Mar 08 2012

Weight Loss Supplements Don’t Work

This is something I and others have been saying and writing about for years – there is no current utility to weight loss supplements. Now a systematic review of the literature has come to the same conclusion. From the abstract:

Weight-loss supplements typically fall into 1 of 4 categories depending on their hypothesized mechanism of action: products that block the absorption of fat or carbohydrate, stimulants that increase thermogenesis, products that change metabolism and improve body composition, and products that suppress appetite or give a sense of fullness. Each category is reviewed, and an overview of the current science related to their effectiveness is presented. While some weight-loss supplements produce modest effects (2 kg), especially in the long term. Some foods or supplements such as green tea, fiber, and calcium supplements or dairy products may complement a healthy lifestyle to produce small weight losses or prevent weight gain over time. Weight-loss supplements containing metabolic stimulants (e.g., caffeine, ephedra, synephrine) are most likely to produce adverse side effects and should be avoided.

Definitely the most troubling category are those that contain stimulants. They are added to give the user a sense of increased energy – it’s a cheap way to make it seem like the supplement is doing something. But the long term effects are negative overall. Your body will simply adjust to the constant use of stimulants, and then if you stop you will likely gain back any weight you lost and more. Further frequent use of such stimulants may not be safe. Ephedra itself was banned by the FDA because of cases of sudden death in users.

The other categories of supplements simply don’t work. For those studies that show a modest weight loss effect (2 kg is not a significant weight loss) subjects also engaged in a reduced calorie diet and/or exercise. Therefore we cannot make any statements about the effectiveness of the supplements themselves.

It should also be pointed out that in the US, due to DSHEA (a 1994 act that essentially removed supplements from FDA oversight) supplement manufacturers can put any combination of herbs and nutrients into a pill and make whatever claims they wish about it (as long as they don’t name a specific disease), without any burden of evidence. Right now you could throw darts at a dartboard with various herbs, minerals, and vitamins on it to come up with a random formula, and then spin a wheel of indications (boosts the immune system, improves metabolism, supports cellular function – whatever) and then market your random ingredients for your random indication, all without a lick of evidence. You can even claim your product was “scientifically formulated.” Now all you need are some anecdotes, but they are easy to come by. If you’re ambitious you can find an MD or PhD to endorse your product in exchange for a piece of the company.  Don’t worry, as long as you don’t make a disease claim (directly – that’s what the anecdotes are for) and you put the quack disclaimer on your website, the FDA can’t touch you.

The Federal Trade Commission (FTC) is a different story. They can still go after you for commercial fraud if you make claims that are not true. To its credit, the FTC has been going after false advertising of supplements, but there are so many products and companies you can simply hide in the herd. Many of the cases the FTC goes after lied in their advertising or used deceptive practices other than just making up claims for random ingredients.

This latest study is evidence, in my opinion, for the utter failure of DSHEA. It has not served the interest of the consumer. It has served the interests of the supplement industry, which by an amazing coincidence is centered in Utah, home state of Orrin Hatch – one of the main sponsors of DSHEA. Go figure. Weight loss supplements are a 2.4 billion dollar industry in the US – an industry based entirely on products that do not work, and some of which are not entirely safe. In addition to this financial waste, weight loss supplements distract people from weight loss methods that at least have a chance to be effective (life style changes, regular exercise, calorie control). If anything the weight loss supplement industry contributes to obesity in this country by distracting the public with worthless products and misleading claims. Thank you, Senator Hatch.

The solution is simple – we need to go back to a regulatory system in which companies need to provide some reasonable level of evidence for safety and effectiveness before they put a product on the market and make health claims for it.

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11 responses so far

11 Responses to “Weight Loss Supplements Don’t Work”

  1. siggybosson 08 Mar 2012 at 9:27 am

    I disagree with your proposed solution where state regulators should set standards.

    No single entity should decide the safety of medical products because of the likely misuse and/or abuse of that power for its own self-interest. For example, Orrin Hatch and his colleagues in the US Congress control all federal regulators. Another problem is that individuals have a false sense of security relying on such regulations.

    The solution is private entities that have an aligned interest with the individual (ie Consumer Reports, Reader’s Digest, Good Housekeeping, blogs, etc). The competition to provide factual information will maintain or increase standards. Also, no one entity has a monopoly over deciding what the standard is. Individuals should have the freedom of deciding for themselves whether the rewards merit the risk regardless of how convincing a study or studies might be to oneself or others.

  2. Steven Novellaon 08 Mar 2012 at 11:35 am

    siggy – you might have had a point 16 years ago when DSHEA was first passed, as a hypothesis. But now, 16 years later, Consumer Reports, etc. have failed to stem the tide of worthless and misleading supplements. It is now completely unreasonable to maintain that position – against all evidence.

    Private entities do not have the resources to do the kinds of testing that would be necessary to ensure safety and accuracy of claims for the 55 thousand supplements that are on the market (with thousands of new ones each year).

    The fact is, there are centralized mechanisms for maintaining a standard of care and quality of products that work. I agree with adding checks and balances, even outsourcing and independent reviews, etc. Whatever is necessary to avoid abuse by centralized power. But the free market is not the answer to this one. Market forces favor appealing claims, not quality control and accuracy. Consumer reports may work for toasters, but not complex medical claims.

  3. tmac57on 08 Mar 2012 at 12:38 pm

    In addition to what Steve said,I will point out that even a group as large as Consumer Reports,has to depend on government watchdogs such as the FDA,EPA,and such for guidance,and data.
    If they had to perform all of those functions themselves,their magazines would cost so much,that no one would be able to afford to buy it.

  4. kikyoon 08 Mar 2012 at 1:32 pm

    I also disagree that competition would lead to equal or better standards of information. Competition drives competitors to increase their market share by whatever means is effective, and the most effective (and cost-effective) means is not always improving the product. Competition in this case would most likely spur the private entities to put all their resources into making sure their message is the most widespread and the most likely to reach people first, rather than into improving their standards of gathering information.

    One of the main advantages of government entities is that the profit motive is removed, and they may judge themselves by other standards than how much money they brought in.

  5. ccbowerson 08 Mar 2012 at 1:33 pm

    I have been a Consumer Reports subscriber for many years, and although they have improved a great deal recently with regards to this topic, the overall quality of their health recommendations and testing through the years have been so so. They are, however, one of the few independent testers of products (testing fish oil supplements and body building supplements for heavy metals, for example), but the supplement industry is quite large for a “jack of all trades” consumer organization.

    It seems to me that the only real solution is something to replace DSHEA to give the FDA more clout in this area. After that attempt failed a few years back due to political pressure by Hatch, I am not holding my breath.

  6. Daneel Olivawon 08 Mar 2012 at 1:41 pm

    Here’s another review, from Edzard Ernst, that I’ve just found http://www.ajcn.org/content/79/4/529.full

    “Results: Five systematic reviews and meta-analyses and 25 additional trials were included and reviewed. Data on the following dietary supplements were identified: chitosan, chromium picolinate, Ephedra sinica, Garcinia cambogia, glucomannan, guar gum, hydroxy-methylbutyrate, plantago psyllium, pyruvate, yerba maté, and yohimbe. The reviewed studies provide some encouraging data but no evidence beyond a reasonable doubt that any specific dietary supplement is effective for reducing body weight. The only exceptions are E. sinica– and ephedrine-containing supplements, which have been associated with an increased risk of adverse events.”

  7. siggybosson 09 Mar 2012 at 9:39 am

    (Response)

    “…Consumer Reports, etc. have failed to stem the tide of worthless and misleading supplements. It is now completely unreasonable to maintain that position – against all evidence.”

    There is no such thing as ‘stemming the tide’ but state censorship of private opinions, which will solely be at the discretion of Orrin Hatch and his colleagues in the US Congress. Private entities such as Consumer Reports aren’t ever going to censor anyone’s opinion, but offer their own opinion based on their research and they are biased toward their own subscribers; I’m not maintaining the above position. For example, Ford has implied their cars are better than GM cars for over a century, and Consumer Reports doesn’t prohibit the freedom of speech, but adds to it by giving its own opinion.

    “Private entities do not have the resources”

    All states receive resources (ie money) via taxes and/or borrowing, which ultimately come from private entities. The US is running annual deficits in the trillions of dollars that is mostly financed by private entities purchasing US debt (China is a large single holder, but small relative to private holders in aggregate). JP Morgan Chase alone has over a trillion in outstanding loans. Oddly, your above statement suggests nothing has adequate resources because state agencies also have inadequate resources, “…the FTC has been going after false advertising of supplements, but there are so many products and companies you can simply hide in the herd.”

    “…Market forces favor appealing claims, not quality control and accuracy. Consumer reports may work for toasters, but not complex medical claims.”

    The first entity in the US to bring national attention to the harmful health affects of smoking, and result in an actual annual reduction in their consumption, was Reader’s Digest. Consumer Reports has just introduced a section on health. The idea that market forces don’t stress quality control and accuracy is nonsense. The potential costs in lost sales due to a bad reputation and/or civil lawsuits will dwarf any regulatory fines, which may occur years later. For example, a bad batch of Tylenol is removed from the shelves within days by the manufactures and/or retailers, while the FDA has a meeting a week later.

  8. siggybosson 09 Mar 2012 at 9:55 am

    (Response continued.)

    I don’t understand why you advocate state agencies setting standards, which may also result in the censorship of your own standards. For example, Galileo advocated heliocentrism and was persecuted by the state because the standard was Scripture passages in the Bible. In this very article you criticized the state (ie Orrin Hatch), but still want to completely entrust it with absolute power over the prevailing standard due to a zeal to control speech. You even stated, “Whatever is necessary to avoid abuse by centralized power” without any indication of how that is to be done and I repeatedly offer evidence that it has never been accomplished. To quote Action, “Power tends to corrupt, and absolute power corrupts absolutely.”

  9. ccbowerson 09 Mar 2012 at 10:32 am

    “The idea that market forces don’t stress quality control and accuracy is nonsense.”

    Market forces are subject to “perceived” quality control, which is as much about PR and marketing as reality. If you want to argue that cigarettes smoking is a good example of market forces correcting a problem, you are delusional. Millions of people have died unnecessarily, and it took a concerted effort from many angles to counter the misinformation put out by the tobacco industry over the decades.

    “The potential costs in lost sales due to a bad reputation and/or civil lawsuits will dwarf any regulatory fines.”

    Sure, but if that risk is years away, the reward may come now and the risk may fall on someone else later. There needs to be a force that is primarily concerned about the long term.

    Listen, if your position were true then we wouldn’t have a problem. Obviously many here think there is a problem…a huge one in the supplement industry. Do you not preceive the problem then?

  10. ccbowerson 09 Mar 2012 at 10:41 am

    …and I don’t want to minimize what independant organizations do… they are important, but it is not enough. What can you expect? An overhyped berry extract cancer cure is easier to sell than the idea that you are not going to find a cancer cure in your local grocery store

  11. robmon 09 Mar 2012 at 2:54 pm

    There is no such thing as ‘stemming the tide’ but state censorship of private opinions,

    So the effects of a supplement on the human body are mere opinions? I was under the impression the effect (or lack thereof) of supplements were a matter of fact. So whether or not a supplement manufacturer is committing fraud, or endangering people’s health, is a matter of opinion?

    If a company is selling it’s product based on false claims it’s committing fraud, and stopping them from doing so is not censorship it’s preventing fraud. I love the line of reasoning that if current regulations fail due to a lack of power to ensure safety and efficacy, fewer rules and less power will somehow lead to more safety and efficacy. After all once a product kills a bunch of people it’s bound to get bad press.

    I don’t understand why you advocate state agencies setting standards, which may also result in the censorship of your own standards. For example, Galileo advocated heliocentrism and was persecuted by the state because the standard was Scripture passages in the Bible.

    I am baffled as to how you could make that argument. The FDA doesn’t censor scientific it makes decisions based on what is safe for human consumption based on scientific research, if supplement manufacturers wanted to market a product they could either cite existing research showing safety and efficacy, or conduct research to demonstrate it. That is perfectly fair considering the potential negative impact on the health of people who use these products. It is also bizarre that you portray Orin Hatch, someone who opposes regulation of supplements, as a tyrannical regulator. The results of government inaction are somehow government tyranny.

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