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Diet and Myths Weight-Loss Lore and Controversies - Weight-loss Schemes Defraud Consumers

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There is a long history of marketing "miraculous," fat-burning pills, potions, and products to Americans seeking effortless weight loss. In Fat History: Bodies and Beauty in the Modern West (New York: New York University Press, 2002) and Losing It: False Hopes and Fat Profits in the Diet Industry (New York: Penguin USA, 1998), authors Peter Stearns and Laura Fraser offered detailed histories of magical cures and weight-loss fads. At the turn of the twentieth century such products as obesity belts and chairs that delivered electrical stimulation, as well as corsets, tonics, and mineral waters, claimed to cause weight loss.

Diet pills arrived on the scene in 1910 with the introduction of weight-loss tablets that contained arsenic (a poisonous metallic element), strychnine (a plant toxin formerly used as a stimulant), caffeine, and pokeberries (formerly used as a laxative). In the 1920s cigarette makers promoted their products as diet aids, urging Americans to smoke rather than eat. During the 1930s diet pills containing dinitrophenol, a chemical used to manufacture explosives, dyes, and insecticides, enjoyed brief popularity after it was observed that factory workers making munitions lost weight. Their popularity was short-lived, as cases of temporary blindness and death were attributed to their use.

The second half of the twentieth century saw the proliferation of questionable, and often entirely worthless, weight-loss devices and gimmicks, including inflatable suits to "sweat off pounds," diet drinks and cookies, and slimming creams, patches, shoe inserts, and wraps to reduce fat thighs and abdomens. Although the claims made for many of these products sounded too good to be true, unsuspecting Americans spent billions of dollars in the hope of achieving quick, easy, and permanent weight loss.

Weighing the Claims

In May 2000 the Partnership for Healthy Weight Management, a coalition of scientific, academic, health care, government, commercial, and public interest representatives, initiated consumer and media education programs that not only aimed to increase public awareness of the obesity epidemic in the United States but also to promote responsible marketing of weight-loss products and programs. The Partnership published a consumer guide, Finding a Weight Loss Plan That Works for You, designed to help overweight or obese consumers find weight-loss solutions to meet their needs. The guide contained a checklist to enable consumers to compare weight-loss plans based on a variety of criteria. (See Figure 9.1.) It also advised consumers FIGURE 9.1
Checklist for evaluating weight-loss products and services
TABLE 9.1
Ad nauseam: The year 2000 Ads Nauseam includes the following dubious claims

"'I LOST 93 POUNDS! … QUICKLY, EASILY & NO DIETING.' New. Now Available Without A Prescription.… People have reported losing the first 10 pounds within a few days and up to 50 pounds the first month. Even if you want to lose 100 or more pounds [product name] can be your answer."
• "LOSE UP TO 2 POUNDS DAILY … WITHOUT DIET OR EXCERISE
'I Lost 44 POUNDS in 30 DAYS'
NEVER be fat again with the [product name] … The [product name] eliminates fat for effortless weight loss. Same results as: Jogging 10 miles per week. An hour of aerobics per day. 15 hours of swimming or cycling per week."
• "The Miracle of Body Fat Reduction Where do you want to lose weight? It's the same for everyone. Body fat always gravitates to the stomach, the buttocks, the hips and legs. [Product name] will help to rapidly reduce the fat in all these areas. It does this by redirecting these problem fat cells to the muscles of the body where it can be burned off more easily. By taking just one tablet before every meal, the weight gaining process can be averted by simply maintaining the same plan."
"FIRST TIME IN THE U.S.A. THE SENSATIONAL FRENCH WEIGHT LOSS DISCOVERY
WATCH POUNDS PRACTICALLY MELT OFF YOUR BODY FROM DAY ONE… AS EXCESS FAT AND UNSIGHTLY CELLULITE ARE INSTANTLY ATTACKED! Eliminates 10–20–35–50 pounds with ease.
NO EFFORT REQUIRED: eat everything you normally eat.
NO RISK TO YOUR HEALTH: no fatigue, no side effects, no mood changes. A 100% natural method to lose weight.
NO DIETING EVER: no food restrictions, or excerise programs.
NO CONSTRAINTS OF ANY KIND: your day to day activities do not change. The only change is how much better you will look."
"Imagine Losing As Much as 50% Of All Excess Fat In Just 14 Days! NOT EVEN TOTAL STARVATION CAN SLIM YOU DOWN AND FIRM YOU UP THIS FAST–THIS SAFELY! … LOSE UP TO 1 FULL POUND EVERY 8 HOURS. LOSE UP TO 2½ TO 3 FULL POUNDS EACH DAY and you do it without counting calories."
• "Amazing Fat Fighting Pill Ends Hunger—Gurantees Super Fast Weight Loss! U.S. Patent reveals weight loss of as much as 28 lbs. in 4 weeks and 48 lbs. in 8 weeks … There now exists an all natural, bio-active weight loss compound so powerful, so effective, so relentless in its awesome attack on bulging fatty deposits that it has virtually eliminated the need to diet … Eat all your favorite foods and still lose weight (pill does all the work)."
"This extraction of sweet acids contained in tropical fruits will allow anyone, including those who have never succeeded in losing weight, to activate their metabolism and lose up to 14 pounds per week."
• "New Medical Breakthrough! 'Lose A Pound A Day Without Changing What You Eat' … You will get a risk free opportunity to get the trim, sexy body you've always dreamed of in days or weeks, instead of months or years, without going through painful excerise and unbearable diets."
"WATCH FAT MELT AWAY WITH [product name]. No impossible excerise! No missed meals! No dangerous pills. No boring foods or small porions! Just fast and easy, effective weight loss! [Product name] is the easiest way to successfully lose weight you'll ever try. It doesn't require gruelling excerise. There are no dangerous pills or tablets to take. Best of all, you continue to eat your favorite foods!"
"The new fat-fighter. Slimming capsules that soak up fat! … This brand new Swiss formulated high power diet-pill has been created and discovered by Dr. ___, M.D., for men and women to lose weight and bind fat from foods you have eaten. The idea is as brilliant as it is simple. Have you ever seen an overweight fish? Or an oyster with a few pounds too many? Everyone knows that sea animals never get fat. That's because their bodies contain [produce name] which is now available as a diet pill for everybody who wants to lose unwanted fat. [Product name] reduces body fat deposits in the belly, thighs, and butt. It also makes sure that the fat from your last meal leaves your body before being digested."
"NOW EVERYONE CAN EASILY BURN OFF EXCESS WEIGHT WITHOUT CHANGING DIET OR TAKING EXCERISE! … You do not have to change the food you eat. This is not a starvation diet—and you do not have to take gruelling pointless excerise. [Product name] starts incinerating your fat and slimming your figure from day one. It is 100% natural so it is totally safe. We guarantee that you'll lose between 2 and 8 pounds a week untill you reach your target weight and sexy figure—and you won't put the fat back on!"
"You lose with weight even it you eat too much. These active pineapple [product name] tablets that you can now receive on a free trial basis force your body to dissolve all its excess fat. You should know that 8 tables contain the weight loss power of 16 whole pineapples. Consequently, even if you continue to eat normally, even if you eat too much, you are literally forced to lose your excess pounds. You will lose at least 16 pounds in the first two weeks. And at least six pounds every week thereafter."
SOURCE: "Ad Nauseam: The Year 2000 Ads Nauseam Includes the Following Dubious Claims," in Ad Nauseam, The Partnership for Healthy Weight Management, Federal Trade Commission, Bureau of Consumer Protection, Washington, DC, 2000 [Online] http://www.consumer.gov/weightloss/adnauseam.htm [accessed February 9, 2004]

about how to select weight-loss programs and services based on specific information from potential providers. The costs of producing the new consumer guide were shared by several of the more than fifty partner organizations, including the International Food and Information Council, the Centers for Disease Control and Prevention, the National Institute of Diabetes and Digestive and Kidney Diseases, and Novartis Nutrition Corporation.

The coalition partners also launched the "Ad Nauseam" campaign to encourage the media to demand proof before accepting advertising copy that contained unbelievable, dubious, or extravagant promises of weight-loss success. The campaign pledged to:

  • Publish an annual list of claims made in ads during the previous year for products or services that promise results so extravagant that any responsible media outlet should have demanded proof before accepting them for publication.
  • Identify the media outlets that published or broadcast the questionable ads.
  • Identify media indicating they have adopted strategies to screen out dubious advertising claims for weight-loss products.

Table 9.1 lists some of the dubious claims the Partnership uncovered during 1999 and 2000. The Partnership also invited the public to participate in identifying questionable weight-loss advertisements and asked consumers to send such ads and the publications they appeared in to the Federal Trade Commission (FTC).

In 2002 the FTC reported that as much as 55 percent of advertising for weight-loss products and services contained false or unsupported effectiveness claims (Weight Loss Advertising: An Analysis of Current Trends [Washington, DC: Federal Trade Commission, 2002]). Nearly 40 percent of the 300 advertisements reviewed by FTC staff made at least one assertion that was most likely false and an additional 15 percent made at least one representation that was very likely false, or in the best cases, lacked adequate substantiation. The report also observed that despite an unprecedented law enforcement effort in the decade preceding the FTC study, the incidence of false and deceptive weight-loss advertising claims appeared to have increased.

On November 19, 2002, the FTC convened a workshop attended by researchers, scholars, media experts, and medical professionals from the government, academia, and private industry that aimed to evaluate claims and develop new and more effective ways to combat false and deceitful weight-loss advertising claims. The FTC summarized the workshop proceedings, including attendees' assessments of eight broad categories of advertising claims, in Deception in Weight-Loss Advertising Workshop: Seizing Opportunities and Building Partnerships to Stop Weight-Loss Fraud (Washington, DC: Federal Trade Commission, 2003). The following section considers the advertising claims and summarizes the attendees' assessments of these claims presented in the December 2003 FTC report. It also draws on an analysis of the FTC report by Stephen Barrett, M.D., in "Impossible Weight-Loss Claims: Summary of an FTC Report" (Quackwatch.org, December 16, 2003).

No Diet or Exercise Required

CLAIM.

The advertised product causes substantial weight loss without exercise or diet.

EXAMPLES.

"U.S. patent reveals weight loss as much as 28 pounds in 4 weeks … The pill does all the work, and Lose up to 2 pounds daily without diet or exercise."

ASSESSMENT.

The consensus was that products purporting to cause weight loss without diet or exercise would either need to cause malabsorption of calories or to increase metabolism. Since the number of calories that can be malabsorbed is limited to 1,200 to 1,300 calories per week, or about one-third of a pound per week, malabsorption alone is unlikely to lead to substantial weight loss. Similarly, there is no thermogenic (heat producing) agent, such as ephedrine combined with caffeine, able to boost metabolism enough to produce weight loss without diet or exercise. In fact, the mechanism by which ephedrine products appear to assist weight loss is by suppressing appetite rather than speeding metabolism. Further, though green tea extract was found to increase metabolism, it was by a scant 4 percent.

No Restrictions on Eating

CLAIM.

Users can lose weight while still enjoying unlimited amounts of high calorie foods.

EXAMPLE.

"Eat All the Foods You Love and Still Lose Weight (Pill Does All the Work)"

ASSESSMENT.

This claim was viewed as a variation of the assertion that dieters can lose weight without reducing caloric intake or increasing exercise, since this claim states that users not only can lose weight without reducing caloric intake but also may increase caloric intake and still lose weight. The assembled experts concurred that if this claim was true, it would defy the laws of physics.

Permanent Weight Loss

CLAIM.

The advertised product causes permanent weight loss.

EXAMPLES.

"Take it off and keep it off; You won't gain the weight back afterwards because your weight will have reached an equilibrium; People who use this product say that even when they stop using the product, their weight does not jump up again."

ASSESSMENT.

Even if a product caused weight loss through a reduction of calories, appetite suppression, or malabsorption, weight would be regained once use of the product stopped and calorie consumption returned to previous levels. Researchers and health professionals have repeatedly observed that dieters tend to regain weight lost over time once the diet, intervention, or other treatment ends. According to the National Academy of Science, Food and Nutrition Board, "Many programs and services exist to help individuals achieve weight control. But the limited studies paint a grim picture: those who complete weight-loss programs lose approximately 10 percent of their body weight only to regain two-thirds of it back within one year and almost all of it back within five years." Further, there are no published scientific studies supporting the claim that a nonprescription drug, dietary supplement, cream, wrap, device, or patch can cause permanent weight loss.

Fat Blockers

CLAIM.

The advertised product causes substantial weight loss through the blockage or absorption of fat or calories.

EXAMPLES.

"The [named ingredient or product] can ingest up to 900 times its own weight in fat, that's why it's a fantastic fat blocker. The Super Fat Fighting Formula inhibits fats, sugars and starches from being absorbed in the intestines and turning into excess weight, so you can lose pounds and inches easily."

ASSESSMENT.

Science does not support the possibility that sufficient malabsorption of fat or calories can occur to cause substantial weight loss. To lose even 1 pound per week requires malabsorption of about 500 calories a day or about 55 grams of fat. To lose 2 pounds per day, as promised in some advertisements, would require the mal-absorption of 7,000 calories per day, which is impossible given that it is several times the total calories that most people consume on a daily basis, let alone the number of calories consumed from fat. The FTC has challenged deceptive fat-blocker claims for some of the most popular diet products on the market. The evidence supports the position that consumers cannot lose substantial weight through the blockage of the absorption of fat. It is not scientifically feasible for a nonprescription drug, dietary supplement, cream, wrap, device, or patch to cause substantial weight loss through the blockage of absorption of fat or calories.

Quick Weight Loss

CLAIM.

The user of the advertised product can safely lose more than 3 pounds a week for time periods exceeding four weeks.

EXAMPLES.

"Lose 3 pounds per week, naturally and without side effects."

ASSESSMENT.

Significant health risks are associated with medically unsupervised, rapid weight loss over extended periods of time. In general, "the more restrictive the diet, the greater are the risks of adverse effects associated with weight loss." One of the best-documented risks is the increased incidence of gallstones. The claim that consumers using products such as these without medical supervision can safely lose more than 3 pounds per week for a period of more than four weeks is not scientifically feasible.

Weight-Loss Creams and Patches

CLAIM.

The advertised product that is worn on the body or rubbed into the skin causes substantial weight loss.

EXAMPLES.

"Lose 2 to 4 pounds daily with the Diet Patch; Thigh Cream drops pounds and inches from your thighs."

ASSESSMENT.

Diet patches and creams that are worn or applied to the skin have not been proven to be safe or effective. Further their alleged mechanisms of action are not scientifically credible.

Guaranteed Success

CLAIM.

The advertised product causes substantial weight loss for all users.

EXAMPLES.

"Lose excess body fat. No willpower required. Works for everyone no matter how many times you've tried and failed before."

ASSESSMENT.

This claim assumes that overweight and obesity arise from a single cause or are amenable to a single solution. Since the causes of overweight and obesity are thought to be genetic factors and environmental conditions, and such contributing factors as diet, metabolic rate, level of physical activity, and adherence to weight-loss treatment vary, it is highly unlikely that one product would be effective for all users. Even FDA-approved, prescription drugs for weight loss have a high level of nonresponders, and gastric surgery for obesity is not successful 100 percent of the time. The claim that a nonprescription drug, dietary supplement, cream, wrap, device, or patch will cause substantial weight loss for all users is not scientifically feasible.

Targeted Weight-Loss Products

CLAIM.

Users of the advertised product can lose weight from only those parts of the body where they wish to lose weight.

EXAMPLES.

Testimonial advertising has included such claims as "And it has taken off quite some inches from my butt (5 inches) and thighs (4 inches), my hips now measure 35 inches. I still wear the same bra size though. The fat has disappeared from exactly the right places."

ASSESSMENT.

Small published studies of aminophylline cream indicate that its use may cause the redistribution of fat from the thighs to other fat stores; however, it has not been shown to cause fat loss. Even if some products were determined able to cause more weight loss from certain areas of the body, no parts would be spared completely—fat is lost from all fat stores throughout the body.

Red Flag Campaign

Another outcome of the November 2002 workshop was the design of another education initiative to assist the media to voluntarily screen weight-loss product ads containing claims that are "too good to be true." The media were targeted for intensive education not only because broad-based public education had proven largely inadequate to protect consumers from persuasive messages trumpeting easy weight loss, but also to acknowledge the media's powerful ability to reduce weight-loss fraud by sharply reducing the dissemination of obviously false weight-loss advertising. On December 9, 2003, the FTC launched its "Red Flag" campaign to more effectively assist the media to reduce deceptive weight-loss advertising and promote positive, reliable advertising messages about weight loss.

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