{"id":42563,"date":"2016-06-08T15:45:10","date_gmt":"2016-06-08T20:45:10","guid":{"rendered":"http:\/\/news.medill.northwestern.edu\/chicago\/?p=42563"},"modified":"2016-06-18T21:38:26","modified_gmt":"2016-06-19T02:38:26","slug":"the-deal-with-diet-pills-weight-loss-supplements-remain-a-wild-west","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/the-deal-with-diet-pills-weight-loss-supplements-remain-a-wild-west\/","title":{"rendered":"The deal with diet pills\u2014Weight loss supplements remain a ‘Wild West’"},"content":{"rendered":"

By Neil Murthy<\/strong><\/p>\n

Meet Whitney\u2014a 42-year-old wife and a mother living on the North Shore.\u00a0 Her favorite pastimes include performing in musical theater, actively participating in her child\u2019s PTA, volunteering with various local charity organizations and mentoring her 7-year-old daughter\u2019s busy round of school, homework and sports.<\/p>\n

She is also on a decades-long quest to lose weight.<\/p>\n

<\/p>\n

Ever since she was in the second grade, Whitney remembers having a problem with excess weight. She was a size ten by high school and her weight soared to her record of 330 pounds when she was pregnant with her daughter. Her weight challenges pushed her to the brink of despair\u2014even to the point of battling with bulimia. For years, she battled her weight and for years, she failed in the process.<\/p>\n

Whitney\u2019s story is not unique. According to the Centers for Disease Control and Prevention (CDC), nearly 71 percent of adult Americans hit the scales at either overweight or obese in 2014. With excess weight rising to epidemic proportions, the ever-burgeoning weight loss industry has become a lucrative market. Like so many millions of other Americans, Whitney turned to the weight loss industry to find relief.<\/p>\n

\u201cI was constantly yo-yo dieting,\u201d said Whitney. \u201cJenny Craig, Optifast, Weight Watchers\u2026 you name it, I\u2019ve tried it. But they never worked.\u201d<\/p>\n

But one thing she firmly avoided was over-the-counter weight loss supplements. For her, the reason why is simple.<\/p>\n

\u201cOne minute you hear the latest craze, and the next thing you know a supplement is going to kill you,\u201d she said.<\/p>\n

Whitney\u2019s instincts are solid. \u00a0A study published in October in the New England Journal of Medicine<\/em> found that approximately 23,000 emergency room visits across the nation per year are attributed to dietary supplements\u201471 percent of which are specifically linked to weight loss products. And the side effects from weight loss supplements are frightening\u2014thousands come to emergency rooms complaining of chest pain, palpitations, and fast heart rate all triggered by over the counter weight loss supplements. In 2013, 29 people in Hawaii succumbed to severe acute hepatitis and fulminant liver failure after taking a supplement called Oxy-Elite Pro, sparking an investigation by the CDC that eventually led to that product\u2019s recall. One patient died and two patients required liver transplants.<\/p>\n

\u201cSome of these supplements don\u2019t even work. These companies just prey on people to latch on to their ideas,\u201d said Whitney.<\/p>\n

A quick glance at your local pharmacy or grocery shelves will show the myriad of weight loss products with nothing short of miraculous claims. \u00a0Words such as \u201crevolutionary,\u201d and \u201clatest scientific discovery\u201d are prominently emblazoned on the packaging. Manufacturers are peddling concoctions of caffeine, herbs and sometimes, in cases where there have been recalls, even banned pharmaceuticals.<\/p>\n

\u201cIt\u2019s a bit of a Wild West out there,\u201d said Dr. Kimberly Anne Gudzune, assistant professor of medicine at Johns Hopkins. \u201cPeople are offered whatever they want without any scientific basis.\u201d<\/p>\n

There is little sign that the weight loss supplement industry will slow down. A Consumer Reports survey last year found that nearly 25 percent of 3,000 Americans surveyed had tried a weight loss supplement. And as the industry continues to expand, the Wild West seems to be getting wilder. And most dietary supplements don\u2019t require FDA approval.<\/p>\n

\"Weight<\/a>
Dietary supplements line shelves of pharmacies, groceries and many other stores. (Neil Murthy\/MEDILL)<\/figcaption><\/figure>\n

The Beginning of the \u201cWild West\u201d<\/strong><\/p>\n

It all began with a simple question\u2014what exactly are dietary supplements?<\/p>\n

Throughout much of the 20th<\/sup> century, the answer to that question has been fraught with contention. Some thought supplements were drugs. Others thought they were foods, and still others thought that they were a separate category in their own right. Throughout the 1960s and 1970s, the Food and Drug Administration (FDA) initially argued that dietary supplements were \u201cdrugs\u201d and therefore had to be regulated as such. The administration therefore wanted to regulate the potency and the combination of the ingredients in supplements, just as they would do for other drugs.<\/p>\n

In 1976, however, Congress passed the Proxmire Amendment to the Food, Drug and Cosmetic Act of 1938, an amendment named for\u00a0\u00a0 Senator William Proxmire (D-Wis.) The amendment struck down the FDA\u2019s plan to regulate daily allowances, combinations or the potency of the ingredients in supplements. Although it was certainly a setback, the FDA regrouped and declared that supplements should fall under the category of \u201cfood additives.\u201d That would have allowed the administration to employ stricter oversight over supplements, and declare certain supplements to be unsafe. The FDA came close to achieving a major victory when Congress passed the Nutritional Labeling and Education Act (NLEA) of 1990, which would have allowed the FDA to review and authorize the health claims made by dietary supplements.<\/p>\n

However, before the act could be implemented, a large grass roots campaign supported by the supplement industry compelled Congress to pass the Dietary Supplement Act of 1992, placing a one-year moratorium on the provisions of NLEA. During that moratorium, Congress passed the Dietary Supplement Health and Education Act (DSHEA) of 1994, which remains the law of the land to this day.<\/p>\n

Spearheaded by Republican Senator Orrin Hatch of Utah and Democratic Senator Tom Harkin of Iowa, DSHEA (pronounced \u201cduh-shay\u201d) declared that dietary supplements were a separate category in its own right, although it fell under the larger umbrella of \u201cfood.\u201d As a separate category, dietary supplements did not have to abide by the regulatory requirements of other foods and drugs. Any dietary supplement that was already on the market by 1994 did not need FDA approval before marketing and did not need to be proven safe or efficacious prior to sale. For newly discovered dietary ingredients, manufacturers have to prove the product\u2019s safety to the FDA, but do not have to prove the product\u2019s efficacy. Essentially, the FDA has little to no oversight over any of the health claims being made, so long as the supplement manufacturer does not claim that the product cures a disease.<\/p>\n

\u201cThe challenge is that, since 1994, companies can make claims\u2014such as \u2018increase fat metabolism\u2019 or \u2018help maintain a normal weight\u2019\u2014without a shred of human data to support their claims,\u201d said Dr. Pieter Cohen, an assistant professor at Harvard Medical School. \u201cThe companies therefore have little incentive to actually test their products.\u201d<\/p>\n

DSHEA was a resounding success for the supplement industry. Their lobbying efforts had literally paid off. Ever since 1990, Senators Hatch and Harkin have been the supplement industry\u2019s largest beneficiaries. \u00a0According to the Center for Responsive Politics<\/a>, Hatch reportedly received $422,737 from the industry while Harkin reportedly received $311,543 in campaign contributions from PACs and individuals based on Federal Election Commission data. \u00a0In a statement published on Senator Hatch\u2019s website, the senator states that he wants to \u201cwork with the supplement industry to ensure that Utah\u2019s economy remains strong and is not targeted by unnecessarily burdensome regulations.\u201d<\/p>\n

With no oversight on claims of efficacy and restricted oversight on safety, the supplement industry grew explosively from sales of $17 billion in 2000 to approximately $34 billion in 2015. The Wild West was now here to stay.<\/p>\n

The FDA\u2019s \u201cUphill Battle\u201d<\/strong><\/p>\n

Visit the FDA\u2019s website and you will see that a part of the FDA\u2019s mission is to \u201cprotect public health by assuring the safety, efficacy and security of drugs and biological products.\u201d<\/p>\n

But ever since the advent of DSHEA, the FDA\u2019s ability to \u201cassure the safety, efficacy, and security\u201d of dietary supplements was mostly sidelined. For one, the FDA\u2019s ability to regulate claims of efficacy was virtually relinquished. Claims of efficacy were relegated to a self-policing supplement industry.<\/p>\n

\u201cYou do not have to prove to us that your product does what it claims to do,\u201d said Lyndsay Meyers, an FDA spokeswoman. \u201cThe manufacturers are supposed to conduct their own research to verify that their claims are accurate, and they don\u2019t have to submit that proof to the agency.\u201d<\/p>\n

Furthermore, the FDA\u2019s ability to ensure the safety of supplements can be circumvented. Although DSHEA calls for companies to prove that new dietary ingredients are safe for human consumption, many companies bypass the process.<\/p>\n

\u201cCompanies sometimes either skip it all together, or they come back and say, \u2018no we disagree with your findings,\u2019 and they just go to market anyways,\u201d said Meyers.<\/p>\n

At times, even banned pharmaceuticals, such as the appetite suppressant sibutramine (known to increase the risk of heart attacks and strokes) and the laxative phenolphthalein (linked to increased risk of cancer) have made their way into weight loss supplements. According to the FDA\u2019s recall and market withdrawals webpage, four distinct weight loss products in the past year alone were found to have either phenolphthalein or sibutramine. All four of those products have now been recalled.<\/p>\n

\u201cSome people who make these supplements are not really up and up in terms of ethics,\u201d said Meyers. \u201cThey are made in the basements in people\u2019s homes, or made overseas and shipped in [people\u2019s] purses. They evade our screening process.\u201d<\/p>\n

The supplement industry itself has acknowledged that this is a serious problem. \u00a0Douglas MacKay is the Senior Vice President of the Council for Responsible Nutrition, a trade association representing more than 150 dietary supplements that lobbies on behalf of the industry in Washington, DC.<\/p>\n

\u201cAdding banned substances to supplements is illegal and totally against the law,\u201d said MacKay. \u201cThese people should go to jail. Consumer safety is our number one priority.\u201d<\/p>\n

The controversy has resulted in several lawsuits. In August, U.S. Attorney Walt Green indicted several Louisiana and Florida residents for including sibutramine in dietary supplements and selling the product as \u201call-natural.\u201d<\/p>\n

Despite the multiple lawsuits, MacKay defended the industry\u2019s practices\u00a0and stated that many manufacturers have responded to consumer concerns by inviting third parties\u2014such as Underwriters Laboratories and United States Pharmacopeia\u2014to certify product safety.<\/p>\n

\u201cWe understand that some consumers want extra verification that someone is looking over the shoulder of a dietary supplement,\u201d said MacKay. \u201cThere are supplement companies that have video feeds on their manufacturing line, where you can watch them make the products and see how it\u2019s done and what goes into it. Those companies market to a clientele that demands transparency.\u201d<\/p>\n

MacKay said that the way to ensure product safety is not increased FDA regulation, and called that idea \u201cludicrous.\u201d<\/p>\n

\u201cYou don\u2019t change the law because there are criminals out there,\u201d said MacKay. \u201cEnforcement of the law is the solution.\u201d<\/p>\n

But because DSHEA has placed such a high burden of proof on the FDA, enforcement of DSHEA would not prevent dangerous supplements from hitting the market. According to DSHEA, if the FDA has a concern with a certain product, the agency has to scientifically prove in a court of law that the product is unsafe. By the time the FDA compiles its scientific argument, the supplement in question has already hit the market and could theoretically harm countless consumers even before the FDA had a chance to step in.<\/p>\n

What the FDA is allowed to do, according to DSHEA, is to conduct post-market surveillance of products. But according to a report from the Office of the Inspector General, only 1 percent of all adverse events from supplements are actually reported to the FDA. Although the FDA encourages the public to report any side effects to the Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS), a large number of adverse events simply go undetected.<\/p>\n

Funding remains another challenge for the FDA. According to Meyers, the team at the FDA that is responsible for overseeing the supplement industry consists of only 24 people and has a budget of less than $5 million annually. It is this team that has the gargantuan task to monitor a supplement industry worth an estimated $34 billion dollars in annual sales.<\/p>\n

\u201cThe FDA doesn\u2019t have the bandwidth to control all of [the supplement industry]. It does not have the people power to catch all the bad guys,\u201d said Dr. David Katz, president of the American College of Lifestyle Medicine.<\/p>\n

\u201cWe\u2019re fighting an uphill battle here,\u201d Meyers conceded.<\/p>\n

The Skinny on Weight Loss Supplements<\/strong><\/p>\n

Behind all of the packaging, behind the fantastical claims, what exactly are inside weight loss supplements? What are their most common ingredients?<\/p>\n

Many of the supplements on the pharmacy shelves contain an amalgamation of a variety of ingredients allowed under the Proxmire Amendment. Most commonly, these supplements consist of green tea, caffeine from coffee beans, and a dried powdered fruit called garcinia cambogia, which multiple studies have shown has little to no anti-obesogenic effect compared to placebo.<\/p>\n

\u201cThe evidence that these supplements actually work is quite weak,\u201d said Anne Till, a registered dietician from Chapel Hill, NC. \u201cSometimes supplements haven\u2019t even gone through human studies. Lots of supplements come on the market with claims that are often unsubstantiated.\u201d<\/p>\n

Till goes on to describe how a team of researchers from the Weight Control at Diabetes Research Center at Brown University in Providence, Rhode Island developed the National Weight Control Registry<\/a> which evaluates the diets and habits of individuals who have successfully lost and kept off at least 30 pounds of excess weight for at least one year.<\/p>\n

\u201cWeight loss supplements don\u2019t even really appear in this registry,\u201d said Till. \u201cNo supplement can produce sustained weight loss.\u201d<\/p>\n

Furthermore, it is very difficult to assess how pure these substances are.<\/p>\n

\u201cThere are no laws that say you have to use high-quality materials,\u201d said Cohen. \u201cManufacturers can buy very cheap stuff and put it into pills and sell it. The millions of dollars spent by lobbyists ensure that you can do this.\u201d<\/p>\n

Given these factors, Dr. Scott Kahan, Director of the National Center for Weight and Wellness in Washington, D.C., warns consumers to not rely too heavily on weight loss supplements.<\/p>\n

\u201c[They] say you can lose 40 pounds in a month or 20 pounds in a week,\u201d said Kahan. \u201cThat\u2019s nonsense. I would run.\u201d<\/p>\n

 <\/p>\n

A Safer Alternative<\/strong><\/p>\n

\n
\"Three<\/a>
Data from the World Health Organization. Graphic by Neil Murthy\/MEDILL<\/figcaption><\/figure>\n
\n

But where do we run to?<\/p>\n

\u201cThe answer to sustained weight loss is lifestyle modification with diet with exercise,\u201d said Till. \u201cPeople are always looking for a quick fix, but there is no quick fix.\u201d<\/p>\n

\u201cMost things in life take time and effort and most people want neither,\u201d said Katz. \u201cThis is definitely a case of the tortoise and the hare \u2013 slow and steady wins the race.\u201d<\/p>\n

It\u2019s no surprise that the medical community has touted the benefits of diet and exercise for years.\u00a0 To address the burgeoning obesity epidemic, the American Board of Obesity Medicine was founded in 2011, and there are now 1,182 certified obesity medicine specialists practicing in the United States. Physicians must undergo extensive training where they learn how to help patients lose weight based on scientific principles. Five of these specialists practice in Chicago.<\/p>\n

Dr. Lisa Oldson is an obesity medicine specialist in Evanston who provides scientifically-grounded weight loss strategies to her patients.<\/p>\n

\u201cI follow guidelines that are evidence-based,\u201d said Oldson. \u201cI go to their homes, open cabinets and read labels. I take them to grocery stores and help them with their shopping carts. I can get a patient to a much healthier place with the scientific tools we have today.\u201d<\/p>\n

One of the patients Oldson counsels is Whitney, who began working with the doctor a year and a half ago. Since starting her sessions with Oldson, Whitney said that she harbors a holistic approach to the process of weight loss\u2014emphasizing the small everyday victories of lifestyle modification, rather than obsessing over the numbers on the weight scale.<\/p>\n

\u201cI feel hopeful with Dr. Oldson. She makes me feel accountable. She has completely reshaped my thinking,\u201d she said.<\/p>\n

Whitney takes great pride in never having tried a weight loss supplement and admits that she never will.<\/p>\n

\u201cFor me, supplements feed into disordered thinking,\u201d said Whitney. \u201cI am not in it for the short term. I\u2019m a mom, a wife and I\u2019m active and I want to stay that way. For me, being healthy is a lifestyle.\u201d<\/p>\n

Photo at top: Over the counter weight loss supplements line the shelves at pharmacies, grocieries and many other stores. (Neil Murthy\/MEDILL)<\/p>\n","protected":false},"excerpt":{"rendered":"

By Neil Murthy Meet Whitney\u2014a 42-year-old wife and a mother living on the North Shore.\u00a0 Her favorite pastimes include performing in musical theater, actively participating in her child\u2019s PTA, volunteering with various local charity organizations and mentoring her 7-year-old daughter\u2019s busy round of school, homework and sports. She is also on a decades-long quest to […]<\/p>\n","protected":false},"author":269,"featured_media":42573,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[27,29,2582],"tags":[61,2858,1131,107,192,2856,2857,2855],"class_list":["post-42563","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-business","category-health-and-science","category-spring-2016","tag-chicago","tag-dietary","tag-fda","tag-health","tag-promo","tag-supplement","tag-supplements","tag-weight-loss"],"yoast_head":"\nThe deal with diet pills\u2014Weight loss supplements remain a 'Wild West' - Medill Reports Chicago<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/news.medill.northwestern.edu\/chicago\/the-deal-with-diet-pills-weight-loss-supplements-remain-a-wild-west\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The deal with diet pills\u2014Weight loss supplements remain a 'Wild West' - Medill Reports Chicago\" \/>\n<meta property=\"og:description\" content=\"By Neil Murthy Meet Whitney\u2014a 42-year-old wife and a mother living on the North Shore.\u00a0 Her favorite pastimes include performing in musical theater, actively participating in her child\u2019s PTA, volunteering with various local charity organizations and mentoring her 7-year-old daughter\u2019s busy round of school, homework and sports. 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