"Lose 10.65 pounds fast!"
Such screaming advertisements are common in many parts of the world and thousands of overweight and obese Canadians fall for them. But the concern is that there are few regulations to govern this booming industry in Canada and not enough people to enforce the ones that exist.
Weight loss is a desperate battle for many of the 20 million overweight and obese Canadians. The struggle to drop pounds often pushes people toward the $40 billion weight-loss industry, where they can get lost in the maze of programs and products that promise to melt away the extra fat.
Overweight people are at high risk of dying from type 2 diabetes, heart disease and stroke. Obesity is now the No. 2 cause of preventable death in Canada, with roughly 25,000 people dying from weight-related illnesses every year, compared with 48,000 from smoking.
Predictably it is boom time for weight loss companies, with all its attendant risks.
In a famous case, the Herbal Magic Systems, a diet company settled out of court a suit against it for over three million dollars. In the documents filed with the court case, the patient's family alleged the Herbal Magic weight-loss program caused Jane's potassium levels to plummet, a condition called hypokalemia, which in turn triggered the cardiac arrest.
Herbal Magic is currently Canada's largest chain of weight-loss centres with more than 350 outlets. The first opened in London, Ont., in 1996 and the company serves about 40,000 customers per year. It has promoted a "lifestyle-based diet combined with herbal supplements and grocery store bought food," for the past decade with few complaints.
An estimated 20 per cent of Canadians regularly use natural remedies because they believe they are safer than man-made pharmaceuticals, according to David Bailey, a clinical pharmacologist at the University of Western Ontario.
In the circumstances experts are calling for more stringent regulations to protect Canadians. They say the vast majority of weight-loss programs and products on the market are not effective, and warn that many are unsafe.
Right now, anybody can set up a weight-loss centre and sell almost anything they want, says Arya Sharma, a professor of medicine at McMaster University who holds a Canada Research Chair in cardiovascular obesity research and management.
"Treating the disease has to be up to (health) professionals, not up to people who could be selling a scam or selling products that are dubious in terms of safety," he said.
Many of the active ingredients in over-the-counter weight-loss supplements are derived from plants, minerals and other natural sources, and range from aloe to licorice, crustacean shells to the mineral chromium picolinate. Although many people assume natural means safe, the products can have drug-like properties and cause serious health problems. But unlike pharmaceuticals, natural weight-loss remedies don't have to go through rigorous clinical trials to prove they are safe and effective before hitting stores.
One of the most popular - and dangerous - weight-loss supplements in the early 2000s relied on chemicals in a shrub native to China and Mongolia. Ephedra sinica, or Ma huang in Chinese, contains ephedra alkaloids that, when combined with caffeine, caused weight loss.
Consumers clamoured for the heavily advertised supplement, but scientists only found out about its associated health problems after it was on the market. Ephedra has been shown to increase the risk of high blood pressure, seizures, heart attack and stroke. In the U.S., in one two-year period, the Federal Drug Administration received 87 reports of ephedra causing adverse health events. Ten of those led to death and 13 to permanent disability.
Health Canada, which banned ephedra weight-loss products in 2001, is charged with overseeing elements of the weight-loss industry.
It tries to keep up with new products through its Natural Health Products Directorate. Products that meet the agency's criteria for safety, efficacy and quality get a licence and an eight-digit Natural Product Number. All 50,000 natural health products for sale in Canada must have an NPN by 2010.
But as of April 20, only 3,203 natural health products had been licensed by Health Canada, said a spokesperson.
Many of these are likely single-ingredient products and not multiple-ingredient weight-loss supplements, says Heather Boon, associate professor of pharmacy at the University of Toronto and an expert in natural health products.
Boon advises consumers to check with their pharmacist before buying any herbal supplement without an NPN, especially if they take multiple herbs or prescription medications.
Natural weight-loss supplements and over-the-counter diet remedies make up the largest portion of the weight-loss industry. Health Canada launched the Natural Health Products Directorate on Jan. 1, 2004 to make sure all natural health products sold in Canada are reviewed for quality, safety and efficacy. But critics say the review process isn't stringent enough. York University health policy expert Joel Lexchin says over-the-counter medications should receive the same scrutiny as prescription drugs, whose manufacturers have to submit reams of scientific data, including rigorous human trials, to prove a potential drug is safe.
In a 2004 study, Robert Saper, director of integrative medicine at Boston University Medical Center, found none of the 26 most common ingredients in over-the-counter weight-loss supplements, including green tea, chromium, and guar gum, met acceptable criteria for safety and efficacy. He also said companies skirted the ephedra ban by using related chemicals, such as those found in bitter orange plants, which can also cause cardiovascular problems.
Any obesity drug - either prescription or over-the-counter - that doesn't prevent or reduce a person's risk of developing the health problems associated with the disease, including Type 2 diabetes, heart disease and stroke, shouldn't be sold, says York University's Lexchin.
"They are garbage. They are not effective," he said. "If something is not effective, and it is not 100 per cent safe - and nothing is 100 per cent safe - there are no grounds for keeping it on the market."