WHILE WEIGHT LOSS potions and gizmos have been in existence since the 1800s, the modern day weight loss business has ballooned into a multi-billion-dollar industry. It is impacting individuals' health negatively, promoting social stigma and discrimination against fat people, and generating unconscionable conflicts of interest among public health policymakers. For years, the commercial weight loss industry was largely unregulated. Only recently, due to Congressional pressure, have the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) begun to enforce existing regulations. These are narrow in scope, however, and it seems clear that more drastic measures must be taken to protect public health.
In his book, Never Satisfied: A Cultural History of Diets, Fantasies, and Fat, Hillel Schwartz traces the early days of the weight loss industry, a succession of 19th-century remedies for fatness ranging from mechanical horses to galvanic belts to specific eating strategies and the myriad of diet foods, drugs, reducing products, and publications available in the 1980s. He writes that the handful of published pieces on weight loss in the late 18th century is "afar cry from the 6,397 technical works on obesity published between 1964 and 1979; a far cry from the 300 diet books in print in the United States in 1984; a far cry from the average of 1.25 dieting articles per issue in the Ladies Home Journal, Good Housekeeping, and Harper's Bazaar between 1980 and 1984, or the 66 articles on dieting that appeared in 22 contemporary magazines in January of 1980."
Indeed, by 1990, the revenues of the commercial weight loss industry totaled more than $30,000,000,000. According to Marketdata Enterprises, $8,000,000,000 was spent on diet centers and programs; group and individual weight loss; diet camps; prepackaged foods; over-the-counter and prescription drugs; weight loss books and magazines; and physicians, nurses, nutritionists, and other professionals specializing in weight loss. Commercial and residential exercise clubs with weight loss programs brought in an additional $8,000,000,000, and revenues from sugar-free, fat-free, and reduced-calorie food products, imitation fats, and sugar substitutes amounted to more than $14,000,000,000.
It is no coincidence that the commercial weight loss industry has become a fixture in U.S. society and that its messages have colored the way most Americans view themselves and others. In his book, Lifespan, Thomas Moore makes the connection between the evolution of obesity as a disease needing treatment and the economic interests of major players in the field. As evidence, he points to the 1985 National Institutes of Health (NIH) consensus conference, which not only proclaimed obesity a "killer disease," but arbitrarily redefined it in such a way as to affect millions more Americans. This redefinition and the call to arms for treatment translated into billions of additional dollars of research money, commercial weight loss industry profits, and physicians' revenues.
Moore revealed that leading obesity researchers had an enormous economic stake in seeing expanded forms of obesity treatment applied to more Americans. Theodore Van Itallie, chairman of the NIH consensus conference planning committee and a researcher at Columbia University. was a paid consultant to United Weight Control. George Blackburn and Thomas Wadden, considered to be leading authorities in obesity research, were on the payroll of Sandoz, the makers of Optifast, a liquid diet product.
This conflict of interest continues, with commercial weight loss and pharmaceutical firms underwriting a significant number of obesity studies. Obesity researchers' professional conferences routinely are funded by commercial interests. The 1991 conference of the North American Association for the Study of Obesity was underwritten by no less than 18 diet companies, pharmaceutical firms, and manufacturers of diet foods, including Sandoz, Weight Watchers, Eli Lilly, Jenny Craig, Nutri/Systems, Upjohn, and Hoffman-LaRoche. Welcoming packets at such conferences often include products from these companies, and, more often than not, sponsors' prepackaged diet foods are served during conference breaks. Moore writes, "It turns out that most [medical obesity experts] are either consultants to the major companies, conducting research for these companies, presenting their results at conferences sponsored by these companies, or sometimes all three."
While weight loss diets and products long have been promoted as a permanent cure for obesity, they rarely produce long-lasting results. According to medical research, fewer than five percent of all dieters succeed in losing a significant amount of weight and maintaining that loss over a five-year period. Ninety percent of all dieters regain some or all of the weight originally lost, and at least one-third gain more. An increasing amount of research has substantiated these failure rates and acknowledged genetic and physiological factors in the determination of body size.
Diet promoters emphasize the supposed health benefits and minimize risks related to dieting. People of all sizes are being misled about the extent and severity of the health risks associated with being fat and are told that being thin is the only way to good health and that dieting makes people thin. Many medical conditions traditionally attributed to obesity -- such as high blood pressure, elevated cholesterol, and heart and gallbladder problems -- often can be caused by the dieting process itself. Recent studies indicate that repeated "yo-yo" dieting may reduce one's lifespan.
These findings, which validate the experiences of fat people who have spent years resisting their body's natural predisposition and have struggled harder to lose weight, have had a dramatic impact on the obesity research community. If, indeed, diets don't work, what options are available to researchers who have depended on diet industry funding and who have dedicated their lives to answering the question, "How can we make fat people thin?"
A natural paradigm shift for obesity researchers would be to discard attempts to make fat people thin and focus on finding ways to maintain and improve their health. Such a shift has not occurred, though. Instead, scientists are hearkening back to the 1960s and 1970s, when diet pills were the rage. Researchers are positioning obesity next to hypertension, as a chronic disease requiring lifelong treatment, even though there is no evidence that obesity significantly decreases longevity. Further, there is no evidence that the deleterious effects of lifelong diet drugs justifies the slight, if permanent, weight loss. Nevertheless, jumping onto the pharmaceutical bandwagon by studying and prescribing phentermine and fenfluramine, researchers once again are assured of deep pockets for further studies and conference sponsorships.
In listening to diet and weight loss promoters hawking their programs and products, one would think that permanent thinness is just a phone call or purchase away. If consumers believe the commercial weight loss industry, as most dieters do, a person need only to take a pill, wear a body suit, buy a prepackaged food plan, or go to weekly meetings to look like a fashion model. As evidence of the ease of the process, weight loss hucksters make wide-ranging claims about the safety, effectiveness, and permanence of their programs and products.
Historically, the government looked the other way, rarely enforcing what few regulations could be applied to a business that had no industry standards or laws governing its operations. It wasn't until 1990, when Rep. Ron Wyden (D.-Ore.) convened hearings on the diet industry through the Subcommittee on Regulation, Business Opportunities, and Energy, that the spotlight began to shine on the omnipresent deception and fraud and the government's lack of action.
During the Congressional hearings, the FDA, FTC, Federal Communications Commission, and the Attorney General were taken to task for their laxity in enforcing existing regulations. Once the heat was turned up, the FDA investigated and banned 111 ingredients from over-the-counter diet pills, ruling them ineffective or potentially harmful, and cracked down on a wide range of products. However, it did not take a strong stance against phenyl-propanolamine (PPA) or benzocaine, two widely used ingredients in diet products.
Culminating a three-year investigation in the fall of 1993. the Federal Trade Commission charged five of the nation's largest commercial diet programs -- Nutri/System, Jenny Craig, Weight Watchers, Physicians Weight Loss Centers, and Diet Center -- with engaging in deceptive advertising by making unsubstantiated weight loss and weight loss maintenance claims, and by using consumer testimonials without proof that they represented the typical experience of the dieters on the programs. Allegations in some of the cases also addressed deceptive pricing, comparative superiority, rate of weight loss, or safety-related claims.
Jenny Craig and Weight Watchers are fighting the FTC charges. while Nutri/System, Diet Center, and Physicians Weight Loss Centers assented to settle under proposed consent agreements that include several provisions similar to those the FTC is seeking in litigation with the other two companies. These would prohibit the companies from misrepresenting the performance or safety of any weight loss program they offer in the future and would require them to have scientific data to back up future claims they make about weight loss and maintenance. Moreover, the FTC set out standards for the type of evidence that would be required to support various maintenance claims. For instance, statements that weight loss is maintained over the long term would have to be based on evidence of consumers followed for at least two years.
In addition, maintenance success claims in most ads would have to be accompanied by various clear and prominent disclosures, including the statement, "For many dieters, weight loss is temporary," as well as disclosures about the average weight loss maintenance for consumers on the relevant program. The disclosure as to average maintenance would not be required in broadcast ads of 30 seconds or shorter. However, the orders and settlements still would require those ads clearly to state, "For many dieters, weight loss is temporary," and that consumers should check with the companies for details about their maintenance records. They would be required to give potential consumers a written document containing maintenance data.
Moreover, the FTC's proposed orders and settlements would require any testimonials the respondents use to represent the results customers generally achieve, unless the companies also clearly and prominently disclose either the generally expected results or a statement such as, "his result is not typical. You may be less successful."
Financial woes
The combination of the findings of the
inefficacy of dieting, increased government regulations, and downturn economy have left commercial diet companies
scrambling. Compounding Nutri/System's
problems with the FTC investigation was
an action taken in the spring of 1993 by a
group of seven creditor banks to take control of the firm's bank accounts and seize
their cash. forcing Nutri/System to close
its 283 company-owned centers and lay off
1,800 employees. Shortly thereafter, the
Jenny Craig weight loss plan engaged in
what could be termed diet cannibalism,
placing ads to attract former Nutri/System
clients, offering to honor the unfulfilled
portions of their memberships.
In 1992, Jason Pharmaceuticals, makers of Medifast, agreed to a cease-and-desist order from the FTC that restricted the claims it could make in its advertising. Since that time, at least six product liability claims have been filed against the firm by dieters claiming problems ranging from gallstones to gangrene. In addition, two former employees are suing Jason, one claiming sexual harassment and the other alleging breach of contract. In the wake of these events, Jason petitioned a Federal bankruptcy court for protection from creditors while the company reorganizes.
Jenny Craig also is having a rough time, as sales and earnings have fallen. Even with this decline, the FTC charges, and an agreement with the Minnesota Attorney General to stop misrepresenting statistics that implied that 93% of its customers permanently lost weight, the chain continues to open outlets.
Despite government enforcement, there is no doubt that the commercial weight loss industry will continue to prey on consumers and reap enormous profits. This is because the diet industry's advertising and marketing strategy is based on the creation and perpetuation of fear, biases, and stereotypes. Overweight persons are portrayed as unhealthy, unattractive, asexual, weak-willed, lazy, and gluttonous. Weight loss or a thin figure are equated with virtue, health. and success. Failure to participate in dieting or lack of success in losing weight are blamed on a lack of willpower, determination, or moral values. Fat people are taught to feel guilty and blame themselves for the failures of weight loss programs, and to expect and accept rejection, mistreatment, and discrimination regarding their weight. This negative image has a devastating impact on millions of fat people, as such messages lower their self-esteem and foster discontent, self-doubt, and self-hatred. especially during the weight regain phase of the dieting yo-yo cycle.
Because the diet industry preys on the low self-esteem and negative body image of both fat and average-size Americans, it will continue to profit, regardless of the caveats required by government regulation. Because consumers will continue to be seduced by advertising that sells them on dissatisfaction with their bodies, bolder steps must be taken.
Because of the biases of the medical community and the difficulty in isolating causes of death, fatalities caused by dieting often mistakenly are blamed on obesity. If doctors report deaths of known dieters, products or programs that are especially dangerous can be discovered sooner. To this end,the Centers for Disease Control should track the incidence of deaths of people who have followed a diet or used diet drugs or products within a year of their demise.
In order for consumers to make informed decisions about weight loss dieting and to help to end the social stigma and discrimination against fat people, a Federal labeling and advertising act that would ban radio and television commercials for weight loss diets and products should be enacted, similar to the 1971 Federal Cigarette Labelling and Advertising Act. In addition. warnings of a diet product's long-term ineffectiveness and possible health risks should be displayed clearly on all products, similar to the Surgeon General's warnings on cigarette packaging.
Government officials must take action. First, they must separate out the cultural bias against fat and the facts about obesity. Second. they must unravel the conflicts of interest that exist between the commercial weight loss industry and the obesity research community, members of which also serve as public health policymakers. Third, they must enact and enforce laws and regulations to protect both the public health and consumers' pocketbooks.
Ms. Smith is executive director, National Association to Advance Fat Acceptance, Sacramento, Calif.
