Doctors call for weight loss industry regulation

Many weight loss products like pills, herbs and some private clinics fail to deliver on their promises and governments should be regulating scientifically unproven therapies, obesity doctors say.

North Americans spend $50 billion a year on pills, potions, diets and programs promising nothing short of miraculous weight loss. Many of them are nonsense, according to an editorial in this week's Canadian Medical Association Journal. 

'The majority of commercial weight-loss providers manipulate vulnerable consumers with impunity, cultivating unrealistic expectations and false beliefs.' — Editorial

"Before we can truly address the devastating obesity epidemic, we must first stem the centuries-old flow of snake oil," the editorial authors wrote.

"We call on governments to require formal accreditation of weight-loss providers to ensure quality and to provide consumers with an easily recognizable means of identifying evidence-based services."

The concern focuses on services that don't have evidence to back up their effectiveness, said Dr. Arya Sharma, one of the authors of the article and medical director of the Royal Alexandra Hospital weight management clinic in Edmonton.

"Although experts agree that obesity management requires long-term behavioural, medical or surgical intervention, the majority of commercial weight-loss providers manipulate vulnerable consumers with impunity, cultivating unrealistic expectations and false beliefs," they wrote.

For example, some weight loss programs promote the use of vitamin B injections or herbal supplements, claiming they help the body burn off fat faster — a claim lacking published medical evidence, the authors said.

Few medically supervised options

Sharma said he is not opposed to commercial weight-loss or obesity-treatment centres that comply with clinical practice guidelines, such as the University of Alberta's obesity program or Weight Watchers and the YMCA in Edmonton.

Dr. Bernstein's Diet and Health Clinics are part of the industry targeted in CMAJ's editorial. Its owner, Dr. Stan Bernstein, directs the blame back on the public-health system, which he said has failed patients by not acting. 

"There's only a handful of physicians that I'm aware of in Canada that are treating obesity," Bernstein said. "The other programs, the commercial ones … do not offer medical supervision or investigation to any degree whatsoever."

Sharma conceded that regulation is only part of the answer. The editorial also calls on doctors and other health professionals to be taught evidence-based principles of obesity management to ensure that family doctors can support weight-loss efforts.

Burt Hawrysh of Edmonton has put his trust in a public health clinic. At 505 pounds, Hawrysh's weight is a serious medical issue.

"It's just the fact of being hungry," Hawrysh said. "That's my big issue… I've always been hungry."

Despite having a doctor, dietician and a psychologist on his weight loss team, Hawrysh said it's a long, difficult battle.

Regulation would make it easier for consumers to choose reputable weight-loss providers, but the challenge is to know where to draw the line on what's enough evidence to advertise a claim, said Diane Finegood, an obesity expert and researcher at Simon Fraser University, who did not contribute to the editorial.

Health Canada regulates weight-loss products as drugs and natural health products.

"Our government will remove products from shelves that pose a health and safety risk to consumers," said Health Canada spokesperson Josee Bellemare.

 "We can also take action against commercial weight-loss providers that promote their products with false advertising. It is important to note that federal regulations apply to the products being sold, not the clinics or weight-loss plans themselves. They involve the practice of medicine, which is under provincial and territorial jurisdiction."

Some of the editorial's authors disclosed potential competing interests. Sharma is the medical director of a weight-loss management program and Dr. Yoni Freedhoff is medical director and co-owner of a weight-management clinic in Montreal.