Losing weight - Association pour la santé publique du Québec

Transcription

The Association pour la santé publique du Québec (ASPQ) is an autonomous non-profit public health
organization, which contributes to the promotion, development and maintenance of the health and
well-being of the Québec population.
Cataloging data previous to publication
Guidebook aimed at health professionals
Lose weight for better not worse
Includes bibliographical references
1. Obesity 2. Weight control 3. Weight loss methods 4. Public health
This guidebook was developed by the Association pour la santé publique du Québec in collaboration
with the Institut national de santé publique du Québec.
This document’s publication was made possible thanks to the financial contribution of Health Canada
within the Prevention and Promotion Program of the Canadian Diabetes Strategy. The views herein
expressed do not necessarily reflect Health Canada’s official position.
Authors:
• Lyne Mongeau, Institut national de santé publique du Québec
• Mireille Vennes, Association pour la santé publique du Québec
• Véronique Sauriol, Association pour la santé publique du Québec
The reading committee significantly contributed to the writing of this guidebook, and the thoughtful
comments of its members improved the text. The following persons were members of the reading
committee:
• Diane Côté, Dt. p, présidente du Collectif action alternative en obésité
• Odette Côté, B.Sc., kinésiologie
• Harold Dion, MD CCMF FCMF, Président du conseil d’administration,
Collège québécois des médecins de famille
• Éveline Hudon, MD M. Cl. Sc.
• Marie-Ève Turcotte, B. pharm.
• Angèle Venne, Inf. B.Sc.
We also wish to thank the following organizations and individuals for their collaboration to
this guidebook:
• Johanne Laguë, Institut national de santé publique du Québec
• Richard Chevalier, Collège de Bois-de-Boulogne, journal La Presse
• Julie Trudel, Institut national de santé publique du Québec
• Valérie Blain, Association pour la santé publique du Québec
Graphic design: Studiométrique (www.studiometrique.com)
ISBN 2-920202-44-8
Legal deposit
Bibliothèque nationale du Québec
Library and Archives Canada
All rights reserved, Printed in Canada
© ASPQ Éditions
Association pour la santé publique du Québec
4126, rue St-Denis, bureau 200, Montréal, Québec, H2W 2M5
Telephone: (514) 528-5811 / Fax: (514) 528-5590
info@aspq.org / www.aspq.org
Table of Contents
Introduction Section 1: What you need to know about weight and weight loss
Weight and health The ABCs of slimming down
Consequences of various weight-loss methods
Losing weight is not to be taken lightly Learn what it takes to act smart
Section 2: A look at weight-loss methods
A look at weight-loss methods: criteria and results Five points about weight-loss methods
Section 3: A detailed look at weight-loss methods
Descriptions of weight-loss methods Conclusion
Section 4: Additional information
A quick overview of weight-loss methods Ingredients found in weight-loss products
Costs of weight-loss methods and comparison
with a consultation with a health care professional
Methodology Resources
References Losing weight: for better, not worse
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57
Introduction
It is common knowledge that obesity and excess weight are on the rise in our
population and our health is being threatened. However, many people, especially
women, do not need to lose weight and are striving to conform to one prescribed
notion of beauty.
While some of these people are trying to lose weight for the first time, many have
already tried on their own or with the help of available methods. And there is no
shortage of weight-loss products, services and methods (WLPSM) available in
Québec! To paint a clearer picture of the current situation, in 2003 the Association pour la santé publique du Québec (ASPQ) and its partners conducted a
comprehensive analysis on WLPSMs. For the purpose of this analysis, WLPSMs
were defined as products (natural products, over-the-counter medication,
meal replacements, etc.), services (weight-loss programs and centres, etc.) and
methods (diets, fasting, etc.) designed for weight loss. Medical and nutritional
interventions regulated by a professional order, including anorexiants (appetite suppressants) prescribed by doctors and personal weight-control practices (watching
intake of fat and sugar, exercising, etc.), were not included in the study.
In this analysis, WLPSMs were inventoried, defined in great detail and assessed
according to criteria from scientific documents that were validated by a panel of
experts from Québec. These established the requirements for several dimensions
of healthy weight loss. The general finding from this analysis is that the majority
of WLPSMs do not meet many of the weight-loss criteria. Consequently, it
is not appropriate to recommend their use for the population in general; however,
a few could be used as adjutant to weight control interventions by some individuals under the supervision of a competent professional. In order to help health care
professionals find their way through the maze of WLPSMs, the ASPQ and the
Institut national de santé publique du Québec (INSPQ) joined forces to produce
this reference guide. It contains helpful, accurate and up-to-date information for
professionals so they can help their clients make informed decisions.
Although this guide is not a reference book on how to counsel people controlling
their weight, it outlines the basic principles in helping clients make safe and
responsible weight-control choices. In addition to the key concepts of weight
loss and information on WLPSMs, you’ll find suggestions on further reading and
on other resources to shed new light on the choices available to people who are
concerned about their weight.
Losing weight: for better, not worse
Clearly, weight is a health determinant. A body mass index (BMI) between 18.5
and 24.9 kg/m2 is considered an normal weight. Beside weight, many factors
determine a person’s health. The Canadian Guidelines for Body Weight Classification in Adults1 state that in the individual, the estimation of an individual’s health
risk should not be based on measures of body weight and waist measurement
alone. Weight is therefore only one part of the picture. When BMI is higher than
25 kg/m2 and waist circumference above the risk threshold losing weight may
be beneficial for health. The result shouldn’t, however, be counterproductive, and methods should not be harmful (see The ABCs of losing weight and
Consequences of WLPSMs). Would it not be paradoxical to damage health while
trying to improve it?
SECTION 1 : What you need to know
about weight and weight loss
Weight and health
Because body image is an important part of our culture, many people tend to
attach too much importance to weight and forget lifestyle habits and other
determinants of health. Losing weight is not the only way to obtain better health:
quitting smoking and managing stress are also great ways to become healthier.
Eating less fat and starting walking, even in the absence of weight loss have the
potential to improve health. Additionally, some studies show that clients aim to
lose 20 to 30%3,4 of their initial weight, which is not realistic from metabolic and
behavioural standpoints. More importantly, this amount is far more weight than
necessary to obtain health improvements. Recent scientific studies show that
health can improve as a result of a moderate and maintained weight loss
of 5-10% of the initial weight.5 Pursuing unrealistic weight-loss goals has been
shown to lead to failure and discouragement6, partly because the weight-loss goal
becomes a fixed idea. If clients cannot be persuaded to set realistic weight-loss
goals compatible with health improvements, they run the risk of frequently changing diet methods and getting caught in a dieting cycle.
Obviously health improvements will be maintained only if the lost weight is not
regained. There is not much point in encouraging weight loss if a professional
evaluates that a client will not be able to maintain the new weight. The choice of
changes to put into place must take into consideration how long new habits can
be maintained. Professionals should also ensure that methods will result in
a loss of fat, and not water or muscle mass. In order to avoid these negative
consequences, the choice of method is again essential.
Explaining these issues to clients should help reduce their desire to lose weight
rapidly and in large amounts. It is essential to clearly explain the relationship
between weight and health to clients who come for a weight-loss consultation. The following diagram (Figure 1), which is easily explained, can help put
things into perspective. Clients will be interested to know that the relationship between changes in diet, being physically active, losing weight and increasing health
is not linear. Scientific studies of the last several years have shown that weight is
not necessarily the most important element of the lifestyle-weight-health triad.
Lifestyle
Health
Weight
Figure 1 – Lifestyle, weight and health connections
Rethinking old ideas
Firstly, more than a person’s weight, localization of excess fat is a major determinant of health risk.1 Thus, many women who have heavier hips, thighs and
buttocks wish to slim down to meet certain beauty standards, but this perceived
excess weight does not represent a health risk.
Secondly, as shown in Figure 1, lifestyles alone can have a direct impact
on health regardless of weight. Recent large-scale cohort studies on men and
women have shown that being physically active markedly reduced the risk of serious illness linked to obesity (Type II diabetes, high blood pressure, cardiovascular
disease and some cancers), regardless of the BMI.7,8
Along the same lines, a recent meta-analysis came to the following conclusions:
1) regular physical activity markedly reduces health risks associated with excess
weight and obesity; 2) obese persons who are physically active can reduce their
risk to the extent that their morbidity and mortality rates are lower than that of men
of normal weight who are sedentary; 3) a sedentary lifestyle and low cardiorespiratory fitness are just as important as excess weight and obesity in predicting mortality.9 The hypothesis that a healthy diet also reduces risks associated with obesity has
been verified in fewer large-scale studies.
Ultimately, weight regulation depends on several factors: physiological
mechanisms and compensatory behavioural reactions, modification of
muscle mass, etc. The reading on the bathroom scale does not always tell the
whole story. Viewing weight loss as the only indicator of success can lead to negative effects. For health practitioners, a lack of weight-loss success in clients can
reduce work satisfaction and lead to reduced interest in weight control counselling
in the long term. For clients who do not experience significant weight loss, efforts
made to change their diet and level of physical activity may be seen as sterile,
even as a complete failure. From a behavioural and psychological perspective, the
absence of results in terms of weight-loss acts as negative reinforcement. Enough
for one to be discouraged for a long time.
By focusing on health results, improved quality of life and on the change
process instead of measuring results only in terms of weight lost,
health-care professionals can help people feel better about the investment
they have made in their health. They will be less attracted to WLPSM
and their promises.
The ABCs of weight loss
Weight generally remains stable when the following equation is balanced:
amount eaten = energy spent
Weight loss occurs in an energy deficit that can be brought about in
three different ways:
1. Solely by increasing the amount of energy spent while maintaining
the amount of food consumed
2. Solely by reducing the amount of food consumed while maintaining
the amount of energy spent
3. By using both strategies and reducing the amount of food consumed
while increasing the amount of energy spent.
Although the first solution is the best, it is not very realistic for many people. The amount of physical activity required to lose weight is very high and must
be done frequently. This requires a lot of effort and many people cannot keep up.
Solution 2 is the most popular, because it is perceived to be easier to restrict
food intake. Solution 3 is optimal, because it promotes better maintenance of
muscle mass and does not require as stringent a restriction in food intake.
WLPSM promoters look less favourably on solutions 1 and 3 because the
concept of effort is harder to sell. They therefore resort to solution 2 or, in order
to bring about results in a majority of persons, they rely on various strategies that
require significant energy restriction that is not initially apparent. Initially, regardless
of its extent, energy restriction will almost always lead to weight loss as
glycogen stores are used up. Subsequently, strict energy restriction can also
result in significant weight loss, but the body may lose water and muscle mass in
addition to the desired loss of fat.10
Other than energy restriction, a balance of macro-nutrients (proteins, carbohydrates and fats) in the diet is also very important during weight loss. A
low carbohydrate diet is likely to cause higher water and muscle mass loss than
other types of WLPSM. This can be explained as follows: some tissue, especially
the brain and neurons, need carbohydrates to function. When they are deprived,
they use stored carbohydrates, but the body doesn’t store much carbohydrate,
and when these have been used up the muscles become a source of carbohydrates (after undergoing a transformation). Unfortunately (!) fat stores cannot supply much carbohydrate. A professional should always ensure that a moderate energy restriction is used and that macro-nutrient intake is balanced.
Even if weight loss can benefit some people, the body interprets restriction as a
threat, a violation of its homeostasis. The more energy is restricted, the harder
the body fights back. Paradoxically, the body protects its fat reserves and uses
its muscles as back-up energy. Loss of muscle mass brings about water loss
and reduces basal metabolism because muscles burn a lot of energy.10 A diet of
fewer than 1000 calories can result in a 20% loss in muscle mass within just a few
weeks.11 Even losing just a half kilogram of muscle slows down one’s metabolism.12
Health professionals should steer clear of muscle mass reduction in their clients,
because a person with small muscle mass has a higher likelihood of gaining
weight later.13,14
What is a moderate restriction?
To appropriately determine a client’s energy restriction, there is only one
method: the starting point must be known, i.e. usual energy intake.15 Such
an assessment is the work of a professional, such as a dietician. No WLPSM begins with an assessment of a person’s usual food intake – the majority are based
on a fixed energy level. Because of this, commercial weight-loss programs
deemed acceptable, even recommended by many professionals, may
induce a significant energy restriction. For example, a program recommending
1200 kcal/day may seem completely safe. But for a person who usually takes in
2400, this is a 50% reduction that is significant enough to offset the metabolism’s
defence mode.
What’s more, consuming 800 to 1200 kcal/day is less than what the majority of
healthy adults need16, and this will likely harm normal functioning. Unfortunately,
the consequences of differential levels of energy restriction are not fully
known, there are also many factors that come into play, and there have not been
enough studies to be adequately informed. In any case, it is wise to limit the difference between energy spent and energy consumed to between 500 and 700
kcal/day.17
Consequences
of various weight-loss methods
There are some harmful physical, behavioural and psychological consequences associated with WLPSMs. Instances of short- and long-term physical consequences
have been documented, varying from minor impacts to death. Consequences
depend on many things, including the length, nature, method and degree
of restriction imposed.18 Short-term consequences such as constipation or
diarrhea, low blood pressure, headaches, dizziness, intolerance to cold, muscle
cramps, hair loss, etc.19,20,21 may be considered minor if the therapy is used occasionally and is short term. But when losing weight becomes a lifestyle, as it is
for some people, as benign as the physical manifestations may be, they affect
productivity.22 Arrhythmia (irregular heartbeat), heart attacks and electrolyte imbalances have been associated with very low calorie diets.18 For more than 25 years,
death has even been linked to these diets.20 More recently, in the early 1980s, six
deaths were reported with the Cambridge liquid diet.20
Weight loss and cognitive restriction23 (replacing eating habits that are regulated
by internal bodily needs by ones that are planned and set according to cognitive
criteria, or modeled on set diets, or even an overall reduced food intake) are also
associated with a reduction of bone mass, which can increase risk of osteoporosis.24,25,26 Cognitive restriction has also been linked to the development of menstrual cycle disorders.27,28,29 Gallstone formation is a known risk of restricted diets
that result in a weight loss of more than 1.5 kilograms per week.18
Beyond physical consequences, there are numerous psychological barriers
linked to a preoccupation with weight that prevent the adoption of healthy
lifestyles. Fear of weight gain is just one of the reasons why people choose to
continue smoking or keep other negative habits.30 Studies have shown that anxiety
about being judged on one’s body can stop people from exercising.31,32,33,34 However, others argue that being preoccupied with one’s weight can be a motivator to
control weight, and is therefore beneficial. Some studies have actually shown that
people trying to lose weight exhibit a better nutritional profile.35,36 The topic is still
rather controversial – although some people benefit from being preoccupied with
their weight, when the distress associated with body image increases its tends to
bring about negative consequences.37
Restricting energy intake commands important behavioural modifications.
Eating 500 to 700 kcal per day less than usual involves significant changes in a
person’s behaviour. If intake is further reduced, greater is food limitation, creating
obsessions and associated reactions (depression, irritability, anxiety, anti-social
behaviour, mood swings, poor self-image, etc.).38,39,40,41 By paying attention to the
body’s outer signals, people can become more and more cognitive eaters which
changes their way of seeing food.42 Frequent dieting can lead to the development
of eating disorders, especially compulsive eating. 38,39,43,44,45
Finally, users of WLPSMs often have a high chance of regaining weight
previously lost and to experience failure. Failing one’s attempt to lose weight
over and over again can result in lowered self-esteem, self-confidence and a feeling of powerlessness. Health care professionals should not downplay any feelings
of shame or guilt in persons who have failed to gain control of their weight.46,47,48,49
Losing weight is not to be taken lightly
The previous pages clearly show that having a normal and stable weight is a
major part of being healthy. But it is also clear that losing weight at any price is not
recommended. However, the importance of weight loss is often overlooked as it
is often thought of as commonplace. Weight loss is discussed everywhere, with
anybody. It doesn’t help that WLPSMs are now so widely accessible and advertised at prime time and seen in newspapers and popular magazines, which makes
them ubiquitous in people’s lives. Claims of instant weight loss without mention of
negative side effects only make them more attractive.
What’s more, without safeguards, recommendations or regulation by authorities
and health care professionals, the population is indirectly told that WLPSMs are an
easy and effortless way to end obesity and achieve the “perfect” body. As a result,
overweight people may feel increasingly guilty and under pressure as WLPSMs are
made more accessible, because the misconception will be that they failed to use
the apparently easy and available solutions.
The lack of thought given to weight loss, weight-loss products and advertising has contributed to making them simple consumer goods, without
much consequence other than on one’s wallet. However, when weight loss
upsets a body’s balance we are no longer talking about economic consumption.
Some people become ill after taking a weight-loss product – this is not something
to ignore – and unfortunately side effects of WLPSMs often remain unknown because many people think that they have failed and are uncomfortable talking
about it. The fact that no one complains does nothing to help control the weightloss industry.
10
Within this context, recommendations on weight loss from health-care professionals can be made too hastily: a reflex suggestion to join a program or go on a
popular diet without taking time to spell out the pros and cons. Similarly, a professional who does not dissuade a client who is keen to use a WLPSM can be seen
as giving approval.
The effectiveness of weight-loss methods and their possible harmful side effects
forces professionals to assess how they can truly help their clients. First, approach the situation with seriousness. Weight issues constitute a very complex
and heterogeneous condition. The increase in our population’s weight can
be explained by our sedentary lifestyle and poor diets. Although these two
factors might explain obesity in a person who consults a professional,
they represent only two of the many possible causes. In fact, a clinician who
meets an obese or overweight person will make a more complete analysis of the
situation by looking at all appropriate causal factors. (Figure 2).
Understand to better counsel
Biology
heredity, glands, illness, taking medication, metabolic upset associated with quitting
smoking and the yoyo syndrome, gender, age and race
dyweight
Bo
e a ti n g
Selfimage
ctivity
al a
sic
Habits and family life
eating and exercising habits, family
dynamics, parents’ preoccupation
with their weight
hab
it s
ph
y
Sociocultural aspects
standards of beauty, environment,
type of employment, socioeconomic
status, support, encouragement
or pressure
Personal aspects
perfectionism, low esteem and self-affirmation, difficulty expressing
oneself, poor body image, anxiety, stress, secondary gains
from being obese
Figure 2- Range of factors causing excess weight and obesity in individuals
Source: CAAO 2003
Using this list, the professional and his or her client will together make a more
thorough analysis of possible causes. Following this, it is a good idea to divide
what can be changed from what cannot, then to establish the importance
of each proposed change. When possible, it is better to act on causes of weight
gain. For example, a person who gained a lot of weight because of a change in
employment would need to recognize what specific changes brought about the
weight gain, and then find ways to adapt. This approach has more staying power
than a popular diet that does not take any causal factors into consideration.
On the other hand, it would be difficult to act on causes for a weight gain that
occurs after quitting smoking, unless it is clearly linked to compensation by eating
more. It is basically impossible to find causes in the case of a person with a normal
weight who wants to slim down. The intervention could include an explanation of
the connection between weight and health, a person’s biology and natural ability to
control weight and should try to determine if the person needs help reviewing his
or her body image.
11
Finally, for a person whose causes for weight gain include serious and ingrained
psychosocial factors (history of abuse, secondary gains of being obese, emotional
deprivation, etc.), the analysis must include the effort necessary to achieve the
goals. Simply improving lifestyle and habits without a goal to lose weight may be
more realistic and beneficial overall.
Why does your client want to lose weight?
In 1998, 88% of overweight women in Québec stated that their desire to lose
weight was to “improve their appearance” versus 82% who “wanted to be healthier”.50 Aesthetic motivation is dominant for normal weight or underweight
women. Besides beauty and health reasons, weight loss can be motivated by a
desire to reach other goals, such as improving self-confidence, increasing attractiveness, capacity to affirm yourself, or because a person does not believe him or
herself capable of something in particular unless weight loss has been achieved.5
These expectations are fed by the idea we see in the media and in ads whose
message is that thin equals youth, success and competency. In general, weight
loss alone is not likely to transform anyone. A person will notice this too when
they fail to reach their goals. Not getting the expected benefits is another reason
why people fail to keep new habits even after reaching weight-loss goals.
It is therefore imperative to understand a client’s real motivations. What
does the client really hope to gain by taking this step? Necessary changes should
be suggested based on the client’s level of motivation. Making a huge effort for
small expected gains can cause the client to give up. With this in mind, both expectations and the actual amount of weight to be lost must be realistic.
12
Weight-control intervention is clearly quite complex and full of nuances.
Practitioners might have to deal with a large range of issues, much more than just
eating habits and physical activity. Faced with this challenge, WLPSMs are of little
use and remain potentially harmful. However, helping and supporting a person with
a weight problem is a real challenge for professionals. When it is done well, the
work can be very gratifying.
• Set a realistic goal for actual weight lost and weight-loss expectations.
• Explain the connection between weight, lifestyle habits and health.
• Explain how positive lifestyle changes can occur, even without weight loss. • Ensure the client understands the physiological limits of losing weight:
the consequences of using WLPSMs and when severely restricting energy
• Adjust changes to be made based on client’s level of motivation.
• Ask clients to think about the importance of making long-term changes
and how to go about doing so.
• Encourage small actions that are more likely to succeed and ensure the
process is followed through.
• As much as possible, apply only a moderate food restriction and add
physical activities.
What conditions are likely to result in the professional’s and
client’s success and satisfaction?
13
SECTION 2 : A look at weight-loss
methods
A
look at weight-loss methods:
Criteria and results
The analysis of WLPSMs conducted in 2003 by the ASPQ and mentioned in the
introduction of this guide was carried out in several steps. First, as many WLPSMs
as possible were identified by using different sources of information. Between
November 2002 and January 2003, approximately 350 WLPSMs were inventoried
from newspapers, magazines, television, Internet, etc. Following this, more than
215 WLPSMs were described in detail and analyzed.
In order to conduct and give the critical analysis a solid basis, the analysis criteria
had to be defined for weight-control practices. These criteria, taken from scientific
documents and recommendations from organizations interested in the issue of
weight, were ratified by a committee of experts.
TYPES OF CRITERIA
The rate of weight loss
Approach required for a program or method (including supervision)
Dietary intervention
Physical activity
Effectiveness of the approach
Safety of the approach
Promotion and advertising surrounding the approach
Cost of the approach
The following were observed during the critical analysis of the various
WLPSMs chosen:
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•Many types of WLPSMs are highly accessible and widely advertised;
•In general, WLPSMs do not meet the criteria for healthy weight
control practices;
•Many WLPSMs do not offer solutions adapted to the needs of people
who are in a comprehensive change process concerning weight issues;
•Using WLPSMs could result in gaining weight back in the short- or long-term
or in a failure while attempting to lose weight. This could affect the client’s
physical and psychological health;
•Not enough is known on the subject to confirm or disprove the effectiveness,
danger or harmlessness of many WLPSMs listed.
In the next pages, the analysis criteria of weight control practices are listed, followed by results of the analysis. The methodology used to identify WLPSMs and
how the analysis criteria were developed is described in greater detail on page 49.
If we keep in mind that, when medically indicated, a weight loss of 5-10% of
the initial weight can improve a person’s health, the method used should promote gradual weight loss, in other words a maximum average loss of 1-2 lbs.
(0.5-1 kg) per week, which translates into a reduction in energy intake of
500-1000 kcal (2000-4000 kJ) per day, and an intake of energy not lower than
1200 kcal (5000 kJ)-1500 kcal (6500 kJ) a day, for women and men respectively.
Ideally, a mixed strategy should be used, in order to promote spending more energy so the amount of food consumed does not have to be so strictly reduced.
methods
The key ingredient is for weight loss to occur gradually. Only 6% of WLPSMs
analyzed meet this criterion and encourage a loss of 2 lbs. or less per week.
Conversely, 30% recommend quick weight loss, and some even go as far as to
say, “Lose 25 pounds in 30 days.”
Some WLPSMs use a “health discourse,” suggesting gradual weight loss, but at
more than 2 lbs. per week.
15
methods
The approach used (including supervision)
Weight loss should be handled using a global approach (incorporate eating
habits, physical activity and behaviour modification), and yet be personalized
(based on the client’s bio-psychosocial assessment and age).
In a global approach to weight loss, no product, food supplement or device
should be required to accompany eating and physical activity plans.
Supervision during weight loss should be provided by a health-care professional, such as a doctor, nurse, dietician or kinesiologist and ideally by a multidisciplinary team of health-care professionals.
Those who develop the method should be or should include health-care professionals, such as doctors, nurses, dieticians and kinesiologists who hold recognized credentials or have in addition received training in one of the following
fields: nutrition, metabolism, physiology or related fields. These people should
also be part of a multidisciplinary team.
The approach
In general, a global approach is not promoted by the WLPSM industry. Less than
1% of WLPSMs analyzed use this approach. For some, complementary products
are suggested but no additional products should be necessary when using a global
approach to weight loss. Some WLPSMs even have their own definition of “global»
and promote so-called complementary or essential products and/or new
technologies.
Some advertisements featuring WLPSMs are contradictory. Even though a global
approach is promoted, client testimonials feature people who are thrilled to be
able to keep eating the way they used to, as long as they respect the caloric limit
proposed in the WLPSM. It is therefore difficult to qualify these WLPSMs as using a
global approach.
16
Less than 1% of WLPSMs could qualify as using a personalized approach, but
since this officially also incorporates a thorough bio-psychosocial assessment, no
WLPSM analyzed meets this criterion.
Some claim to use a personalized approach, especially weight-loss programs and
centres. However, it is wise to make a visit to be sure that their claims are valid.
When investigating franchises, one must check that a personalized approach is
used in every location. In many cases the personalized approach turns out to be
supplying clients with a range of products, claiming to be adapted to the consumer
while no global assessment of his or her real needs has been made.
Supervision available during weight loss is rarely through a qualified person. Less
than 5% of WLPSMs – essentially weight-loss programs and centres – claim to offer supervision by health-care professionals, such as doctors, nurses, dieticians or
kinesiologists. At best, a dietician would work as a program or method supervisor
but does not offer adapted services directly to the client. Thus, there is no multidisciplinary expertise readily available.
Rather than offering organized supervision, some WLPSM developers and promoters are now offering supervision and guidance through the Internet. Some provide
their clientele with on-line monitoring, which might include a BMI calculation, recipes and helpful tips, discussion groups, etc. In some cases, on-line consultations
with professionals are available, but it is nevertheless difficult to establish
their suitability.
methods
Supervision
Lastly, less than 5% of WLPSMs are developed by health-care professionals, for
example, physicians in the case of popular diets. In one case, the approach and
proposed products were said to have been examined by a multidisciplinary team
acting as advisors. Some natural products are developed by pharmaceutical laboratories, and others are developed by naturopaths or independent herbalists.
17
methods
The weight-loss approach should promote healthy eating based on a varied
diet from the four food groups described in Canada’s Food Guide to Healthy
Eating (CFGHE)51, according to Canada’s Guidelines for Healthy Eating.51 In a
personalized approach, weight loss should be combined with dietary recommendations based on an assessment of the individual’s eating habits.
Without a doubt, a healthy diet is essential to good general health. However, less
than half of WLPSMs (40%) suggest following a healthy, balanced diet and 38%
do not even refer to it. In other cases, the concept of healthy eating is used by
WLPSMs to claim the enhancement of the effectiveness of the approach.
Approximately 10% of WLPSMs go as far as minimizing the importance of diet,
stressing their approach requires no effort, no deprivation, and no changes in
eating habits.
What’s more, 12% of WLPSMs fail to meet healthy eating principles because:
• They promote a diet too low in energy;
• The distribution of macro-nutrients is very different from what is suggested
in Nutrition Recommendations for Canadians;52
• They lack variety, a basic principle of Canada’s Guidelines for Healthy Eating
(ex.: unbalanced diet, eating only one food, too many restrictions, using
meal-replacement products).
For less than 2% of WLPSMs, personalized eating plans are allegedly offered, but
in many cases healthy eating is proposed only as a complement to the products.
18
Lastly, less than 5% of WLPSMs directly refer to Canada’s Food Guide to Healthy
Eating, which should serve as the basis for food interventions proposed in the
programs.
The approach used to lose weight should promote regular physical activity
(ideally 30 minutes a day), and this should be introduced gradually based on
the client’s age and existing physical activity habits.
We already know that playing sports or being active regularly benefits health.
According to scientific documents53, physical activity is the main factor in keeping
weight off. Interestingly, 58% of WLPSMs analyzed make no reference to physical
activity and some of them go as far as downplaying its importance, stressing their
approach requires no effort, no exercise, and no lifestyle changes.
methods
Physical activity
Within the range of available WLPSMs, only 34% encourage physical activity.
Most contain general statements explaining that physical activity can benefit
health. Once again the notion is used to enhance the perception of effectiveness.
There is generally little information provided on the frequency and duration of
physical activity. However, 11% of WLPSMs give instructions and promote regular
exercise, sometimes including an activity list.
With the exception of training centres that usually offer exercise programs adapted
to clients’ needs, there exists practically no personalized and progressive plan
based on a needs assessment.
19
methods
The weight-loss approach should be based on well-founded scientific principles, including evidence-based data. Its long-term effectiveness (1 year
minimum) should also be assessed.
Effectiveness is interpreted differently from one WLPSM to another and it usually
implies the short-term. If we consider a definition of weight-loss maintained over 1,
3 and 5 years, very few weight-loss methods qualify. Additionally, keeping in mind
that an approach’s effectiveness and safety is based on different criteria (global
and personalized approach, gradual weight loss, professional supervision), no
WLPSMs analyzed can qualify.
During analysis, one way to verify the effectiveness and safety of a natural product
claiming therapeutic properties is to see if it bears a DIN (Drug Identification Number). A DIN guarantees that a product’s safety, effectiveness and quality have been
examined by the Therapeutic Products Directorate (TPD).54 In the future, natural
products will need to be labelled with a product number (NPN)55 to be
marketable.
At the time of analysis, less than 6% of WLPSMs listed in categories that required
their products to bear DINs had such a number. Meal replacements are not subject
to this requirement, but are governed by specific regulations.56
Of all the WLPSMs analyzed, excluding those with a DIN:
• Just over 1% figure in statistics and less than 3% are mentioned
in reliable and thorough studies able to demonstrate their effective
weight-loss properties. In two cases, some active ingredients
were rigorously studied, but not the entire product;
20
• At least 3% were part of rigorous studies that showed they were
not effective for weight loss or were recognized as being ineffective.
More than half of these are devices or machines, while the others supposedly
bring about substantial weight loss by transdermal means.
While all WLPSMs analyzed claim they are effective for weight loss, more than
one third contain one or several ingredients found on lists of weight-loss ingredients banned by the Food and Drug Administration (FDA)57 because they were not
shown to be effective.
The weight-loss approach used must be safe, meaning that there should not be
doubt as to its safety.
There are very few thorough studies that demonstrate the safety of WLPSMs. Yet,
in their documentation and advertising, they make safety claims, such as “no
side effects” and “no risk.”
It is possible that ingredients found in some products are not dangerous on their
own, but they could increase health risks if a global approach requiring a significant
energy restriction is followed (ex.: consuming only a liquid formula over a span of
several days).
methods
Analysis shows that at least 34% of WLPSMs come with warnings, either on the
label, in the accompanying documents or in advertisements. Most commonly,
these warnings are general in nature and address children, pregnant women and
women who are nursing. They are sometimes presented in the form of recommendations to consult a doctor before starting any weight-loss method or using a
particular WLPSM (something that products from the United States are required to
mention in their advertisements).
There are also warnings that accompany devices and machines that may affect
people who have pacemakers or other medical devices (ex.: medical pumps). In
certain cases, the warnings are not found on the packaging, but rather on the accompanying documents inside.
Many products contain ingredients (ex.: cascara buckthorn, milk thistle, high mallow, psyllium, senna, etc.) with known side effects, yet no warning appears on the
label. Out of 215 WLPSMs analyzed (where the list of ingredients was available),
49 contained ingredients known to have side effects, contraindications or possible
interactions with foods or medications (see the chart of natural products on page
41). The majority of these products do not come with any warning. In other
cases, warnings are often general and do not address the problematic ingredient.
At least 6% of WLPSMs are presented as harmless, without side effects, but one
of them contains high levels of bladderwrack and the resulting high level of iodine
increases the risk of hyperthyroidism58. Its use is therefore contraindicated.57
Finally, in some cases it is not possible to confirm the safety of a product because
the list of ingredients (mostly for mail-order products) is not accessible.
21
methods
Promoting and advertising the approach
The claims of a weight-loss approach should respect current laws and regulations. They should make realistic affirmations and contain correct and complete
information.
Analysis of WLPSM promotion and advertising shows there are significant differences between their alleged benefits and healthy weight-control practices. Various
marketing strategies for WLPSMs are shown in the following list.
Main strategies used in advertising
(not mutually exclusive)
• Natural
• Scientifically proven/clinical study/approved by an MD
• Health discourse
• Impressive photos
• Testimonials
• Guarantee
• Permanent weight loss
• Effortless (no need to eat less and/or no exercising)
• Before and after photo shots
The popular “health discourse” marketing strategy includes statistics on overweight and obesity in commercials and the various ways these conditions affect
health. The consumer is fooled thinking he or she is dealing with a weight-loss
specialist. Once trust is gained, the consumer uses a product that seems harmless
and believes it to be the solution to weight loss.
22
For several of the WLPSMs analyzed, dubious marketing strategies were employed
(experience weight loss while sleeping, permanent, substantial in little time and
sensational testimonials). These marketing strategies were revealed after a major
study59 was published by the Federal Trade Commission (FTC) covering 300
WLPSMs available in the United States.
In the analysis, 30% of medications sold without a prescription, food supplements,
creams, body-wrapping techniques, patches, devices and appliances were recognized as using implausible allegations in advertisements according to experts at a
FTC meeting.60
• Everyone will experience substantial weight loss
• Lose weight permanently
• Lose a substantial amount of weight and still eat unlimited amounts of
calorie-rich food
• Lose a substantial amount of weight by blocking fat or calorie absorption
• Lose a substantial amount of weight by using a particular
transdermal product
• Lose a substantial amount of weight without reducing energy intake or
increasing physical activity
• Safe weight loss of more than 3 lbs. per week for more than four weeks.
methods
Claims deemed as implausible:
Several WLPSMs products are presented as useful adjuncts in treating obesity or
even diabetes. Article 3 of the Canadian Food and Drugs Act says, “No person
shall advertise any food, drug, cosmetic or device to the general public as a treatment, preventative or cure for any of the diseases, disorders or abnormal physical
states referred to in Schedule A.”61 Obesity is a disease listed in Schedule A.
During this analysis, it was not possible to verify if the labelling and allegations of all
products sold as meal replacements respected the Food and Drugs Act, in terms
of foods used in special diets.
Similarly, the Québec magazine Protégez-Vous conducted a study in March
199862, on meal replacements in an effort to reveal problems with labelling and
erroneous claims. This study showed several infractions of Canadian regulations
B.24.202 and B.24.204 of the Food and Drugs Act and the Guide to Food Labelling and Advertising. It also revealed a number of important elements that did not
conform to the Guide.
23
methods
Costs of the approach
Weight-loss products and methods should come with complete information
on the total potential cost of the weight-loss approach (including all its
components).
Weight-loss services should offer complete information on the total potential
cost of the weight-loss approach (including all components and follow-up) as
well as instalment payment methods.
Using WLPSMs in a weight-loss approach can be expensive. There are often additional costs that arise from purchasing products or services suggested to enhance
results. The chart on page 46 illustrates the potential costs of a weight-loss approach that uses WLPSMs and compares it to the cost of consulting a health-care
professional.
The fact that WLPSMs are very prevalent and visible detracts from concern about
their high cost. Out of 215 WLPSMs evaluated, at least 60 were available in
pharmacies, 88 in health-food stores and almost all were available on the Internet.
Accessibility will probably increase because pharmacies and health-food stores are
popping up in larger supermarkets or department stores and the topic of obesity is
very present in the media.
24
weight-loss methods
1. Industry legislation
• In Québec and Canada there is no legislation pertaining to the WLPSM
industry.
• A lack of resources prevents the thorough application of regulations on
certain components of WLPSMs, most notably public fraud, contracts
governed by the Consumer Protection Act and the Food and Drugs Act.
• In many cases, government does not intervene until a complaint has
been made. Unfortunately, people who put weight back on rarely complain,
especially because they consider themselves as responsible for failing.
methods
Five points about
2. Effectiveness
• Few thorough studies support affirmations of WLPSMs’ long-term safety
and effectiveness.
• Repeated failures, due to lower mid- and long-term effectiveness of WLPSMs,
can hinder the healthy control of one’s weight.
3. Safety
A WLPSM may be dangerous:
• Because it causes overly rapid weight loss, which results in a loss of muscle
mass, resulting in a slower metabolism;
• Because it denies or neglects the importance of lifestyle changes and it is the
maintenance of a lower weight over the long term that really matters
for health;
• Because it can cause minor undesirable side effects (fatigue, constipation,
nausea and diarrhea) that reduce a person’s general productivity and
well-being;
• Because it can cause major undesirable side effects (arrhythmia, electrolyte
imbalances, development of eating disorders, formation of gall stones,
decrease in bone density and death).
4. Supervision
• Pretention of supervision that responds to specific individual need is common.
• Supervision offered through programs and commercial weight-loss centres
is not generally provided by health-care professionals, despite promoters’
confusing claims regarding specialties and titles.
5. Natural does not necessarily mean safe
• The erroneous belief that natural products are safe and do not have
undesirable side effects is widespread and would explain in part the interest
in these products and the tendency among some to self-medicate.
25
methods
• Whether intentionally or not, individuals usually fail to inform health-care
professionals that they are taking natural products.
• Several adverse side effects are due to the significant variation in the quality
and quantity of ingredients found in natural products.
• The complete list of ingredients, their amounts and known side effects are not
always mentioned on the label.
WLPSMs are increasingly part of the problem rather than the solution
because they can act as significant obstacles to the adoption of a
healthy approach to a weight problem or body-image problem.
26
(ex. : Centre de santé minceur, Centre de la diète, Infraslim centre minceur, etc.)
Manufacturers’ claims
• Personalized
• Quick, permanent and significant weight loss
Alleged means of action
• Variety of technologies
• Consultations
• Diets based on reduced food intake, food combinations, products and
meal replacements, etc.
SECTION 3 : A detailed look at
weight-loss methods
Weight-loss centres
Manufacturers’ warnings/contraindications
• Generally none
Results of analysis
• Despite promoters’ confusing claims regarding specialties and titles, supervision
is not necessarily provided by health-care professionals.
• Suggested weight loss is quick and significant.
• The approach proposed by centres does not always include an eating or
exercise program.
• Few thorough studies support the effectiveness and safety of products or
technologies recommended by centres.
• Statistics on the effectiveness of the approaches proposed by centres are
rarely known.
• Affirmations of permanent weight loss, very common in centres, are not
backed by scientific literature.
• Centres often propose an approach based on health, but their practices
tend to focus more on aesthetics (ex.: reshaping, body sculpting, etc.).
• Treatment is usually offered on a one-time basis and is not necessarily part
of a global approach.
Argument
Weight-loss centres suggest using technologies or products whose effectiveness
has not necessarily been shown in thorough studies. They rely, rather, on sensational testimonials from “satisfied clients” to support their claims.
The economic aspect must be considered. These centres are often company
franchises looking to make a profit. If the first attempt to lose weight does not bear
fruit, a “higher performing” product or technology will be offered to eliminate
extra pounds.
Finally, despite the fact that the word “health” appears in many company names,
supervision proposed in centres is not necessarily offered by a health-care
professional.
27
Weight-loss programs
weight-loss methods
(ex. : Weight Watchers, Minçavi, Herbalife etc.)
Developers’ claims
• Guaranteed weight loss
• Personalized approach
• Balanced program
Operating procedures
• Hypocaloric diets with or without exercise and/or products
• Weekly group meetings
Developers’ warnings/contraindications
• Generally none
Results of the analysis
• On average, the suggested energy intake varies between 1000 - 1500
calories.
• There is a contradiction between what is promoted officially, what is
advertised and what is practised: for example, scientific recommendations
suggest a weight-loss goal of 5%, but the method or approach suggests a
higher weight loss; claims are made that the program follows Canada’s Food
Guide to Healthy Eating, but it does not respect a balance of macro-nutrients;
claims are made that the program promotes a healthy and balanced eating
program, but in fact it works with a calorie point system.
• Supervision is not necessarily provided by health-care professionals and is
not necessarily based on individuals’ needs.
• The weight-loss approach is not necessarily based on an individual
assessment, even if self-assessment is sometimes recommended at the start
of the program.
• The weight-loss approach sometimes requires food supplements and suggests
consuming foods prepared and marketed by the programs.
28
Notes from the scientific literature
• Few evaluation studies on weight-loss maintenance or program effectiveness
are available63.
• Even when weight loss is not necessary, people adopt a weight-loss
approach64.
Weight-loss programs often do not include an initial individual needs assessment,
qualified supervision or training of professionals. Programs do not always take into
account an individual’s environment, history or psychosocial condition.
What’s more, competition can arise among people in the program, despite the
promotion of co-operation and mutual support, and the program’s success or
failure depends essentially on the individual. Some people can deprive themselves
of food before they are weighed, but eat right after, often impulsively. They therefore eat based on an external locus of control rather than on their real physiological needs.
weight-loss methods
Argument
Lastly, it is not by counting calories or points that a person will learn anything of
lasting value concerning food and healthy eating habits.
29
Meal replacements
weight-loss methods
(ex. : Slim Fast, Nutribar, Scan Diet, etc.)
• Reduces weight by 1-2 lbs. per week
• Allows for long-term weight-loss maintenance
• Modifies eating habits in the short- and long-term
• Reduces risk of illness
• Contains all nutrients found in a balanced meal
Directions for use
• Replace one or two meals a day with a suggested weekly menu
for 8-12 weeks
• To keep lost weight off, continue to substitute one meal a day
• Replace all daily meals (based on one of the listed products)
Nutritional value
Ex: a bar
- 230 to 260 calories
- 56% carbohydrates
- 23% fats
- 21% proteins
Recommended diet of 1200 calories per day, as prescribed in the regulation
• No adverse side effects listed.
• For those under 18, pregnant women or women who are nursing, and people
with health problems, the manufacturer recommends consulting a doctor before starting any diet for weight loss.
30
• The approach is not personalized and does not lead to a behaviour
modification approach, based on a previous assessment of an individual’s
lifestyle and state of health.
• By suggesting meal replacements, some manufacturers do not respect
current regulations.65
• Using meal replacements does not promote a varied diet, as recommended
in Canada’s Food Guide to Healthy Eating.
• Meal substitutes are not particularly tasty or mouth-watering.66
• A meal replacement diet is monotonous.
weight-loss methods
• By replacing all meals with a meal substitute, as recommended by the
manufacturer, there is a risk of developing nutritional deficiencies.16
• Consuming meal substitutes does not encourage learning about or adopting
long-term healthy eating habits.16
• A person who chooses not to consume meal substitutes and whose
complementary meal is not nutritionally sound would tend to follow a diet with
very few calories, which can be dangerous without medical supervision.16
• Research on the effectiveness of meal substitutes for weight loss
or maintenance is financed in whole or in part by manufacturers of these
products. This creates the potential for a research bias.
Argument
Meal substitutes are an unnatural way to eat and do not lead to learning the basics
to ensure long-term weight-loss maintenance. Additionally, to keep weight off, it is
suggested to continue integrating the product in daily meal planning. Is it possible
to eat meal substitutes for life?
Using meal substitutes means consuming less food than is recommended by
Canada’s Food Guide to Healthy Eating. Their consumption also develops a taste
for sugar. Not only are these people depriving themselves of other flavours and
tastes, but they are also avoiding sugary foods that taste better!
In general, people do not have all the necessary information to be able to compare
a meal’s energy content with that of a meal substitute. For example, a sandwich
(approximately 300 calories) nearly matches the energy content of a meal substitute, but it is a much better choice because it will often include a serving from each
food group.
Lastly, the level of food restriction imposed by following a diet of just 1200 calories
per day is certainly not suitable for everyone.
31
Diets
weight-loss methods
• Hypocaloric (ex.: Scarsdale)
• High protein (ex.: Atkins)
• Based on the glycemic index (ex.: Montignac)
• Dissociation and prohibition of certain foods (ex.: Fit for Life, Montignac)
• Based on Ayurvedic type (ex.: Rainbow diet)
• Based on blood groups (ex.: D’Adamo), etc.
Some diets have a determined duration, while others require long-term lifestyle
changes.
Developers’ claims
• Guaranteed permanent weight loss
• Balanced
• No deprivation
• Prevent cardiovascular problems and obesity
Nutritional value
• Exclusion of certain macro-nutrients (ex.: carbohydrates, fats)
• An average of 800 to 1800 calories per day
Developers’ warnings/contraindications
• Generally none.
• Sometimes a time limit is suggested for very low energy diets.
• Sometimes the diet is not recommended for pregnant women or children.
32
• Several diets contain less than 1200 calories per day and suggest weight loss
at a rate of one kilogram (approximately 2 lbs.) per week.
• Not all of the diets suggest a global approach which should include
physical activity.
• No personalized supervision is offered.
• Food variety is often limited.
• Food supplements or products are frequently suggested.
• The diets adopt the same basic principle: weight loss varies according to
the amount of food restricted. Hypocaloric diets result in short-term weight
loss, but in 90 to 95% of cases weight is put back on within five years after
the program or diet ends.67
• Various physical symptoms are associated with hypocaloric diets: fatigue,
constipation, nausea, diarrhea.19 Depending on the degree to which calories
are restricted, side effects can include arrhythmia, electrolyte imbalance21,
reduction of bone mass23,26, and iron deficiencies.68
• Certain diets provoke nutritional deficiencies, especially in vitamins A and E,
magnesium, zinc, fibre, potassium and calcium.69
Argument
Popular diets are not effective or safe in the long run because they do not incorporate a global and personalized approach. A popular diet is not for everyone:
THE one-size-fits-all diet does not exist.
weight-loss methods
• Psychosocial effects, notably loss of self-esteem, self-confidence and
satisfaction with one’s body, were noticed following frequent dieting.46
• There is a strong connection between frequent dieting and eating disorders.45
Some diets even recommend eliminating or reducing the consumption of foods
that are recommended by Canada’s Food Guide to Healthy Eating. Doing this may
result in significant nutritional deficiencies and physical or psychological symptoms.
Lastly, a diet might become so complicated and restrictive that a person simply
does not eat. The resulting reduction in energy intake will induce weight loss.
33
Natural/over-the-counter/
homeopathic products
weight-loss methods
(ex. : Chitosol, Crave free, Triolax, Xenadrine, etc.)
• Quick weight loss, effortless, localized, permanent, sometimes sensational
• Used in conjunction with treatment for obesity
• Reduced production of LDL cholesterol and triglycerides
• Help troubles with metabolism due to obesity
• Burn or absorb fats and sugars
• Block absorption of carbohydrates and fats
• Appetite suppressant or regulator
• Raise basal metabolism
• Help to stabilize weight
• Often none
• Generally, the product claims to be safe, non-toxic and have no side effects.
• Generally, the product is not recommended for pregnant or nursing women.
A general warning from an organization like the FDA or Health Canada might
be included. For example, there could be a warning that the product is in no
way designed for diagnosing, treating, curing or preventing illness.
List of common ingredients (non-exhaustive list)
• Algae
• Fruit enzymes
• Caffeine
• Ephedra or Ma Huang
• Cascara buckthorn
• Garcinia cambodgia
• Chitosane
• Guarana
• Chromium
• Guar gum
34
• St. John’s Wort
• Senna
• Green tea
• Cider vinegar
• Yerba mate
• In most cases, the therapeutic product has no identifying number (DIN). In the
future, natural products will have to bear a product number (NPN).
• Ingredients often have different designations and their quantity is not always
indicated.
• In several cases, serious potential side effects are often ignored.
• Truthful and complete product information, especially on real contents is not
always accessible.
• Few studies confirm the effectiveness and/or safety of products.
• Several ingredients are laxatives and/or strong diuretics.
• General information is given on eating habits and physical activity or it is
absent from the product’s accompanying literature.
• No supervision or follow-up is offered.
• Some herbs are thought to be effective and/or risk free simply because of
their country of origin or that they have been used for generations
(ex.: the Orient).
weight-loss methods
• Some natural products are likely to cause adverse side effects which can be
attributed to ingredient substitution, too low or too high a dose, medicinal
herbs or supplements of mediocre quality, poorly identified ingredients (wrong
species), variability of component elements, heavy metal contamination,
adulteration by prescribed medication, fortification and enrichment70,
interactions with prescription medication71 and allergic reactions.72 Some
products may also contain ingredients derived from herbs that are naturally
toxic.73
• The use of some ingredients found in natural weight-loss products have
already been questioned by Health Canada and the American FDA, including
Ephedra74, birthwort75 and St. John’s Wort.76
• Studies have proven that other compounds like chromium77, chitosan78,
bladderwrack57, psyllium as well as guar gum79 have proven ineffective in
weight loss and were noted for their potential side effects.
• Other ingredients regularly found in natural weight-loss products, such as
cassia or senna and cascara buckthorn, have a laxative and/or diuretic effect.
These products can result in serious electrolyte imbalances, damage to the
kidneys, gastro-intestinal complications, and arrhythmia.80
• Natural health products are popular because more than 50% of Canadians
use them.81
• In general, people seem to believe these products are safe because they
come from natural plants.73
• In a prospective study82, half of patients who were asked about their use of
diet supplements did not inform their doctors. Considering the possible
interactions between medication and natural products, we should worry
about the risk to consumers.
Argument
By simply listing so-called effective ingredients, natural products perpetuate the
idea that excess weight will miraculously disappear and melt away.
But more importantly, using these products to lose weight can be risky – some of
them even result in serious health problems or death. Therefore, the principle of
caution always has to be applied, and not use natural products whose safety and
effectiveness for weight loss have not been proven scientifically.
35
weight-loss methods
Transdermal products: creams, patches,
wraps, sprays and gels
(ex. : Patch Minceur, Cellimine Zones rebelles, Élancyl Chrono-actif, etc. )
• Weight loss
• Cellulite treatment
• Firms and tones body
• Appetite control
• Reduced fat and sugar absorption
• Excess cutaneous fatty tissue disappears
• Based on algotherapy
Main ingredients listed
• Algae
• Caffeine
• Fruit enzymes
• Garcinia cambogia
• Green tea
• Generally none.
• Sometimes the product is contraindicated for pregnant women and/or people
with health problems.
Results of analysis
• No eating or physical activity program is offered.
• No thorough study supports claims for effective weight loss.
• At an FTC meeting, a group of experts found allegations of substantial weight
loss through transdermal products to be implausible, based on current
scientific findings.60
36
Argument
Products are presented as being miraculous, but is it really possible to lose weight
or make “fat melt away” by wrapping yourself in plastic? Seriously, there is no
over-the-counter transdermal product available recognized for its effectiveness
in weight loss.
(ex. : Press Point, Bracelet minceur, Gaine Lanaforme, Pantashort amincissant, etc.)
• Weight loss, weight-loss maintained
• Stimulate and firm muscles effortlessly
• Tone thighs, flatten stomach
• Reduce excess subcutaneous fatty tissue
• Curb appetite, reduce snacking
weight-loss methods
Machines, devices and techniques
Alleged means
• Acupressure
• Electrical stimulation
• Electrical acupuncture
• Magnets/magnetic field
• Generally none.
• No side effects.
• Not recommended for pregnant women or people with pacemakers.
Results of analysis
• Weight loss of more than 1-2 pounds per week is often suggested.
• The role of food and exercise is often minimized.
• The approach is neither personalized nor global.
• Weight-loss affirmations are not backed by any conclusive research.
• At an FTC meeting, a group of experts found allegations of substantial weight
loss through products used on the exterior of the body to be implausible,
based on current scientific findings.60
Argument
Promised results often seem marvellous, but is it really possible to control your appetite with a (programmable!) bracelet or to fight unsightly cellulite just by wearing
a special pair of shorts? No machine, device or technique has been recognized on
its own as effective for weight loss. And if some machines result in weight loss that
is measurable, they would be affecting water weight loss, not fat.
37
Conclusion
Obesity and excess weight are on the rise. Consequently, health risks in the population are also increasing. Concurrently, having a thin and young body perseveres
as the popular dream. As a result, trying to lose weight is as popular for individuals
with excess weight that is harmful for their health as for individuals who have aesthetic objectives.
A multitude of products, services and methods to lose weight (WLPSMs) is being
offered in response to this demand. This market is constantly growing in an environment that lacks proper regulation. To complicate matters further, myths and mistaken ideas surround WLPSMs: that weight can be lost without making any effort or
changing long-term habits, that a healthy weight must be achieved to reap health
benefits and that strenuous exercise is required to be healthy. Finally, weight loss is
often considered as an ultimate goal and answer to many problems, rather than an
improvement to one’s overall health.
With so few resources, our health-care system responds poorly to those requiring
healthy and safe weight controls. With such important needs, competent resources
that are financially accessible are severely lacking.
With an increasing focus on obesity, health-care professionals will be more and
more in demand to guide people through weight management, answer questions
related to weight loss, and intervene when individuals try dangerous quick fixes.
This reference guide does not cover all possible weight-related issues, but is designed to give health-care professionals the major elements involved in providing
effective care: the basic principles of healthy weight management, the key facts on
WLPSMs, and their limitations and risks associated with their use.
Above all, this guide aims to destroy the myth of a one-size-fits-all solution for
weight loss. As is often the case, the individual approach is the best one!
39
of weight-loss methods
WLPSM
40
Characteristics
Risks
Problems
Strict and monotonous menus.
Deficiency in
calcium and
some fatty acids.
Fatigue, constipation, nausea.
Very restricted
diet and lost
weight is regained
quickly.
Consumption of
starchy food, legumes, fruits and
sugar is prohibited. No restriction
of foods rich in fat
and protein.
Deficiency of
vitamins, fibers
and mineral salts.
Fatigue, constipation, high
cholesterol.
Serious health
consequences,
especially cardiovascular problems.
Hypoglycemic Exclusion of foods
with a high glyce(ex.:
mic index (white
Montignac)
flour, potatoes,
cooked carrots,
etc.). Don’t mix
fat and carbohydrates.
Nutritional deficiency due to an
insufficient consumption of some
food categories.
Deprivation of
foods recommended by CFGHE. 83
Diet is difficult to
understand. The
hypothesis that
foods low on the
glycemic index
promote weight
loss is not scientifically demonstrated.
Dissociated food or
single food
Consumption of
one food category
at a time.
Deficiency in calcium, vitamins and
minerals, possibly
in protein too.
Complex eating
guidelines, deprivation of foods
recommended by
CFGHE.
Some foods are
incompatible with
our blood type.
Does not promote
the consumption
of a variety of
foods as recommended by
CFGHE.
Diet leads to a deprivation of foods
recommended by
CFGHE. Basics of
the diet are not scientifically validated.
Hypocaloric
diets
(ex. : Scarsdale)
High protein
(ex.: Atkins)
Diets
SECTION 4 : Additional information
A quick overview
(ex.: Fit for life,
Montignac)
Based on
blood types
(ex.: D’Adamo)
WLPSM
Characteristics
Risks
Problems
Commercial
weight- loss programs
Restricted diet.
Generally group
meetings for support and motivation.
Weight frequently
gained back when
ending the program.
Approach is not
necessarily
personalized.
Possibly no prior
individual needs assessment, qualified
supervision or professional training.
Use of slimming
techniques, natural
products and inner
cleansing treatments (purges).
Food combining.
Nutritional deficiency. Proposed rate
of weight loss is
too high.
Supervision not
necessarily assured
by health-care professionals. Claims of
product and technique effectiveness
not supported by
thorough studies.
Low-calorie diet.
Replace one or
two meals by
substitutes.
Lack of dietary
variety. Incorrect
use may cause energy and nutritional
deficits. Might result
in too rapid
weight loss.
(ex.: Weight Watchers, Minçavi, etc.)
Weight-loss
centres (ex.: Centre
de santé minceur,
Centre de la diète,
Infraslim centre minceur, etc.)
Meal substitutes
(ex.: Slim Fast, Nutribar, Scan Diet, etc.)
Inherent risks in
taking numerous
natural products.
A quick overview
Denatured relationship with food.
Consumption of
fewer food choices
recommended by
CFGHE.
41
A quick overview
WLPSM
Characteristics
Risks
Problems
Natural products
Often made of
laxative and diuretic
plants. Contains
so-called “miracle”
ingredients.
Effectiveness and/or
safety of natural
products poorly, or
not at all assessed.
No acknowledged
effect on weight
loss. Serious side
effects, intoxication
and death listed.
Weight loss, apTransdermal
products: creams, petite control,
fat dissolves by
patches, etc.
diffusion of “active”
(ex.: Patch Minceur,
ingredients across
Cellimine Zones
the epidermis.
rebelles, etc.)
safety of transdermal products have
not been proven.
No transdermal
product available
over the counter
has been recognized as effective
for weight loss.
Weight loss through
acupressure, electrical stimulation,
electrical acupuncture, magnets/
magnetic field.
safety of machines/
devices/techniques
has not been
proven.
No machine/
device/technique
has been recognized as effective
for weight loss.
(ex.: Chitosol, Crave
free, Triolax, Xenadrine, etc.)
Machines/
devices/ techniques
(ex.: Bracelet
Minceur, Pantashort
amincissant, etc.)
42
(non-exhaustive list)
Ingredients
Effectiveness for
weight loss
Safety/adverse
side effects
Possible interactions with
medications and
contraindications
Citric acid
Fruit enzymes
Ex.: bromeline (from
pineapples), papain
One of 111
ingredients found
in weight loss
products which
the American FDA
has banned for its
unfounded claims
of effectiveness.57
Not documented.
Bromeline: interactions with anticoagulants and inhibitors
of thrombocytic
aggregation.84
Papain: interactions with Warfarin,
a medication used
to prevent blood
clots.84
Usnic acid
Commercial product (Lipokinetix)
containing usnic
acid, taken off the
market by the FDA
in 2001 due to side
effects.
Severe liver toxicity,
Hepatitis, acute
liver failure requiring
transplants.85
Not documented.
Marine algae
Ascophyllum
bladderwrack
Lack of proof of
efficacy.57
Some types of
algae are toxic and
can store heavy
metals and other
toxic substances
.62 The high level
of iodine in bladderwrack may
increase the risk of
hyperthyroidism. Its
use is therefore not
recommended.57
Prolonged ingestion
of bladderwrack
can reduce iron,
sodium and potassium absorption.
May interfere with
thyroid treatment, to
be avoided by those
suffering from acne.
Some people might
easily overdose on
iodine.62
Ingredients in weight-loss products
43
44
Ingredients
Effectiveness for
weight loss
Safety/adverse
side effects
medications and
contraindications
Aristolochia
Not documented
for weight loss.
100 documented
cases of nephropathy, 30 of which
resulted in terminal
kidney failure requiring transplants.75,86
Not documented.
Substitution of
S. tetandra (han
fang ji) in a weightloss product by
Aristolochia westlandii (guan fang ji).
Cascara buckthorn
Powerful laxative
Weight loss due to
the laxative effect.
May cause recurrent diarrhea.62 The
use of laxatives over
long periods of time
can create a dependence.87,88
Losing high
amounts of liquid
can result in low
levels of potassium.
This deficiency may
possibly cause
heart problems.84,87
Chitine
Substance extracted from the shell of
crustaceans
Chitosane
Glucosamine polymere produced with
chitine57
Effectiveness not
proven: no effect on
weight loss shown
in humans.62
Scientific data
contests effectiveness for weight loss
in humans.89
Some fats could
block the absorption of fat-soluble
vitamins; risk of
short- and longterm deficiency.62
Gastro-intestinal
symptoms.89
Dangerous for
people with seafood
allergies.62
Ingredients
Effectiveness for
weight loss
Safety/adverse
side effects
medications and
contraindications
Chromium (Cr)
Chromium Picolinate
The FTC has concluded that there is
insufficient scientific
proof to support allegations in ads for
chromium-based
products.57
Recent studies
show that high
doses can be dangerous.57
Reports of severe
muscle injury (rhabdomiolisys) and
kidney damage.90
Not documented.
Ephedra
Ephedrine
Ma-Huang
Herbal ecstasy
Mahuang
Mahuanggen
Ma huang root
Modest short-term
weight loss.89
Palpitations, psychiatric symptoms,
gastro-intestinal
symptoms, shaking,
insomnia, 16 000
reports of adverse
side effects, including 17 deaths, 15
myocardial infarctions and 24 cardiac,
cerebro-vascular
and neurological accidents, 11 strokes
and 16 psychiatric
symptoms.74,91
Persons suffering from coronary
thrombosis, diabetes, glaucoma, hypertension, thyroid,
cardiac or prostate
problems.74,88
Often combined
with caffeine or
guarana
45
46
Ingredients
Effectiveness for
weight loss
Safety/adverse
side effects
medications and
contraindications
Garcinia cambogia
HCA
(hydroxycitric acid)
Effectiveness not
proven.62,89 To
date, thorough
studies do not support the use of HCA
as an anti-obesity
agent.57
Little data on its
safety when consumed regularly.62
Migraines, respiratory and gastro-intestinal problems.89
Not documented.
Germander
Teucrium
chamaedrys
Banned in France,
therefore not recommended.57
Hepatitis,
hepato-toxicity,
jaundice.92,93
Not documented.
Guar gum
Not effective for
weight loss.89
Diarrhea and
gastro-intestinal
problems.89
Could decrease
absorption of oral
contraceptives
and potentiation of
insulin.79
Gymnema
sylvestre
Not documented.
Not documented.
Possibility of
interactions with
certain diabetes or
hypertrigly-ceridemia
medications.76
St.John’s Wort
No proof of
effectiveness for
weight loss.57
Minor gastrointestinal irritations,
allergic reactions,
fatigue, restlessness.88
Interaction with
medications.76
Reduces activity
of medication like
antihistamines, oral
contraceptives,
some anti-retroviral
drugs, antiepileptics, cyclosporins,
etc.84
Ingredients
Effectiveness for
weight loss
Safety/adverse
side effects
medications and
contraindications
Common plantain
or Psyllium
(Plantago major)
May reduce shortterm food intake,
but the only randomized test did not
reveal any effect on
body weight.57,89
When taken in large
quantities may
cause gastrointestinal
problems.57,88
May potentially
affect or slow
absorption and
the mechanism of
certain medications
taken at the same
time, particularly
derivatives of coumarin and cardiac
glycoside, vitamins
and minerals
(calcium, iron
and zinc).57,84,88
Senna or cassia
Depends on the
quantity in the
product; several
products contain
insufficient quantities of laxative
substances to bring
about the desired
effect.62
The use of laxatives
over long periods
of time can create
dependence and
cause recurrent
diarrhea.88
Losing high
amounts of liquid
can result in low
levels of potassium.
This deficiency may
possibly cause
heart problems.62
The increased
intestinal movement may reduce
absorption of some
orally administered
medication.84,88
47
Cost of weight-loss methods
48
compared to consulting a health-care professional (2004)
Length/
Type of
WLPSM
Costs/General rates/
Initial costs
3 months
6 months
1 year
Weight
Watchers
Enrollment: $22
Weekly fees: $14
First visit: $36
Following weeks: $14
5- or 12- week package:
$69 or $154
Semi-annual or annual
membership: $299 or $529
$210
(including
enrollment,
first visit and
12-week
package)
$360
(including
enrollment,
first visit and
semi-annual
membership)
$590
(including
enrollment,
first visit
and annual
membership)
Minçavi
Enrollment: $30
Re-enrollment (with or
without weigh-in journal):
$16 or $23
New eating program: $5
Adult weigh-in: $8
Students: $5
Every 2 weeks: $14
On-line consultation:
$40 and +
$170
(including
enrollment,
new eating
program,
1 virtual
consultation and 1
weigh-in per
week for 12
weeks)
$310
(including
enrollment,
new eating
program,
2 virtual
consultations and 1
weigh-in per
week for 24
weeks)
$610
(including
enrollment,
new eating
program,
4 virtual
consultations and 1
weigh-in per
week for 52
weeks)
Slim Fast
Bar: $11 for 6
Powder: $12 for 530 g
Soup: $12 for 6
Packages: $2/package
$330
(60
products/
month for 3
months)
$500
(180 products the first
3 months
then 30
products/
month the
following 3
months)
$830
(60
products/
month
the first 3
months
then 30
products/
month the
following 9
months)
Length/
Type of
WLPSM
Initial costs
3 months
6 months
1 year
Lypozic
$60 for 4 products
(Slim Gel, Diu Slim, Taille
Mince, Coupe Fringale)
30 days
$180
(taking 4
products
together
as recommended)
$360
(taking 4
products
together
as recommended)
$720
(taking 4
products
together
as recommended)
Abs+
$35 for 90 capsules
Weight loss: 6 capsules
per day
Weight maintenance:
3 capsules per day
Lean+
$30 for 60 capsules
$55 for 120 capsules
2-4 capsules per day
Shape+
$33 for 120 capsules
4 capsules per day
$475
(taking 3
products
together
as recommended in
a publicity
brochure)
$950
(taking 3
products
together
as recommended in
a publicity
brochure)
$1895
(taking 3
products
together
as recommended in
a publicity
brochure)
8-week program, 3x/week
$23/session
Opening a file: $60
$610
(including
opening a
file and 24
sessions)
(Leblanc
Natural products)
Greens +
(Natural
products)
Kilo Cardio
(Energy Cardio program)
$1010
(annual
subscription and
program
costs)
49
Length/
Type of
WLPSM
Initial costs
3 months
6 months
1 year
Dietician
Fee suggested by the
OPDQ 94: $75/hour
Fee suggested by a group
of dieticians in a private
practice and according to
number of visits:
$29 to $43
From $215
to $375
(average
cost for approximately
5 visits)
From $495
to $855
(average
15 visits)
From $870
to $1500
(average
30 visits)
Kinesiologist
Between $50 and $60/hour
(fee variable depending
on the professional/no fee
suggested by the FKQ 95)
Supervised and adapted
program: from $20 to
$35/hour
From $200
to $300
(average
4 visits)
From $300
to $360
(average
6 visits)
From $600
to $720
(average
12 visits)
Note: None of the above-mentioned costs includes taxes.
50
The ASPQ education project (Éducation aux saines pratiques de contrôle
du poids comme stratégie de promotion d’un mode de vie sain) for healthy
weight-control practices was designed to promote healthy lifestyles and counteract unhealthy weight-control practices to prevent obesity and diabetes and related
health complications. This project was funded by Health Canada through its Canadian Diabetes Strategy – prevention and promotion contribution program.
The first part of this project was a critical analysis of weight-control practices offered by the private industry. Various products, services and weight-loss methods
(WLPSM) available in Québec were identified and documented in order to examine
the differences between these WLPSMs and the criteria of healthy weight-control
practices found in scientific literature and approved by a committee of experts.
Methodology
In the second part, two educational guides were produced — one for adolescents,
“What’s up, Jennifer?” and another for adult women called “Lose weight…or
be yourself?” These two guides were distributed in women’s magazines in
February 2004. Then in May of the same year, the Ministère de la Santé and des
Services sociaux came out with a second distribution of the guide for adolescents
through the CLSC network and Directions de santé publique du Québec. Both
guides can now be ordered from the ASPQ (www.aspq.org).
1. Identifying WLPSMs available in Québec
The first step was to find different sources of information that would identify the
greatest number of WLPSMs available in Québec. The sources that were found,
which had to cover a large range of WLPSMs and be available in Québec, are
listed in the following table.
Information sources
to identify WLPSMs
% of WLPSMs present
(not mutually exclusive)
Daily newspapers and regional weeklies
16 %
Magazines and journals
19 %
Television
7%
Pharmacies
29 %
Natural food stores
42 %
Advertising (leaflets, flyers, etc.)
40 %
Books
7%
Internet
82 %
51
The original plan was to make an exhaustive inventory of WLPSMs available in
Québec. However, their number and quantity is always changing, so it was decided to select some WLPSMs in a given window of time, from November 2002 to
January 2003 inclusive. Personal weight-control practices (monitoring fat or sugar
consumption, exercising, etc.) were not included in the study. Products sold by
prescription, medical treatments, medical weight-loss clinics and dietician clinics
were also excluded, most notably because they fall under a field of practice regulated by a professional order.
In the end, more than 350 WLPSMs were selected from the various sources consulted. Because of their wide variety and to make the analysis easier,
WLPSMs were classified into eight categories. Some of the WLPSMs listed were
not described or analyzed because:
• There was not enough information on the given WLPSM to be able to perform
an adequate analysis;
• Some products were very similar, as with slimming creams, which were
numerous and more often designed to treat cellulite than weight loss;
• Sometimes one product was marketed under different names, for example in
the United States and in Canada;
• The WLPSM was not easily or not at all available in Québec (ex.: Jenny Craig).
52
Subsequently, 215 WLPSMs were described based on information available
in ads from different sources: the media, Internet sites, pamphlets, sales
outlets, etc. These were the WLPSMs chosen for analysis. The following
table shows the breakdown of the selected WLPSMs, as well as those documented and analyzed, according to category. The WLPSMs chosen for analysis were
described on health and safety data sheets. Observations were compiled in
a database for statistical purposes.
WLPSM
chosen
WLPSM
analyzed
n
%
n
%
Non-prescription medication and
natural products (ex.: appetite suppressants, fat burners, laxatives, diuretics)
203
57.8
152
70.7
Meal substitutes
and food products
23
6.6
13
6.0
Weight-loss programs
11
3.1
8
3.7
Weight-loss centres
20
5.7
9
4.2
Diets
35
10.0
18
8.4
Patches, creams, sprays, wraps
31
8.8
7
3.3
Machines and devices (ex.: electrical
stimulation, acupressure, pressure
therapy, etc.)
21
6.0
7
3.3
Alternative methods (ex.: hypnosis,
aromatherapy, acupuncture, fasting)
7
2.0
1
0.5
Total
351
100
215
100
WLPSM CATEGORY
53
2. Establishing analysis criteria for weight-control
practices
To properly conduct the critical analysis of the various WLPSMs listed, the analysis
criteria of weight-control practices had to be defined. These criteria, taken from
scientific literature and recommendations from organizations interested in weight
issues were approved by a committee of experts. The eight members of the
committee had different expertise on the subjet of weight (nutrition, obesity,
public health, kinesiology, pharmacology and toxicology, health sociology and
consumer rights):
Martin Brochu, assistant professor in the kinesiology administrative unit at the
Université de Montréal;
Dr. Véronique Déry, specialist in public health and scientific director at the Agence
d’évaluation des technologies et des modes d’intervention en santé;
Lise Dubois, nutritionist, health sociologist and professor in the department of
social and preventative medicine at the Université Laval;
Dr. Dominique Garrel, endocrinologist and director of the nutrition department at
the Université de Montréal;
Simone Lemieux, nutritionist, professor in the department of food sciences and
nutrition at the Université Laval and part of the Obesity Research Chair team;
Lyne Mongeau, nutritionist, scientific advisor to the Institut national de santé publique du Québec, the Direction Développement des individus and des communautés, Lifestyles unit, and member of the Association pour la santé
publique du Québec’s Council of Governors;
Gilles Morissette, senior officer in competition law, in the Canadian Competition
Bureau;
54
Dr. Albert Nantel, specialist in pharmacology and toxicology and scientific advisor
to the Institut national de santé publique du Québec, and the Biological, Environmental and Occupational Risks Branch, Health and Environment Unit.
• Health Canada
• Canadian non-government organizations
• National Heart, Lung, and Blood Institute (National Institutes of Health)
• Partnership for Healthy Weight Management
• Michigan Task Force to Establish Weight Loss Guidelines
• American Heart Association
• NHS - National Health Services
• World Health Organization
Summary of the main guidelines that exist for healthy weight-control
practices
In light of comments and suggestions from committee members, the criteria have
been revised and measurement indicators or elements have been identified. This
was a necessary distinction. In fact, owing to the diversity of WLPSMs and the
limits of current regulation, it was difficult to establish criteria directly applicable to
WLPSM analysis.
WLPSM effectiveness and safety criteria are a good example. Although current
regulation does not require most WLPSMs to prove claims of effectiveness or
safety, consumers still need this type of information to make an informed decision
about weight loss.
A new set of criteria was proposed to the committee members. Comments from
the committee were then integrated into a series of final proposals approved by
all committee members. The criteria refer to a weight-loss approach in the widest
sense and are divided into eight categories:
CRITERIA CATEGORIES
Approach required for a program or method (including supervision)
Physical activity
Promotion and advertising surrounding the approach
Cost of the approach
55
Resources
56
Health-care professionals who wish to have more information on the topics
discussed in this reference guide may consult this list of related resources.
Books
Web sites
• Apfeldorfer G (1997). Maigrir, c’est dans la
tête, Paris, Éditions Odile Jacob, 348 p.
• Apfeldorfer G (2000). Maigrir, c’est fou!,
Paris, Éditions Odile Jacob, 304 p.
• Berg FM (2001). Children and Teens Afraid
to Eat. Helping Youth in Today’s WeightObsessed World, Hettinger, Healthy Weight
Network, 339 p.
• Berg FM (2000). Women Afraid to Eat.
Breaking Free in Today’s Weight-Obsessed
World, Hettinger, Healthy Weight Network,
384 p.
• Cash TF (1997). The Body Image Workbook:
An 8-step program for learning to like your
looks, Oakland, New Harbinger Publications,
221 p.
• Fairburn CG, Brownell KD (2002). Eating
Disorders and Obesity. A Comprehensive
Handbook, 2nd ed., New York, The Guilford
Press, 633 p.
• Fischler C (2001). L’Homnivore, Paris, Éditions Odile Jacob, 440 p.
• Foster GD, Nonas CA (2004). Managing
Obesity: A Clinical Guide, Chicago, American
Dietetic Association, 247 p.
• Kirby J (for The American Dietetic Association) (1999). Maigrir pour les nuls, Alameda,
Sybex, 374 p.
• Kratina K, King NL, Hayes D (1996). Moving
Away from Diets, Lake Dallas, Helm Seminars
Pub, 174 p.
• OPDQ (2000). Manuel de nutrition clinique,
Montreal, Ordre professionnel des diététistes
du Québec.
• Wadden TA, Stunkard AJ (2002). Handbook
of Obesity Treatment, New York, The Guilford
Press, 624 p.
• Waterhouse D (1994). Mince alors… Finis
les régimes!, Montreal, Éditions de l’Homme,
258 p.
• Wilson TG (1996). Acceptance and Change
in the Treatment of Eating Disorders and Obesity. Behavior Therapy, 27:417-439.
• Zermati JP (2002). Maigrir sans régime,
Paris, Éditions Odile Jacob, 416 p.
• Québec-Ossg. Bariatric surgery support
group, [On line], May 9, 2004. http://ossg.ca
(May 21, 2004).
• FTC (Federal Trade Commission). “Weight
Loss Advertising: An Analysis of Current
Trends.” A Federal Trade Commission Staff
Report, [On line], September 2002. [http:
//www3.ftc.gov/bcp/reports/weightloss.pdf]
(August 1, 2003).
• NHLBI (National Heart, Lung, and Blood
Institute). “Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight
and Obesity in Adults,” [Summary], [On line],
1998. [http://www.nhlbi.nih.gov/nhlbi/] (September 18, 2000).
• Health Canada. “The VITALITY Approach
– a Guide for Leaders,” Ottawa, Department
of Public Works and Governement Services.
Health Canada publications service, cat.
no H39-525/2000F, [On line], 2000. [http:
//www.hc-sc.gc.ca/hpfb-dgpsa/onpp-bppn/
vitality_approach_f.pdf] (September 7, 2003).
Training
Le Collectif action alternative en obésité
(CAAO). Small-group training seminars.
Telephone: (514) 270-3779,
e-mail address: caao@cam.org
Web site: www.caao.qc.ca
1 Health Canada 2003). Canadian Guidelines
for Body Weight Classification in Adults, Ottawa, Office of Nutrition Policy and Promotion.
Health Canada publications service, Cat no.
H49-179/2003F, p. 9.
2 Consult the previous reference for full information on levels of risk.
3 Foster GD, Wadden TA, Vogt RA, Brewer G
(1997). What is a reasonable weight loss? Patient’s expectations and evaluations of obesity
treatment outcomes. Journal of Consulting
and Clinical Psychology. 65:79-85.
4 Jeffery RW, Wing RR, Mayer RR (1998).
“Are smaller weight losses or more achievable
weight-loss goals better in the long-term for
obese?” Journal of Consulting and Clinical
Psychology. 66:641-645.
5 NHLBI (National Heart, Lung, and Blood
Institute) (1998). “Clinical Guidelines on the
Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults,” [Summary], [On line], [http://www.nhlbi.nih.gov/nhlbi/]
(18 septembre 2000).
6 Cooper Z, Fairburn CG (2001). “A new cognitive behavioural approach to the treatment
of obesity.” Behaviour Research and Therapy.
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7 Lee CD, Blair SN, Jackson AS (1999). “Cardio respiratory fitness, body composition, and
all-cause and cardiovascular disease mortality
in men.” American Journal of Clinical Nutrition.
69:373-380.
8 Farrell SW, Braun L, Barlow CE, Cheng YJ,
Blair SN (2002). “The relation of body mass
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9 Blair SN, Brodney S (1999). “Effects of
physical inactivity and obesity on morbidity
and mortality: current evidence and research
issues.” Medicine and Science in Sports Exercise. 31:S646-S662.
10 Ravussin E (2002). “Energy expenditure
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CG, Brownell KD, 2nd ed., New York, The
Guilford Press, Chap. 10, pp. 55-61.
11 Pavlou KN, Steffee WP, Lerman RH, Burrows V (1985). “Effects of dieting and exercise on lean body mass, oxygen uptake, and
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12 Cunningham JJ (1982). “Body composition
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13 Astrup A, Gøtzsche PC, Van de Werken K,
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B (1999). “Meta-analysis of resting metabolic
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14 Leibel RL, Rosenbaum M, Hirsch J (1995).
“Changes in energy expenditure resulting from
altered body weight.” New England Journal of
Medicine. 332(10):621-628.
15 Wadden TA, Berkowitz RI (2002). “VeryLow-Calorie Diets.” Eating Disorders and
Obesity. A Comprehensive Handbook. Fairburn CG, Brownell KD (ed.), 2nd ed., New
York, The Guilford Press, Chap. 96, pp.
534-538.
16 Melanson K, Dwyer J (2002). “Popular
diets for treatment of overweight and obesity.”
Handbook of Obesity Treatment. Wadden TA,
Stunkard AJ (ed.), New York, The Guilford
Press, Chap. 12, pp. 249-282.
17 Calloway W (1988). “Biologic adaptations
to starvation and semi-starvation.” Obesity
and Weight Control. Frankle RT and Yang MI,
New York, Aspen Publication, pp.97-108.
18 Gregg EW, Williamson DF (2002). “The
relationship of intentional weight loss to disease incidence and mortality.” Handbook of
Obesity Treatment. Wadden TA, Stunkard AJ
(ed.), New York, The Guilford Press, Chap. 7,
pp. 125-143.
19 Valdez R, Gregg EW, Williamson DF (2002).
“Effects of weight loss on morbidity and
mortality.” Eating Disorders and Obesity. A
Comprehensive Handbook. Brownell KD, CG
Fairburn (ed.), New York, The Guilford Press,
Chap. 88, pp. 490-494.
20 Berg FM (1999). “Health risks associated with weight loss and obesity treatment
programs.” Journal of Social Issues. 55(2):
277-297.
21 Rasio E (1970). “Répercussions métaboliques du jeûne.” Revue Médicale de Bruxelles.
26(10):569-579.
22 Petersmark and Smith (1989). Toward
safe weight-loss recommendations for adult
weight-loss programs in Michigan. Michigan
Health Council, Lansing MI, Michigan Department of Public Health.
23 Apfeldorfer G, Zermati J-P (2001). “La
restriction cognitive face à l’obésité, histoire
des idées, description clinique.” La Presse
médicale. 30 (32): 1575-1580.
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