purposes carry risks identified only recently.

Satisfaction Guaranteed

"... Guarantee: If after 30 days ... you have not lost at least 4 pounds each week, ... your uncashed check will be returned to you ... ."

Here's another red flag: money-back guarantees, no questions asked.

Good luck getting your money back. Marketers of fraudulent products rarely stay in the same place for long. Because customers won't be able to find them, the marketers can afford to be generous with their guarantees.

Product No. 3: Unapproved weight-loss product marketed as an alternative to a prescription drug combination

FDA issued an import alert for a Canadian-made weight-loss product whose claims compared the product with two prescription weight-loss drugs taken off the market after FDA determined they posed a health hazard.

Promises of Easy Weight Loss

"Finally, rapid weight loss without dieting!"

For most people, there is only one way to lose weight: Eat less food (or fewer high-calorie foods) and increase activity.

Note the ambiguity of the term "rapid." A reasonable and healthy weight loss is about 1 to 2 pounds a week.

Paranoid Accusations

"Drug companies make it nearly impossible for doctors to resist prescribing their expensive pills for what ails you ... ."
"It seems these billion dollar drug giants all have one relentless competitor in common they all constantly fear--natural remedies."

These claims suggest that health-care providers and legitimate manufacturers are in cahoots with each other, promoting only the drug companies' and medical device manufacturers' products for financial gain. The claims also suggest that the medical profession and legitimate drug and device makers strive to suppress unorthodox products because they threaten their financial standing.

"This [accusation] is an easy way to get consumers' attention," says Marjorie Powell, assistant general counsel for the Pharmaceutical Research and Manufacturers of America. "But I would ask the marketers of such claims, 'Where's the evidence?' It would seem to me that in this country, outside of a regulatory agency it would be difficult to stop someone from making a claim."

Think about this, too: Would the vast number of people in the health-care field block treatments that could help millions of sick, suffering patients, many of whom could be family and friends? "It flies in the face of logic," Barrett says on his Quackwatch Website.

Meaningless Medical Jargon

"... Hunger Stimulation Point (HSP) ..."
"... thermogenesis, which converts stored fats into soluble lipids ..."
"One of the many natural ingredients is inolitol hexanicontinate."

Terms and scientific explanations such as these may sound impressive and may have an element of truth to them, but the public "has no way of discerning fact from fiction," Aronson says. Fanciful terms, he says, generally cover up a lack of scientific proof.

Sometimes, the terms or explanations are lifted from a study published in a reputable scientific journal, even though the study was on another subject altogether, says Martin Katz, a compliance officer and health fraud coordinator for FDA's Florida district office. And chances are, few people will check the original published study.

"Most people who are taken in by health fraud will grasp at anything," he says. "They're not going to do the research. They're looking for a miracle."

Resources:

I. Resources provided by the FSA to help evaluate supplement use:

Tips For The Savvy Supplement User: Making Informed Decisions And Evaluating Information --http://www.cfsan.fda.gov/~dms/ds-savvy.html (includes information on how to evaluate research findings and health information on-line)
Claims That Can Be Made for Conventional Foods and Dietary Supplements --http://www.cfsan.fda.gov/~dms/hclaims.html, (provides information on what types of claims can be made for dietary supplements).

II. Additional Dietary Supplement Resources

Administration on Aging, DHHS: http://www.aoa.gov

Food and Drug Administration, DHHS, Center for Food Safety and Applied Nutrition:

National Institutes of Health, DHHS

National Center for Complementary and Alternative Medicine (http://nccam.nih.gov) and Clearinghouse (1-888-624-6226)
Office on Women's Health, DHHS: http://www.4woman.gov/owh/index.htm or 1-800-994-WOMAN
Federal Trade Commission: http://www.ftc.gov
U.S. Department of Agriculture, Food and Nutrition Information Center: http://www.nal.usda.gov/fnic
Sample Products for Which FTC has taken action on false claims.http://www.ftc.gov/bcp/reports/dietadvertisingcases.shtm
The International Bibliographic Information on Dietary Supplements (IBIDS) database allows you to SEARCH dietary supplements. http://ods.od.nih.gov/Health_Information/IBIDS.aspx