Australia has a seriously escalating obesity problem. In the past 20 years the number of people with weight problems has doubled; about 60% of Australian adults are overweight or obese, and we're on track to reach 70% by 2010.
What everyone is looking for is a quick, easy, personalised and private solution--which is why pharmacy-based diet programs appeal. There's no fronting up for group counselling or public weigh-ins; most use meal replacements that sound like an easy calorie-counting-free option; and the speed at which some claim you can lose weight effortlessly is counted in weeks, not months or years.
Our findings confirm these diet plans, if followed closely, will certainly shed the kilos in record time, but are they safe and are customers properly assessed and monitored by the pharmacies? Do these fast-track diet plans address the real issues at the root of the weight problem? And is it the pharmacies themselves who end up profiting the most?
CHOICE goes undercover
To anonymously assess these programs CHOICE sent three overweight people to a selection of pharmacies offering seven different diet programs, and asked a panel of experts to assess our findings (see Meet the Experts, below right).
All the pharmacy plans involve a weekly visit to your pharmacy consultant and a diet that restricts carbohydrates to some extent. All except Ultra Lite use meal replacements to keep your intake in check. The basics of each program are shown in the table, page 14.
The least you might expect on your first visit is for your consultation and weigh-in to take place in a private area away from other shoppers. But in five of our 20 consultations, privacy was not considered: for example, a MediTrim consultant used an open area near the pharmacist; one Xndo consultation took place behind a screen next to shelves where shoppers were browsing; and one Dr Tim's Success consultant interviewed our shadow shopper at the pharmacy counter where other people were being served.
On average, the first consultation was 40 minutes, however they ranged from a fairly brief 20 minutes for Dr Tim's Success to about 80 minutes for Ultra Lite. Most pharmacies gave our shoppers the name of a person to keep in touch with and return to for weigh-ins, and suggested weekly follow-up visits.
Most consultations involved their weight being measured, and about three-quarters checked waist circumference, which is useful for getting an overall picture and measuring improvements. Some programs used bio-impedance scales (see Body Fat Scales, CHOICE October 2005 or www.choice.com.au) to assess factors such as body fat and metabolic rate. Our panel thought these assessment methods were generally good, however they were concerned about the limited training consultants received in order to correctly interpret them (see Our 'Highly Trained' Consultants, opposite).
Who will pharmacies accept?
Our experts agreed all the program consultants asked our shadow shoppers enough about their health to cover themselves but, at too many pharmacies, little more. Our shadow shoppers were asked about current medical conditions, such as diabetes or high blood pressure, and any medications they were taking.
However, the majority of consultants didn't assess family medical history, current exercise levels, usual diet and lifestyle, alcohol intake and previous weight loss methods. No program asked our shadow shoppers all of these important background questions, although Xndo did best, covering more of these issues than the other programs. But some (Kate Morgan, Betty Baxter and two Tony Ferguson consultants) only asked the basics.
Most claim to screen for people with known risk factors. Those with diabetes must get their GP's agreement, for example. However, this is no guarantee of their doctor's ongoing input. Most programs rightfully said they wouldn't accept pregnant or breastfeeding women (some would only if their GP recommended it), but Tony Ferguson and Ultra Lite accept some children. Our experts described this as "disgraceful and irresponsible", as they consider these diet strategies inappropriate for children.
The experts are concerned that people who are not overweight are eligible to go on most of the diets. Of the programs that told us about their practices, only Betty Baxter and Dr Tim's Success excluded people of normal, healthy weight from participating. Betty Baxter allows people with a normal body mass index (BMI) to join only if they have other measures that suggest they need to lose weight, such as high body fat or waist measurement. Dr Tim's Success is the only program limited to people who are overweight or obese.
Our 'highly trained' consultants
"Dedicated support staff"; "our trained consultants will always be available", "trained pharmacy consultants", "fully trained ... program partners", Despite the rhetoric, four of the programs provide pharmacy consultants with just three to six hours' basic training. Of the remainder, MediTrim, Tony Ferguson, Ultra Lite and Xndo offer two-day basic training, while only Dr Tim's Success, Tony Ferguson, Ultra Lite and Xndo told us they require consultants to pass a test, which our experts supported. Ongoing training is also variable, ranging from none to an additional 16 hours per year. Only three companies volunteered details of what their training covered and in all cases some of the precious time covered "marketing techniques", "selling tips" or "overcoming objections".
Our experts regard the level of training as grossly inadequate to deal effectively with the complex issues surrounding weight loss. Behavioural counselling--helping people understand why they eat as they do and how to help them make permanent changes-was largely overlooked in the programs' simplified, one-size-fits-all solutions.
Are the diets nutritionally OK?
Most programs rely on limiting carbohydrates and restricting kilojoules to put the dieter into a state of ketosis (see Did You Know?, page 12). However, our experts have several issues with the nutrition profiles of the diets.
* Most are around 4000kJ per day in the main weight-loss stage. Only AlphaSlim, Betty Baxter and Kate Morgan come close to 5000kJ per day, which is regarded as the minimum to get all your necessary micronutrients. At less than 500gkJ--even with added supplements--levels of other nutrients and beneficial food chemicals such as phytochemicals can be compromised. Decreases in metabolic rate are also a risk, as the body tries to protect itself against starvation. Since we assessed the diets Tony Ferguson has changed its program to include an option that increases the energy to 5g00kJ per day and contains more carbohydrates.
* Some of the programs contain about 100 grams of carbohydrates per day; several contain much less. Too little will result in ketosis and can also risk the loss of muscle rather than fat. Although in some cases eating sufficient protein can help protect muscle, it's a fine balancing act as too much protein can also cause problems.
* All the diets fall short on fibre in the weight-loss phase (except Betty Baxter which adds it to the meal replacements). Some are low even when a fibre supplement is included--too little fibre can cause constipation.
* To keep the carbohydrates low, some programs either ban or severely limit cereal foods, including wholegrains, which are proven to have long-term health benefits, such as reducing the risk of some cancers and heart disease.
* MediTrimand Xndo replace meals with drinks that don't meet the Australian standard for meal replacements, but both are careful not to call their drinks meal replacements.
* The only program to get the nutritional thumbs-up from our experts is Betty Baxter, which has a reasonable amount of kilojoules, enough carbohydrates to keep ketosis in check and allows low-GI wholegrain carbs even in the early stages.
The big upsell
Apart from the cost of the program and meal replacements where they're used, most programs also include supplements which add to the pharmacy's bottom line.
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Multivitamin and mineral supplement
Most programs recommend these, which the pharmacy conveniently sells (program-branded or otherwise). Only Dr Tim's Success doesn't require you to buy any additional supplements to meet vitamin and mineral needs. However, one of our shadow shoppers was sold three pharmacy-packaged vitamin and herbal supplements as part of their Dr Tim's Success starter kit.
The fact so much of the nutritional intake is from supplements or vitamins added to the meal replacements concerned our panel. Real food is the best way to get vitamins and minerals--not enough is known about the other important components of real food, and taking more of some nutrients than you might need in the form of multiple supplements is not ideal.
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Diet pills The most popular diet pill-type supplement with most programs is chromium, which is supposed to reduce sugar cravings. But our experts say the evidence for this is far from convincing.
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Fibre supplements are another popular upsell--either program-branded or not--and they're available from the pharmacy. According to the experts and our analysis of the diets, you're likely to need them. The fibre levels of all programs, except Betty Baxter, are too low and constipation is a real possibility.
Flaxseed oil Our experts questioned why several programs suggest daily flaxseed oil as a way of getting sufficient omega-3 fats. Flaxseed oil goes rancid very quickly and can have a most unfavourable fat profile. Other, more stable oils, such as olive oil. would be better.
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Other extras Xndo had the most extras on offer--instant coffee, soft drink and cordial at $1.60 per serve.
nutshell
* Pharmacy diet plans may help to shed extra kilos quickly, but most fail to deal effectively with the complex broader issues around weight loss.
* CHOICE cannot recommend these programs until consultants improve their training and move beyond the "one-size-fits-all" approach.
Did you know?
What is ketosis? When your body doesn't get enough carbohydrates, it produces ketones from body fat, which it burns instead of carbohydrates to produce energy. Some people experience ketosis when they eat fewer than 100g of carbohydrates a day; once carbohydrates are at 50g most people will experience it. Some organs of your body, such as the brain and red blood cells, need glucose for energy, and if you don't eat enough carbohydrates to supply them, your body will break down protein--from your muscles if you're not eating enough protein--as an energy source for these organs.
What are the benefits? Quick initial weight Loss (mainly due to fluid loss] may increase your motivation. Some people claim the fluid Loss also reduces feelings of bloating. Ketosis can also help make you feel. Less hungry.
And the downsides? Some undesirable side-effects are mild dehydration, poor athletic performance, nausea, bad breath, risk of blood pressure problems, an increased risk of osteoporosis and muscle and blood vessel damage. It may also make concentrating on mental tasks more difficult.
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Meet the experts
Thanks to our expert panel who digested many kilos of information about the programs to help us assess each one.
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Susie is an accredited practising dietitian who specialises in obesity. She holds an honours degree in psychology and is the specialist obesity dietitian at The Children's Hospital at Westmead in Sydney. She is a spokesperson for the Dietitians' Association of Australia.
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David is Associate Professor and course co-ordinator of Food Science and Nutrition at Deakin University and current chair of the Victorian Division of the Nutrition Society of Australia.
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Melanie is an accredited practising dietitian specialising in obesity, with a particular interest in weight-loss surgery. She is a spokesperson for the Dietitians' Association of Australia.
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Matt is an accredited practising dietitian and exercise physiologist specialising in weight management. He is the founder of SmartShape and runs training courses on nutrition and weight loss for health and fitness professionals.
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Rosemary is a well-known and widely respected nutritionist. She is the author of numerous scientific papers, is associated with several universities and sits on many prestigious scientific committees.
CAN MEAL REPLACEMENTS EVER BE USEFUL?
Doctors and dietitians sometimes use meat replacements in hospitals and clinics to treat obese and very obese people, whose health is seriously at risk. These people usually have health problems, such as heart disease or high-blood pressure, and have failed to Lose weight using other approaches. Meal replacements are also commonly used before weight-loss surgery, such as gastric banding. They're most likely to be effective when there's dose medical supervision and effective counselling on tong-term diet. lifestyle, behavioural and psychological issues. And this is the critical area where our CHOICE shadow shop found the pharmacy-based meal replacement programs fall short.
CHOICE verdict
These programs are of obvious financial benefit to the pharmacies, and a constant stream of short-term clients will shift a lot of product off the shelves. Will you lose weight? If you follow them closely, yes. Will the pharmacy setting provide you with your own highly skilled weight-loss advisor? Our experts think not. Considering the inadequate training of consultants, little ability to tailor programs and deal with individual circumstances and habits, as well as the lack of close, qualified supervision, CHOICE does not recommend these programs.
The current regulations and voluntary codes of practice covering weight-loss programs are insufficient. CHOICE wants to see a national accreditation system, including minimum standards for training, covering all programs, consultants and leaders who counsel people on losing weight.
PRODUCT FEATURES
Program (in Meal Meets Claimed weight-
alphabetical replacements Australian loss/average
order) meal time on program
replacement
standard
AlphaSlim Two per day, plus a Yes (C) 0.5kg to 1 kg
Pharmacy main meal at night per week/until
Weight Loss (A) and fruit for weight lost
snacks. A "free day"
is introduced after
four weeks
Betty Baxter Two per day, plus a Yes Maximum 1 kg per
Complete Weight main meal at night week/six to
Management and snacks eight weeks (at
a time)
Dr Tim's Two per day, plus a Yes Up to 6kg
Success main meal at night (women), 9kg
(fruit for snacks (men) over four
after two weeks) week/12 weeks
Kate Morgan Two per day, plus a Yes (D) 1kg per week/12
Weight Loss main meal at night to 16 weeks
and fruit for snacks
MediTrim (B) Three per day No (E) 1 kg to 2kg per
initially, then two week; time on
per day plus a main program not
meal at night and known
fruit/nuts for
snacks
Tony Ferguson Two per day, plus a Yes No claims on
Weightloss main meal at night weight loss/five
and fruit for snacks weeks (at a
time)
Ultra Lite None. Based on na 10kg/five-week
Weight counting and program; 15kg to
Management limiting 20kg/10-week
carbohydrate content program
using ordinary foods
Xndo Weight Two per day, plus a No (E) 0.5kg to 1 kg
Control System main meal at night per week/until
and fruit for weight lost
snacks. There is
also a non-meal
replacement option
PRODUCT CONSULTANTS' TRAINING
Program (in
alphabetical
order) Initial Ongoing Contact
AlphaSlim Three hours "As scheduled or alphaslim.com.au
Pharmacy required"
Weight Loss (A)
Betty Baxter Four hours Nine to 16 hours bettybaxter.com.au
Complete Weight per year
Management
Dr Tim's Three hours Within first few drtimssuccess.com.au
Success months, four to
six hours;
two-hour
refresher
training
available.
Online training
is also
available "at
anytime"
Kate Morgan Six hours No structured katemorgan.com.au
Weight Loss program;
experienced
staff require
little ongoing
training
MediTrim (B) Two days Not known meditrim.com.au
Tony Ferguson Two days Four-hour tonyferguson.com
Weightloss training on
maintenance
diet; advanced/
master
practitioner
training from
2009
Ultra Lite Two days Recommend ultralite.com.au
Weight refresher
Management training once
per year
Xndo Weight Two days "Regular xndo.com.au
Control System advanced
training
courses"
PRODUCT COSTS
Program (in Membership, Ongoing meal
alphabetical diet plan/ replacements Supplements
order) diary per week to buy
AlphaSlim $29.90 $43.28 Optional multivitamin;
Pharmacy fibre supplement;
Weight Loss (A) flaxseed/olive/
grapeseed oil; chromium
supplement
Betty Baxter $25.90 $45.15 Multivitamin; flaxseed
Complete Weight oil; chromium supplement
Management
Dr Tim's $21 (F) $45.15 (H) None (J)
Success
Kate Morgan $24.95 $45.50 Multivitamin; fibre
Weight Loss supplement; chromium
supplement
MediTrim (B) $25.00 $42.00 MediTrim multivitamin
($24.95/60 tablets);
MediTrim Fibre complex
($27.50/500g); MediTrim
Balance ($28.50/60
tablets); MediTrim Fat
Burner ($34.95/60
tablets); MediTrim
Appetite reduce
($34.99/60 tablets);
flaxseed oil; apple
cider vinegar
Tony Ferguson $24.95 $45.50 Tony Ferguson branded
Weightloss Simply balanced
(multivitamin; $26.95/60
tablets), Simply fibre
($18.40/280g), Simply
chromium ($13.80/60
tablets)
Ultra Lite $395 (G) na (G) Flaxseed oil; apple
Weight cider vinegar; urine
Management test strips and
potassium supplement (K)
Xndo Weight $19.95 $41.86 Xndo branded law joule
Control System "snack water" ($15.99-
16.99/10); low-joule
coffee sachets
($18.99/10); lemon tea
booster (tea with
vitamins and minerals,
$39.99 for 30); Xndo
Block & Burn ($14.99/
week, 15 tablets)
TABLE NOTES
(A) All information from AlphaSlim.
AlphaSlim's program details were not
made available to us in time to include
them in the shadow shop.
(B) All information from MediTrim website
and shadow shop--company did not
return our survey (but did confirm the data
we collected as correct).
(C) Shakes meet standard; soups are low
in phosphorus.
(D) Kate Morgan evening meals are not
meal replacements.
(E) The company does not specifically claim
their products are meal replacements.
However, they are used to replace meals.
(F) The starter pack is $66 and includes the
first week's shakes, worth $45.
(G) For the five-week program, includes first
and then weekly consultations, manual and
recipe book, enough vitamin-drink sachets
for four sachets per day Depending
on the pharmacy, this cost may or may
not include flaxseed oil, apple cider
vinegar, urine test strips and a potassium
supplement ($47.95 if bought separately);
10-week program is also available.
(H) One shadow shopper was told her
weekly visits would cost $5 each, even
though the company says they should
be free.
(J) No additional supplements are
required, according to the company's
information; however, one shadow
shopper was sold extra herbal and vitamin
supplements in the pharmacy.
(K) These may be included in the program
price at some pharmacies. Vitamin-drink
sachets are included in the cost.
Source Citation
"Losing weight on a 'program': pharmacies are getting into the weight loss business, but how do these diet plans weigh up? Our CHOICE investigation reveals some serious shortcomings." Choice [Chippendale, Australia] Feb. 2009: 12+. Academic OneFile. Web. 3 Jan. 2010.
Gale Document Number:A194277044
Disclaimer:This information is not a tool for self-diagnosis or a substitute for professional care.
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