Lean times ahead for Anti-Obesity "cures" ?
(December 11th 2008) Professor M.E. Lean is concerned with.... obesity! In fact, with anti-obesity foods and diet supplements. He says that more must be done to prevent unscrupulous sellers of "quack" medicines and "health foods" from exploiting the adipose-rich. Jeremy Garwood reports.
Who could eventually be more qualified for doing research on obesity and advancing the debate about increases in obesity than M.E. Lean, Professor of Human Nutrition at the University of Glasgow?
In the last editorial of the British Medical Journal, Lean called for further enforcement of the European Union Directive on Unfair Commercial Practices to stop misleading marketing targeted at vulnerable groups of patients; for example, "diabetic foods, which do not benefit people with diabetes." However, says Lean, unscrupulous trading is most commonly linked to obesity. "In 2000, $35 billion was spent in the United States on weight loss products. Many of these products use false and unsubstantiated claims, enticing 7% of the entire population to buy them every year." Similar problems exist in Europe.
It is already illegal for unsubstantiated claims to be made about the composition or nutritional function of food products, for example, that they are low in fat, high in fibre, or help lower cholesterol. It is also illegal to claim that a food can treat or prevent any disease - including obesity. However, many unsubstantiated claims are still made, or implied. Misleading marketing can be found within brand names and images on packaging, in shelf or shop names, or on websites which suggest, without evidence, that products help control weight, are slimming, or are "health foods".
For example, the US Good Housekeeping Insitute recently investigated several diet supplements with negative results - "Relacore", without supporting evidence, claims to help patients develop "a feeling of well-being and more energy as well as less anxiety" by reducing "the production of cortisol brought on by stress" thus reducing "fat storage". "Estrin-D" is another product that claims to "assist weight loss in menopausal women" but 7 of its 14 ingredients are stimulants, including caffeine, making its recommended dose equivalent to drinking "11 cups of coffee", but the manufacturer claims "this is just the energizing this group of women need". Finally, there is "The Grapefruit Solution" which comes in a capsule and claims to help overweight people lose an average of 2.4 pounds (1.1 kg) in 12 weeks. However, people on real grapefruit diets were found to lose an extra pound over the same period (grapefruits are supposed to help control weight by lowering insulin levels).
As Lean explains, the distinction between medicines and foods can be blurred when the latter are marketed for health reasons. Whereas medicines are only licensed in Europe after stringent experimental research to establish safety and efficacy, food products marketed for health have largely escaped these controls.
With no requirement for research, these products have been hugely profitable. Ironically, well-informed public denouncement of these products usually leads to increased sales. Furthermore, products investigated by advertising trading standards authorities can disappear and reappear with modified names, or in a different country.
In the UK, the Joint Health Claims Initiative was set up to establish a code of practice for health claims on foods. It wants to introduce a process for their evaluation that is similar to the systematic evidence base required for drugs.
Of the hundreds of anti-obesity products on sale, Lean says that "only appropriately delivered diets and exercise, oristat (a lipase inhibitor), sibutramine (an appetite suppressant), and bariatric surgery are safe, efficacious, and cost effective."
"Nothing justifies the commercial exploitation of vulnerable patients with quack medicines". Lean hopes that the new EU regulations will be enforced proactively "to help direct doctors and consumers towards safe, cost-effective, and evidence-based management of diseases." He is even optimistic that they will serve to keep us leaner and prevent obesity by prohibiting advertisements that encourage children to buy energy-dense products or to pester their parents to buy
