ObesityWeek 2018:

Debunking Weight Loss Products, Pills, Procedures Is Essential to Patient Health

With Scott Kahan, MD, and Caroline Apovian, MD 

With 93 million adults facing obesity in the United States, and many more overweight, fielding questions about the best way to lose weight presents as a constant task for clinicians.1

Whether you are an endocrinologist, primary care provider, or other healthcare practitioner, patients have likely asked about a never-ending range of remedies—everything from acupuncture to green tea, bitter orange, adrenal support, glutamine, B12 injections, DMEA, Yohimbe to hypnosis, detox cleanses, and hoping to gain benefits from a variety of supplements for whatever ails them.

Patients may even come to the office with the ads and internet claims that make promises such as "Fat Banished!" or present books with titles that tout the fastest, surest cure to adiposity. Many other individuals may be disciples of TV doctors who push supplements and products that will miraculously solve their health concerns. 

Doctors must advocate against unfounded weight loss methods with their obese patients.

Managing Patients' Magical Thinking About the Latest Weight Loss Possibilities

Weight management guidelines published by The Obesity Society and other professional organizations address the importance of lifestyle changes such as exercise and diet in weight control2,3 "but they don't cover what people should not be doing," said Scott Kahan, MD, MPH, FTOS, director of the National Center for Weight and Wellness and medical director of the George Washington University's Strategies to Overcome and Prevent (STOP) Obesity Alliance in Washington, DC.

With other experts on The Obesity Society Clinical Committee, Dr. Kahan undertook an ambitious project to examine the world of popular diet and obesity treatments.4 "Our group set out to identify commonly used, frequently advertised, often purported obesity treatment that we presumed to be either potentially ineffective, unsafe, or at a minimum unfounded without any evidence to support the claims," he told EndocrineWeb. He and others presented findings for a systematic review of the literature at ObesityWeek 2018 in Nashville, Tennessee.

The project began with the committee brainstorming and then went further to include an extensive literature search, analysis of the studies, and some sobering conclusions. "There has never been a comprehensive, wide-ranging and systematic review of these seemingly common weight control treatments," Dr. Kahan said.

Bottom line, after analyzing decades of studies and numerous approaches and products? "We found there is virtually no scientifically rigorous data to support the use of virtually any of these popularly touted weight loss remedies," Dr. Kahan said.

We found this especially troubling since there are nearly 100,000 dietary supplements are on the market and 52% of adults report taking one or more supplements.5 Of those making a serious weight loss attempt, 45% of women and 20% of men say they were trying dietary supplements.4,6

About 23,000 emergency department visits and more than 2,000 hospitalizations a year have been attributed to dietary supplements, and weight loss supplements are often a causative factor.7

Evaluating Popular Products, Devices, Pills Positioned to Burn Fat and Solve Obesity

The TOS committee compiled a list that included weight loss products or therapies, vitamin, supplements, and services. "The vast majority were dietary supplements and herbal preparations," Dr. Kahan said. The most common remedies covered B12 injections, green coffee bean extract, citrus formulas such as bitter orange, as well as, psyllium, amphetamine-based supplements such as DMAA and many others. Services and products included hypnosis, acupuncture, detox cleanses and extended to diets such as the Simeon HCG, gluten-free, and Eat-Right-for-Your-Type.4

"For the systematic review, the committee focused mostly on the dietary supplements and some of the other services like hypnosis and acupuncture specially geared to weight loss," he said.

From an initial list of 21,000 studies, published in medical journals from 1960 onward, the team applied scientifically accepted criteria to exclude studies that did not meet the rigor, eventually arriving at only 313 full-text articles of potentially unfounded treatments.4,6

Among the products and remedies that were examined in the included studies were: acupuncture, calcium/Vitamin D, chitosan, chromium, ephedra/caffeine, garcinia, green tea, linoleic acid, mind-body, and Phaseolus (a/k/a runner type green bean plant).4,6

Not Even One Study Demonstrated an Evidence Basis to Support Benefit

Even the trials that meet the initial scientific criteria fell short in the rigor of data, Dr. Kahan said. "The problem was that most of the studies were so tiny that we couldn’t draw much of a conclusion from the findings,” and the studies that did have sufficient data typically had a null effect, he told EndocrineWeb.

With the contents of supplements having a ''wide latitude" due to the 1994 Dietary Supplement Health and Education Act,8 It's a very interesting conundrum, as “we are in effect in this situation now that there is like the Wild West,” he said.

"The lion's share of the advertising and claims out there are for supplements, and some of these products are extremely expensive but ultimately they don't offer anything of value or benefit to patients except false hope and empty promises," said Dr. Kahan. Except perhaps, according to statistics, landing a number of our patients in the emergency department.7

"I think since there is very little clear research on dietary supplements, physicians tend to shy away from talking about dietary supplements [with their patients], and it is not discussed much in medical school," he said.

Time to Become More Vocal in Challenging Products Offering Empty Promises

"A lot of clinicians have a negative feeling about supplements, which our study would seem to back up, given such poor evidence about effectiveness even for those with a little bit of data, and now with enough data to back up the wildly inflated claims on the internet and elsewhere," said Dr. Kahan.

Given the confirmation that there is insufficient evidence to support most of the pills, supplements, and popular remedies sought out by our patients for weight loss and other common conditions, clinicians must become more active in educating patients about this lack of proof of efficacy, and the potential for harm, Dr. Kahan said.

Doctors who know and recognize that obesity is a chronic, relapsing disease that requires ongoing and long-term management, will have no trouble dismissing the myriad snake oil products that patients seek validation for, said Caroline Apovian, MD, FACP, FACN, FTOS, professor of medicine and pediatrics at Boston University School of Medicine and past president of The Obesity Society.   

"We are just a few years away from the parallel we will end up making for other diseases that were 'treated' with snake oil therapies, such as stroke, hypertension, gout, and arthritis," she told EndocrineWeb, having reviewed the presentation and study findings but wasn’t involved in either"We have proven surgery and efficacious medications that received approval by the Food and Drug Administration specifically to manage this condition."

To get the idea across to patients, she said, it might help to explain that ''any patient who lost weight following bariatric surgery or with the help of [anti-obesity] medications and now has a body mass index of 23 will still have obesity just like a person with hypertension whose blood pressure remains around 120/80 with the help of medications [still has hypertension]."

Her message for physicians is this: "Tell patients to stop using anything that is not FDA-approved for obesity treatment." She tells her patients to stop taking unproven remedies that do not require a medical prescription for obesity since obesity is a serious chronic illness that requires medical intervention.

Among the next steps, the National Academy of Medicine received a grant from Google to address misinformation presented online in key health-related subject areas, including obesity/weight loss, to help consumers become better informed so they can navigate the avalanche of data around effective and appropriate weight loss methods.

Next Summary:
Emerging Obesity Treatments: Gastric Embolization, Oral Hydrogel
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