Deception In Weight-Loss Advertising Workshop: Seizing .

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DECEPTIONIN WEIGHT-LOSSADVERTISINGWORKSHOP:Seizing Opportunitiesand Building Partnershipsto Stop Weight-Loss FraudA Federal Trade CommissionStaff ReportDecember 2003

Federal Trade CommissionTIMOTHY J. MURIS, ChairmanMOZELLE W. THOMPSON, CommissionerORSON SWINDLE, CommissionerTHOMAS B. LEARY, CommissionerPAMELA JONES HARBOUR, CommissionerThis is a report of the Bureau of Consumer Protection of the Federal Trade Commission. The viewsexpressed in this report are those of the staff and do not necessarily represent the views of the FederalTrade Commission or any individual Commissioner. The Commission has voted to authorize the staffto publish this report.

DEPARTMENT OF HEALTH & HUMAN SERVICESPublic Health ServiceOffice of the Surgeon GeneralRockville MD 20857We are witnessing a growing epidemic of obesity in this country. This epidemicnot only costs this nation over 117 billion a year, but it also steals 300,000 lives.Unfortunately, there is no miracle pill that can help Americans lose excess weight, so wehave to rely on responsible behavior – including eating right and being physically active.The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,released in December 2001, called upon almost every segment of the public and privatesectors to work together to help Americans make healthy eating and physical activitychoices.By improving our nation’s “health literacy” we can ensure that Americans havethe information and tools they need to make effective decisions that will improve theiroverall health and lead to longer, healthier lives. The media can play an important role ineducating consumers by providing accurate information about weight loss programs andweight management products.In September 2002, the Federal Trade Commission staff released a report, WeightLoss Advertising: An Analysis of Current Trends, that found as much as 55 percentof advertising for weight loss products and services contained false or unsupportedefficacy claims. Follwing up on that report, the FTC staff convened a workshop whererepresentatives of the scientific community, the weight loss industry, and media tradeassociations discussed ways that industry and the media could reduce the spread offalse promises of miraculous, fast, and effortless weight loss. This FTC staff report onthe workshop lays out a number of opportunitites for industry and media to assume aleadership role in addressing deceptive weight loss advertising.The FTC staff has proposed a plan to reduce deceptive weight loss advertisingthat includes several segments of the commuity working together to promote positive,reliable messages about weight loss through advertising. A major part of the FTC staffeffort is a list of seven scientifically infeasible claims frequently found in misleadingweight loss ads. Advertising can play an important role in providing consumers with theinformation they need to make healthy weight loss choices.I would like to thank and congratulate Chairman Muris, the other Commissionmembers, and the staff who continue to work so tirelessly with the weight loss industryand media to promote positive, reliable messages about weight loss.Richard H. Carmona, M.D., M.P.H., F.A.C.S.Surgeon GeneralU.S. Public Health Service

ContentsExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iI.Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1II.Workshop Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2A.The Science Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.2.3.4.5.6.7.8.B.The Industry Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181.2.3.4.C.Consumers who use the advertised product can lose substantial weight withoutreducing caloric intake and/or increasing their physical activity. . . . . . . . . . . . . . . 4Consumers who use the advertised product can lose substantial weight while stillenjoying unlimited amounts of high calorie foods. . . . . . . . . . . . . . . . . . . . . . . . 7The advertised product will cause permanent weight loss. . . . . . . . . . . . . . . . . . . 8The advertised product will cause substantial weight loss through the blockage ofabsorption of fat or calories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Consumers who use the advertised product can safely lose more than three poundsper week for a period of more than four weeks. . . . . . . . . . . . . . . . . . . . . . . . 12Users can lose substantial weight though the use of the advertised product that isworn on the body or rubbed into the skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13The advertised product will cause substantial weight loss for all users. . . . . . . . . . 15Consumers who use the advertised product can lose weight only from those partsof the body where they wish to lose weight. . . . . . . . . . . . . . . . . . . . . . . . . . . 17False and Deceptive Ads Tarnish Reputable Marketers . . . . . . . . . . . . . . . . . .Industry Self-Regulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .The Role of the National Advertising Division of the BBB. . . . . . . . . . . . . . . . .The Creation of a Partnership Involving the Media in Self-Regulation . . . . . . . . .19202224The Media Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251.2.3.Advertising Clearance Standards Vary Significantly Across the Cable, Newspaper,and Magazine Industries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Practical Impediments Faced by the Media in Reviewing Weight-Loss Ads . . . . . . 27Potential Roles for the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28III. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30A.Summary of the Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30B.Weight-Loss Advertising Guidance for the Media. . . . . . . . . . . . . . . . . . . . . . . . . . 32IV. Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Endnotes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Appendix A: Biographical Sketches of Panelists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Executive SummaryThis staff report (Workshop Report) provides a summary and analysis of the Federal TradeCommission’s public workshop on Deception in Weight-Loss Advertising. It includes a detailedreview and summary of the workshop discussion and relevant public comments submitted inconjunction with the workshop. It also sets forth the staff’s recommendations for future FTC action.The workshop, held on November 19, 2002, was a part of the FTC’s effort to curb false anddeceptive advertising of weight-loss products and services. The workshop followed the September2002 release of the FTC staff report on weight-loss advertising (Weight-Loss Advertising Report).The Weight-Loss Advertising Report concluded that, despite unprecedented levels of FTC lawenforcement and substantial consumer education efforts, false and deceptive weight-loss advertisingwas widespread. Against this backdrop, it should be noted that, according to the U.S. SurgeonGeneral, overweight and obesity have reached epidemic proportions in the United States. As a result,at any given time, tens of millions of consumers are trying to lose weight and spending billions ofdollars each year on weight loss products and services. Too often, however, these products do notprovide the advertised results.Accordingly, the goal of the workshop was to explore new approaches to stopping false weightloss advertising. In particular, the workshop participants considered whether the FTC should compilea concise list of scientifically suspect claims found in weight-loss ads and discussed whether specificguidance identifying false claims could assist the industry and the media in eliminating false claimsfrom weight-loss ads.The all-day workshop consisted of three panels: science, industry, and media. The sciencepanel, comprised of ten experts in nutrition and the study and treatment of overweight and obesity,evaluated eight weight-loss claims and considered whether the claims promised results that werenot scientifically feasible. The discussion was limited to claims for nonprescription drugs, dietarysupplements, creams, wraps, devices, and patches (“nonprescription weight-loss products”). Overall,the experts believed that there are certain weight-loss claims for these products that are not feasiblebased on the current state of the science. Based on these discussions, as well as the written commentsreceived before and after the workshop, the published scientific and medical literature, and thei

investigative experience of FTC staff, this staff report concludes that the following claims are notscientifically feasible at the current time for nonprescription weight-loss products: Consumers who use the advertised product can lose two pounds or more per week (overfour or more weeks) without reducing caloric intake and/or increasing their physicalactivity. Consumers who use the advertised product can lose substantial weight while still enjoyingunlimited amounts of high calorie foods. The advertised product will cause permanent weight loss (even when the user stops usingthe product). The advertised product will cause substantial weight loss through the blockage of absorptionof fat or calories. Consumers who use the advertised product (without medical supervision) can safely losemore than three pounds per week for a period of more than four weeks. Users can lose substantial weight through the use of the advertised product that is worn onthe body or rubbed into the skin. The advertised product will cause substantial weight loss for all users. Consumers who use the advertised product can lose weight only from those parts of thebody where they wish to lose weight.*The second panel examined whether the weight-loss industry could fashion a more effectiveself-regulatory program. Members of the industry favored strengthening self-regulatory guidelinesand considered whether an outside group such as the National Advertising Division of the Council ofBetter Business Bureaus (NAD) could assist with self-regulation. Such industry-based efforts will bean important component in curbing problematic ads.Finally, the third panel considered the media’s part in disseminating problematic ads andexamined the possibility of an increased role for the media in screening weight-loss ads. Panelistsraised concerns regarding media screening of weight-loss ads, including various practical issues. Forexample, media members pointed to the short time frames available to make decisions regardingwhether to run an ad and the difficulty of making judgments on whether an ad makes false claims.* Although this report concludes that this claim is not scientifically feasible when made in the context of an adpromising substantial weight loss, it has not been included in the FTC staff’s media guidance brochure (“guidance”),which is being released simultaneously with this report, because the claim does not appear to be widespread.ii

Having considered the panel discussions and the written comments, the FTC staff believes thatguidance on scientifically infeasible claims for nonprescription weight-loss products could be usefulto the industry, the media, and consumers. Industry members can incorporate information from theguidance into new or existing self-regulatory codes that can aid them in preparing truthful ads. Mediaoutlets can compare ads they receive with the guidance and reject patently false ads before they reachthe consumer. And, consumers can use the guidance in evaluating which weight-loss products theyshould avoid. Accordingly, the staff recommends publication of guidance that specifically identifiesthose weight loss claims that are not feasible based on current scientific knowledge.At the same time, the staff will continue its other efforts to stop false and deceptive weight-lossadvertising by: encouraging the media to implement viable media clearance standards and encouraginglegitimate advertisers and their representatives to support this program; working with interestedpublic and private entities to develop self-regulatory weight-loss advertising guidelines; supportingthe development of effective industry self-regulatory programs; and working with private sectororganizations to develop effective consumer education. In addition, the staff will recommend tothe Commission that it bring enforcement actions against companies that use scientifically infeasibleclaims to promote weight-loss products. In any enforcement action, the Commission retains theburden of proving that the claims are false, deceptive, or unsubstantiated.Finally, the FTC staff will continue to monitor weight-loss advertising over the course of thenext year to measure improvement. Based on the results of continued monitoring, the staff will makefurther recommendations as are necessary and appropriate.iii

I. BackgroundSix out of every 10 Americans are overweight or obese.1 The estimated cost of obesity exceeds 100 billion per year.2 Not surprisingly, at the same time, millions of Americans are trying to loseweight.3 The marketplace has responded with a proliferating array of products and services, manypromising miraculous, quick-fix remedies.4 Tens of millions of consumers have turned to over-thecounter remedies, spending billions of dollars on products and services that purport to promote weightloss.5To document more systematically the extent of false and deceptive weight-loss advertising, theFTC staff, with the assistance of the Partnership for Healthy Weight Management,6 collected andanalyzed a nonrandom sample of 300 advertisements, mostly disseminated during the first half of2001, from broadcast and cable television, infomercials, radio, magazines, newspapers, supermarkettabloids, direct mail, unsolicited commercial e-mail (spam), and Internet websites. In addition,to evaluate how weight-loss advertising has changed over the past decade, the staff compared adsdisseminated in 1992 in eight national magazines with ads appearing in 2001 in the same publications.7The results were released in September 2002, in a report entitled Weight-Loss Advertising:An Analysis of Current Trends. The report concluded that the use of false or misleading claims inweight-loss advertising was widespread. Nearly 40% of the 300 ads made at least one representationthat almost certainly was false. An additional 15% of the ads made at least one representation thatwas very likely to be false or, at the very least, to lack adequate substantiation.8 The report furthernoted that the incidence of false weight-loss product advertising appeared to have increased overthe last decade, despite an unprecedented level of law enforcement.9 Concurrent with the release ofthe report, the FTC announced that it would host a workshop to consider additional or alternativeapproaches to combat false and deceptive weight-loss product advertising.10The workshop was held on November 19, 2002.11 It consisted of three panels designed toconsider the scientific feasibility of certain claims made for weight-loss products (the “sciencepanel”) and to explore ways that members of the weight-loss industry and the media can contribute tocurtailing weight-loss fraud (the “industry” and “media” panels).The science panel was comprised of researchers, academics, and medical professionals from thegovernment, academia, and private industry. Each panel member evaluated the claims and opinedon whether they are scientifically feasible given the current state of knowledge and technology. Theindustry panel included representatives from the weight-loss industry, such as companies that sell1

weight-loss products and trade associations that represent the dietary supplement industry. The paneldiscussed the problem that false and deceptive advertising poses for the industry, and considered howindustry self-regulation could be improved. The media panel consisted of academics, media experts,and representatives of media trade associations and media outlets, and focused its discussions on therole of the media in disseminating false and deceptive weight-loss ads, as well as new approaches toeffective media screening.The workshop was productive and fostered communication among various groups about how bestto address the problem of false and deceptive weight-loss advertising. To aid in this undertaking, theFTC solicited and received public comments before and after the workshop. This report provides asummary and analysis of the workshop and relevant public comments.II. Workshop DiscussionA. The Science PanelIn its Federal Register Notice announcing the workshop, the FTC solicited comments on thecreation of a list of weight-loss claims that are generally agreed to be false.12 The notice also includeda list of eight claims found in ads for nonprescription weight-loss products and requested commentson whether, given the current state of the science, these claims are false.13 Specifically, commenterswere invited to discuss the state of the science tending to prove or disprove the claims. No commentswere received prior to the workshop specifically addressing the individual claims or offering evidenceto prove or disprove any of the claims. Moreover, no scientific evidence was submitted during thepost-workshop comment period that suggested that, for any of the products considered, any of thesubject claims could be true.The scientific panel members – consisting of researchers, academicians, medical professionals,and industry experts14 – were each asked to consider whether certain advertising claims werescientifically feasible and the conditions that might affect the feasibility of each claim. The discussionwas limited to nonprescription drugs, dietary supplements, creams, wraps, devices, and patches(“the advertised product” or “the covered products.”) The panel did not consider the feasibility ofsuch claims for prescription drugs, meal replacement products, low calorie foods, surgery, hypnosis,or special diets such as the Atkins diet or very low calorie diets.15 Although claims made for theseproducts or services also may be false, misleading, or unsubstantiated, including some of the claims2

identified in this report, consideration of these additional products and services was beyond the limitedscope of the workshop.16The science panelists considered the following eight claims: The advertised product causes substantial weight loss without diet or exercise. Users can lose weight while still enjoying unlimited amounts of high calorie foods. The advertised product causes permanent weight loss. The advertised product causes substantial weight loss through the blockage of absorption offat or calories. The user of the advertised product can safely lose more than three pounds a week for timeperiods exceeding four weeks. The advertised product that is worn on the body or rubbed into the skin causes substantialweight loss. The advertised product causes substantial weight loss for all users. Users of the adversised product can lose weight from only those parts of the body wherethey wish to lose weight.17For each claim, panel members were asked individually whether they believed that the claim isfeasible, given the current state of scientific knowledge. In making this determination, panelists wererequested to express their individual expert opinions based upon a reasonable degree of scientific andmedical certainty.18 Panelists were asked to consider theoretical and biological plausibility, scientificfeasibility, possible mechanisms of action, and relevant scientific studies.19Following a presentation on the principles of weight loss,20 the panel’s FTC moderator explainedthe framework for discussing the eight claims and said that the panelists would be polled regardingtheir opinions on each claim.21 Care was taken to ensure that the panelists understood the precisequestion being polled.22 In certain instances, more than one poll was taken, either because a panelist’scomments suggested some misunderstanding of the question, or to test different variations of aparticular claim.23The following sections will review the discussion of the panelists, evaluate each claim, andrespond to public comments relating to the claims.3

1.Consumers who use the advertised product can lose substantialweight without reducing caloric intake and/or increasing theirphysical activity.a.ClaimAs demonstrated in the Weight-Loss Advertising Report, claims that users can lose weightwithout reducing caloric intake or increasing physical activity were common in weight-loss ads.Forty-two percent of the ads that the staff reviewed in the Report promised weight loss without dietor exercise, and in many cases, the claims were extreme. For example, many promised that userscould lose a pound or more a day, while others claimed that users could lose three to four pounds perweek, all without diet or exercise. It also appeared that these types of claims have increased over thelast decade. To illustrate, none of the ads that the staff reviewed in its 1992 sample claimed that userscould lose weight without diet or exercise.Examples of this claim include, “U.S. patent reveals weight loss of as much as 28 pounds in 4weeks. Eat all your favorite foods and still lose weight. The pill does all the work,”24 and “Lose upto 2 pounds daily without diet or exercise.”25b.Panel DiscussionMr. Almada began the discussion by indicating that there is research on certain fibers, syntheticephedrine and caffeine, herbal varieties of ephedra and caffeine, green tea extract, and garciniacambogia that supports claims that users can lose weight without changing eating patterns or levels ofphysical activity.26 Mr. Almada indicated that he thought studies supported a finding of weight loss ofone pound, plus or minus a half a pound, per week, for 8 to 12 weeks.27 Dr. Heymsfield examinedthe claim from a different perspective:The way I read this is that you could lose a substantial amount of weightwithout reducing your intake and/or increasing your physical activity. Justscientifically, you. would have to block absorption, change partitioning, orincrease your resting metabolic rate. Those are the three ways that are left afteryou eliminate food intake and physical activity. [We know] you can’t blockabsorption to the extent that would be safe or effective even. Partitioning, thereare no agents that we really know of, and resting metabolic rate, I’m unaware ofany compound that will increase your resting metabolic rate safely or to the pointthat would cause substantial weight loss.28The panelists then discussed what the weight-loss limits would be without reducing caloric intakeor increasing exercise. Dr. Heymsfield indicated that he thought the effect, if any, would certainlybe less than one-half pound per week.29 Dr. Wadden questioned whether even a half pound per week4

would be possible.30 Dr. Heymsfield advised the group that in his research on ephedrine/caffeineproducts, weight loss appeared to be attributable to reduction in food intake, but that there were somestudies showing some very small increases in resting metabolic rates.31 Mr. Almada indicated thatthere were some studies from Europe indicating that more than half of the effect was due to appetitereduction.32 Dr. Stifler said that he believed there would be no weight loss, substantial or otherwise,for any of the covered products without reducing caloric intake or increasing exercise.33Following this discussion, the experts were polled. Nine of the ten experts indicated that giventhe current state of scientific knowledge, no nonprescription drug, dietary supplement, cream, wrap,device, or patch would cause users to lose weight without reducing caloric intake and/or increasingphysical activity.34 The panelists were also polled concerning their views on the same claim withthe assumption that the weight loss would exceed one pound per week.35 All of the experts exceptMr. Almada indicated that losing more than a pound per week without reducing caloric intake and/orincreasing exercise was not scientifically feasible.36c.Written CommentsA joint comment filed by the Magazine Publishers Association and the Newspaper Associationof America (“Joint MPA/NAA Comment”) claims that “substantial weight loss” may mean differentthings to different people.37 Any ambiguity about the meaning of the word “substantial” is resolvedby defining it to mean more than one pound per week, as was done in the alternative formulation ofthe claim used in this instance.d.AnalysisThe FTC has considerable experience with claims that users can lose substantial weight withoutdiet or exercise. For example, in FTC v. SlimAmerica, the FTC challenged claims that a productcalled Super Formula38 could cause dramatic weight loss, including as much as 49 pounds in 29 days.39The court, after hearing from experts on both sides, concluded:To lose one pound of weight, according to a credible expert, the averageindividual needs a deficit of approximately 3,500 calories between caloric intakeand caloric output. Although drugs may make it easier to achieve this deficit,they cannot alter this basic equation. Thus, it would be impossible for a personwho did not diet or exercise to lose weight simply by taking the defendant’s drugor weight loss product. It is thus elementary that if a person consumed calories inexcess of his/her daily needs, and did not diet or exercise there would be weightincrease, rather than decrease.405

Theoretically, products purporting to cause weight loss without diet or exercise would either needto cause malabsorption of calories or to increase metabolism (so-called “thermogenic agents”). Asdiscussed below, the number of calories that can be malabsorbed appears to be limited to 1200 to 1300calories per week, or roughly one-third of a pound per week, at best. Accordingly, malabsorptionalone is unlikely to lead to substantial weight loss.41With regard to thermogenic agents, it is often difficult to evaluate the supporting evidence, giventhe lack of rigorous methodology in many of the studies in question.42 In any event, the effect ofpurported metabolism boosters appears to be very limited. For example, a study of green tea extractfound only a 4% increase in metabolism.43 Ephedrine, usually sold in combination with caffeine, hasbeen one of the most popular thermogenic agents marketed over the past five years. It appears toproduce only modest weight loss, mostly due to its appetite suppression effect.44The significance of the small amount of weight that can be lost through malabsorption orincreased metabolism is debatable. It is clear, however, that as the amount of claimed weight lossincreases, the likelihood that such weight loss can be achieved without restricting caloric intake orincreasing exercise decreases dramatically. For example, weight loss in the range of two pounds perweek over periods of time beyond four weeks (eight or more pounds per month) would require a netcaloric deficit of 7,000 calories per week, or a 1,000 calories per day, over an extended period oftime. That would amount to 40% of the total calories consumed per week on a 2,500 calorie per daydiet.45 As noted below, about 180 calories per day appears to be the outer limit for malabsorption. Inaddition, the staff is unaware of any scientific literature suggesting that 40% increases in metabolismcan be achieved without producing toxic effects on the body.In summary, the amount of weight loss that can be achieved through the use of nonprescriptionproducts without reducing caloric intake or increasing exercise is likely to be no more than one-fourthto one-third of a pound per week, with additional weight loss being attributable to reduced caloricintake. Accordingly, weight loss in the range of two pounds per week over periods of time beyondfour weeks (eight or more pounds per month) without restricting caloric intake or increasing exerciseis not now scientifically feasible.466

2.Consumers who use the advertised product can lose substantialweight while still enjoying unlimited amounts of high caloriefoods.a.ClaimSome ads go beyond merely claiming that no diet or exercise is required; these ads claim thatusers can lose substantial weight and still eat unlimited amounts of high calorie foods. For example,one ad stated, “Eat as much as you want, the more you eat, the more you lose, and we’ll show youhow.” Another example is, “Eat All the Foods You Love and Still Lose Weight (Pill Does All theWork).”47b.Panel DiscussionAccording to Dr. Stifler, there is an established dose response between the amount of caloriesconsumed and the amount of weight loss (or weight gain) that results.48 As Dr. Stifler noted: “Thebottom line is you have to manage calories in order to lose weight.”49 Dr. Hubbard agreed, saying “itis a law of physics and you cannot lose weight unless you change your energy balance.”50 Dr. Sternobserved that even a small amount of high calorie foods can have a significant effect on weight.51 Dr.Heymsfield noted, and Dr. Wadden agreed, that the claim need not be limited to high calorie foods tomake it false.52Following this discussion, the panelists were polled and all the experts indicated that given thecurrent state of scientific knowledge, no nonprescription drug, dietary supplement, cream

the body or rubbed into the skin. The advertised product will cause substantial weight loss for all users. Consumers who use the advertised product can lose weight only from those parts of the body where they wish to lose weight.* The second panel examined whether the weight-loss industry could fashion a more effective self-regulatory program.File Size: 546KBPage Count: 74