Can Supplements Help You Lose Weight?

There are no surprises here! The bottom line is that there is no magic bullet; no instantly successful pill or potion. There is no supplement that is both safe and effective for losing weight. But I’m not here to leave you without hope. There are some possible options to consider.

Overweight and Obesity

Obesity and overweight are conditions that are epidemic in North America, particularly in the US. In 2020, the CDC reported that about seventy percent of US adults were overweight or obese, about forty percent obese, and nearly ten percent severely obese. Obesity is most common in African Americans (48 percent), followed by Hispanics (43 percent), Caucasians (33 percent), and Asians (11 percent).

Body mass index (BMI) is a standardized measure used to diagnose whether you are overweight or obese. There are multiple websites with BMI calculators. You only need to enter your height and weight. It is a useful tool because it is fast and easy. According to the CDC, here’s how to interpret your BMI:

  • If your BMI is less than 18.5, it falls within the underweight range.
  • If your BMI is 18.5 to <25, it falls within the normal range.
  • If your BMI is 25.0 to <30, it falls within the overweight range. Some experts say if your BMI is 27.0 to 29.9, it falls into the extreme overweight range.
  • If your BMI is 30.0 or higher, it falls within the obese range. 

Obesity is frequently subdivided into categories:

  • Class 1: BMI of 30 to <35
  • Class 2: BMI of 35 to <40
  • Class 3: BMI of 40 or higher. This is also called “morbid,” “severe,” or “extreme” obesity.

However, BMI does not directly measure fat but estimates body fatness based on excess weight. In other words, BMI does not distinguish between weight due to fat, muscle, water/fluids, or bone. 

As a result, BMI calculations may overestimate body fat in muscular individuals or underestimate body fat in people, especially older people, who have lost muscle. Because of this limitation, many experts recommend using BMI in conjunction with other body-composition tests, including abdominal circumference, skinfold tests, or body fat measured by biometrical impedance.

I have also reviewed a lot of weight loss supplements, if you are interested, you might check them out.

Consequences of Obesity

Repercussions of the obesity epidemic are enormous. The rates of comorbid conditions like type 2 diabetes have sharply increased as obesity raises the risk of diabetes by ten to twenty times. As a result, rates of diabetes have jumped by 60 percent in the last ten years.

Similarly, obesity is associated with high blood pressure. Evidence suggests that every twenty-pound increase in body weight is associated with a three-point increase in systolic blood pressure and over two points of increase in diastolic blood pressure.

Obesity is also associated with abnormal lipid levels and elevated levels of inflammatory agents in your bloodstream (fibrinogen and C-reactive protein).

All of these factors increase the risk of cardiovascular disease events, including coronary heart disease, myocardial infarction, heart failure, and stroke, as well as chronic kidney failure.

Why are so many people overweight or obese? There are several explanations, but the most fundamental reason is that we consume more calories than we burn.

Two main reasons for this are increased calorie intake and decreased physical activity.

Other factors that may contribute include genetics and family history.

Furthermore, several health conditions (i.e., hypothyroidism or polycystic ovarian syndrome [PCOS]) may cause a person to become overweight. Lastly, some medicines (particularly corticosteroids, antidepressants, or antiepileptic drugs), certain emotional factors (anger, stress, anxiety, depression), smoking cessation, aging, pregnancy, and lack of or poor sleep can contribute to weight gain.

Beware of Weight Loss Claims

For those who are overweight or obese, multiple medical studies have concluded that the best way to accomplish sustained, healthy weight loss is to aim for a caloric intake that is modestly below daily requirements to create a calorie deficit. 

For most people, this means lowering total daily calorie intake by 500 to 1,000 calories while adding thirty minutes of exercise at least five days a week. This approach can decrease weight by 5 to 10 percent over three to twelve months. Sadly, most people in the US aren’t willing to focus on their nutrition and their exercise.

Approximately 15 percent of US adults have used a weight-loss dietary supplement at some point in their lives; more women (21 percent) report use than men (10 percent). Americans spend about $2.1 billion a year on weight-loss dietary supplements, and one of the top reasons people take dietary supplements is to lose weight. 

As you’ll see, these many millions of Americans are both wasting their money and potentially endangering themselves.

But what about the myriad ads, claims, and testimonials about unbelievable weight loss with supplements? According to the Federal Trade Commission, “Wouldn’t it be nice if you could lose weight simply by taking a pill, wearing a patch, or rubbing in a cream? Unfortunately, claims that you can lose weight without changing your habits just aren’t true.”

Rosario Méndez, an attorney with the FTC, couldn’t be clearer: “Ads for weight loss products promise miracles. They might say that the product works for everyone or will let you lose weight permanently. Those claims are lies. Dishonest advertisers will tell you anything to get you to buy their product. They might have images of ‘doctors’ in their ads and even ‘news reports’ to make you believe that the product works.”

Ms. Méndez adds, “The FTC has investigated, sued, and stopped many companies that made false weight-loss claims in their ads…. If you get wooed by a weight-loss ad with wild promises, all you’ll lose is your money. And the products might not even be safe.”

According to the FTC, “Here are some of the (false) promises from weight loss ads:

  • Lose weight without dieting or exercising. (You won’t.)
  • You don’t have to watch what you eat to lose weight. (You do.)
  • If you use this product, you’ll lose weight permanently. (Wrong.)
  • To lose weight, all you have to do is take this pill. (Not true.)
  • You can lose 30 pounds in 30 days. (Nope.)
  • This product works for everyone. (It doesn’t.)
  • Lose weight with this patch or cream. (You can’t.)

“Here’s the truth:

  • Any promise of miraculous weight loss is simply untrue.
  • There’s no magic way to lose weight without a sensible diet and regular exercise.
  • No product will let you eat all the food you want and still lose weight.
  • Permanent weight loss requires permanent lifestyle changes, so don’t trust any product that promises once-and-for-all results.
  • FDA-approved fat-absorption blockers or appetite suppressants won’t result in weight loss on their own; those products are to be taken with a nutrient- dense diet and regular exercise.
  • Products promising lightning-fast weight loss are always a scam, and they can ruin your health.
  • Even if a product could help some people lose weight in some situations, there’s no one-size-fits-all product guaranteed to work for everyone.
  • Everyone’s habits and health concerns are unique.
  • Nothing you can wear or apply to your skin will cause you to lose weight. Period.”

ConsumerLab.com is clear: “There isn’t overwhelming evidence that any dietary supplement enables significant, long-term weight loss.” The NIH Office of Dietary Supplements writes, “Sellers of (weight loss) supplements might claim that their products help you lose weight by blocking the absorption of fat or carbohydrates, curbing your appetite, or speeding up your metabolism. But there’s little scientific evidence that weight-loss supplements work. Many are expensive, some can interact or interfere with medications, and a few might be harmful.”

Public health experts from Harvard T.H. Chan School of Public Health in Boston write, “Dietary supplements sold for weight loss….are not medically recommended. They have been shown to be ineffective in many cases and pose serious health risks to consumers due to contamination with banned substances, prescription pharmaceuticals, and other dangerous chemicals.” 

The Harvard experts add, “In fact, the FDA has been well aware of this heightened risk for many years.” The FDA has issued special warnings in the past “to consumers regarding supplements sold for weight loss, muscle building, and sexual function as being more likely than other supplements to be deceptively marketed and tainted with toxic ingredients.”

FDA regulators explain, “Know this: many so-called ‘miracle’ weight loss supplements and foods (including teas and coffees) don’t live up to their claims. Worse, they can cause serious harm.”

The FDA has discovered hundreds of products that are marketed as dietary supplements but actually contain hidden active ingredients—for example, prescription drugs, unsafe ingredients that were in drugs that have been removed from the market, or compounds that have not been adequately studied in humans.

This federal law makes it the responsibility of the company selling natural medicines to make sure that its products are safe and that any claims made about such products are accurate.

Therefore, as the FDA says, “Just because you see a supplement product on a store shelf does not mean it is safe.” 

Some are dangerous! Only after safety issues are suspected can the FDA investigate and then, when warranted, take steps to have these products removed from the market. Recent history should be instructive. 

This list is adapted from Futures Recovery Healthcare: Fen-Phen—recalled. Fenfluramine, one of the two active ingredients in the off-label diet drug combination 

  • Fen-Phen was recalled in the late 1990s after the drug was linked to cases of heart damage and lung disease. Phentermine, the other primary ingredient in Fen-Phen, is still prescribed in some instances for weight loss but should be used only with a doctor’s prescription. 
  • Ephedra—banned. Once widely sold as an ingredient in diet supplements, ephedra is a Chinese herbal stimulant banned in 2004 because of evidence that its use increased the risk of heart attacks and strokes. In 2005, a lower court ruled that ephedra could be used in small doses. In 2006, a federal appeals court reinstated the FDA’s original ban, ruling that ephedra was too dangerous to take as a supplement at any dose.
  • Hydroxycut®—recalled and banned. Hydroxycut® products containing ephedra were banned and recalled in 2009 because of twenty-three reports of liver damage from the drug, one person requiring a liver transplant, and at least one death.  In a 2011 report, CBS News wrote, “In a normal world a company like [the] maker of the diet supplement Hydroxycut shouldn’t exist. Twice its products have killed people. Twice its products have been removed from the market by the FDA. Twice, the company has ‘reformulated’ the product to replace its active ingredient with a completely different substance. Yet [the company] continues to sell its snake oil, making the same ‘clinically proven’ claims for each generation of its product, often with identical wording.” Natural Medicines gives a NMBER® rating of 2 out of 10 for the reformulated product.
  • Meridia®—withdrawn from the market. Sibutramine, a prescription drug sold as Meridia®, prescribed initially as a long-term appetite suppressant and weight-management solution, was voluntarily withdrawn from the market by the manufacturer in 2010 after a clinical study indicated that the drug increased the risk of heart attacks and strokes. In 2018, the FDA announced it had uncovered sixty-eight natural medicines being marketed illegally for weight loss that contained significant amounts of sibutramine. 

The FDA warned that it “cannot test all products on the market that contain potentially harmful hidden ingredients. Enforcement actions and consumer advisories for tainted products only cover a small fraction of the tainted over-the-counter products on the market.”

The FDA continuously issues public notifications and has issued warning letters, seized products, and criminally prosecuted people responsible for marketing illegal diet products. In addition, the FDA has recalled many tainted weight-loss products and maintains an online list of its public notifications and tainted weight-loss products.

As the FDA concludes, “These deceptive products can harm you!” Unfortunately, as the FDA also warns us, “Hidden ingredients are increasingly becoming a problem in products promoted for weight loss.”

Supplements That Might Work For Weight Loss

According to Natural Medicines, there is no herb, vitamin, or dietary supplement (natural medicine) that is “Likely Safe” or “Effective” for weight loss. However, there are four worth considering that may pan out in the future.

Blond psyllium

Blond psyllium is a water-soluble fiber that has been shown in some preliminary clinical evidence to reduce body weight and appetite in people who are overweight or obese. Unfortunately, there are no long-term studies of its use for weight loss.

Adults may take 3 to 6 grams of psyllium (1 to 2 teaspoons) in or with eight ounces of water two to three times a day (although in studies doses of up to 36 grams a day have been used). ConsumerLab writes: Psyllium (such as in Metamucil®) may help control hunger. A clinical study (funded by the maker of Metamucil®) of 30 healthy adults put on reduced-calorie, low fiber diets found that drinking 6.8 g of psyllium (2 teaspoons) mixed with 1.2 cups of water before breakfast and lunch for three days modestly decreased hunger and desire to eat between meals, as compared to placebo of matching taste and color. A lower dose (3.4 g) was not as effective, and a higher dose (10.2 g) was no more effective. The specific psyllium product used was Metamucil® Orange Sugar-Free Fiber Singles (Procter & Gamble). Mild to moderate gastrointestinal side effects were reported in about 7 percent of people taking 6.8 g psyllium.

Konstyl is a sugar-free (stevia-sweetened) option. ConsumerLab adds, “It’s not clear if the same benefits would be seen for a person already consuming greater amounts of fiber from their diet.

A side benefit of blond psyllium, according to Natural Medicines, is that 3.4 to 5.1 grams three times a day is “Likely Effective” for lowering cholesterol levels in people with high cholesterol, is “Effective” for improved stool consistency in treating constipation, and is “Possibly Effective” for lowering blood pressure and blood sugar. Psyllium can cause gas and bloat, so many experts recommend starting with lower doses and slowly increasing.

ConsumerLab adds, “Psyllium, a gel-forming viscous soluble fiber, may help control hunger and also improve blood glucose levels and insulin response and modestly lower total and LDL (‘bad’) cholesterol.” Furthermore, Natural Medicines warns, “Blond psyllium and other high-fibre products can reduce the absorption of nutrients including calcium, iron, zinc, and vitamin B12 [cobalamin].” They advise health professionals: “For patients taking supplements, including multivitamins, recommend that they take these one hour before or four hours after blond psyllium to avoid this interaction.”

While many psyllium-containing supplements list only “psyllium” as an ingredient, there are two types of psyllium: blond psyllium and black psyllium. They come from different plant species. Although both are useful for treating constipation, only blond psyllium has been evaluated for overweight or obese patients.

Natural Medicines lists dozens out of about two hundred products containing blond psyllium that it gives a NMBER rating of 9 out of 10 and about one hundred Canadian-licensed products rated 8 out of 10 or higher. NSF® has “Certified” one psyllium product, but the form of psyllium is not labeled.

ConsumerLab and Labdoor have not tested any blond psyllium products. Again, two of the most commercially prominent products are Metamucil® and Konsyl. 

Conjugated linoleic acid (CLA)

A heavily advertised supplement for weight loss is conjugated linoleic acid (CLA). CLA is primarily found in dairy products and beef. Researchers are evaluating CLA’s potential to reduce body fat. Taking 1.8 to 6.8 grams daily seems to decrease body fat mass, increase lean body mass, and reduce waist and hip circumference in some adults. However, CLA does not seem to reduce total body weight or BMI, and there is some concern about its long-term safety.

ConsumerLab concludes, “[CLA] has not been conclusively shown to reduce overall weight.” Natural Medicines tells health professionals, “Until more is known, advise obese patients against using CLA for weight loss.” ConsumerLab did test nine popular CLA products in 2015, and “Approved” seven (a 22 percent failure rate); however, I’d need more information on safety and effectiveness before I could recommend it.

Alpha-Lipoic acid 

Natural Medicines advises, “Clinical studies and analyses of clinical research show that taking alpha-lipoic acid (ALA) 300–1800 mg daily for 8–48 weeks can modestly reduce body weight by [1–3 pounds] and body mass index….when compared with placebo in overweight or obese patients…. While these improvements are statistically significant, they may not be clinically meaningful.” Again, I’d need more information on safety and effectiveness before I could recommend it.

Phaseolus vulgaris

Phaseolus vulgaris is a starch blocker made from the white kidney bean (Phaseolus vulgaris). These products were extensively publicized and sold in the 1970s but removed from the market because the FDA deemed them unproven drugs. Since the passage of DSHEA, starch blockers have been marketed as natural products to avoid the FDA’s scrutiny for efficacy.

ConsumerLab says Phaseolus “may not be effective for weight loss but may modestly help reduce body fat at doses ranging from 445 mg to 3,000 mg per day.” Some studies have evaluated Phaseolus vulgaris extract combined with other ingredients (garcinia extract, inulin from chicory root, or elemental chromium) and found the combination products modestly reduced weight, BMI, and percent body fat in obese individuals. Phaseolus is generally safe in short-term clinical studies with the most commonly reported side effect being mild gastrointestinal symptoms.

ConsumerLab has “Approved” one Phaseolus product, Rock Star Skinny Gal Thermogenic. Although this product claimed “No caffeine,” ConsumerLab found 51.6 mg per serving with a cost of “50 cents per serving.”

Natural Medicines lists no US products (out of over five hundred) that are NMBER rated at 8 out of 10 or higher. I would need more data on effectiveness, safety, and quality to recommend any Phaseolus product.

The Bottom Line: What Actually Works For Weight Loss

For my patients who are overweight or obese, I recommend the following:

1. Nutrition

It’s not just a cliché: “A moment on the lips means a lifetime on the hips,” or as my wife’s family says, “Put it on the lips, wear it on the hips!” Scientists have proven that “even short periods of bingeing on junk food can leave the body more prone to gain weight for years to come.” So what’s the best nutrition plan for weight loss? Everyone has an opinion, but what do the experts say? 

My favorite answer to this question comes from annual ratings of diets from US News and World Reports. The editors convene “a panel of food and health experts to rank 35 diets on a variety of measures,” such as “the diet’s ability to help a person lose weight in the short and long term.”

What did they recommend in their 2020 report? In the “Best Weight-Loss Diets” category, they rank the WW (Weight Watchers) diet #1, the Vegan diet #2, and the Volumetrics diet #3. In the “Best Fast Weight Loss” category, they rate the HMR Program #1, the Optavia diet #2, and the Atkins diet #3. Finally, in the “Best Commercial Diet Plans” category, US News recommends the WW (Weight Watchers) diet #1, the Jenny Craig diet #2, and the Nutritarian diet #3. You can read much more about each of them at tinyurl.com/v6ydcfx.

Also, for the third consecutive year, the Mediterranean diet ranked #1 as the “Best Diet Overall.” (Read more about it in chapter 8, “Cholesterol and Dyslipidemia.”)

If you can afford it, I’d start with one of the top commercial plans, and then once you are successful, I’d recommend transitioning to the Mediterranean diet.

Dr. Worthington writes, “We have a number of diet monographs on our site, and many of them show short-term benefit for weight loss. However, it’s hard to say which diet is best to recommend. Overall, following any one specific diet is probably less important than focusing on overall calorie reduction. Ensuring that a diet promotes moderation AND meets individual preferences is the best way to ensure that a diet strategy will lead to long-term adherence and weight loss maintenance.”

The CDC adds, “The key to achieving and maintaining a healthy weight isn’t about short-term dietary changes. It’s about a lifestyle that includes healthy eating, regular physical activity, and balancing the number of calories you consume with the number of calories your body uses.”

2. Movement

I recommend walking because it is simple. Aim for 150 minutes a week. That’s just 30 minutes a day, five days a week. And, your 30 minutes doesn’t have to be in one session. The CDC says three 10-minute sessions have the same healthful benefits.

According to the most recent physical activity guidelines published in JAMA, “Even two minutes of any physical activity—taking the stairs, walking the dog, or carrying out the trash—can add up to significant health benefits, such as improved blood pressure, enhanced brain function, reduced risk of cancer, and weight loss.”

However, as preventive medicine expert Thomas McKnight, MD, MPH, says, “It’s easy for patients to take in more calories by eating than they are burning with exercise. The elbow is more powerful than the knees, in that sense.”

3. Restful sleep

This one is a surprise to most of my patients. Yet, as WebMD writes, “Catching enough ZZZs is almost as important as exercise or nutrition if you’re looking to lose weight. Studies link a lack of sleep to feeling hungrier and gaining weight. When you skimp on shut-eye, you’re

more likely to eat bigger portions, crave high-carb foods, and choose fatty snacks. Plus, chances are you’ll be too tired to work out—a double whammy. Try to aim for 7 to 8 hours per night.”

This is due to sleep’s impact on two essential hunger hormones, ghrelin and leptin. I tell my patients, “Ghrelin gives you a Greater appetite, while Leptin gives you Less appetite. When you do not get adequate sleep, the body makes more ghrelin and less leptin, leaving you hungry and increasing your appetite.”

If you can’t follow these three recommendations or they don’t work for you, don’t turn to false promises, unnecessary expense, and the potential danger of supplements for weight loss. Dr. Worthington warns, “Weight loss supplements are one of the top three classes of supplements that are tainted with unlisted drugs.” 

Instead, turn to your family physician to discuss adding either an over-the-counter or a prescription anti-obesity drug to use along with items number 1 through 3 above. If you’re overweight or obese, there is hope in these recommendations. 

The National Weight Control Registry housed at Brown School of Medicine is a research study that includes people eighteen years or older who have lost at least thirty pounds of weight and kept it off for at least one year. There are currently over ten thousand members enrolled in the study, making it perhaps the most extensive study of weight loss ever conducted. Members complete annual questionnaires about their current weight, diet, and exercise habits and behavioral strategies for weight loss maintenance.

The research has shown that those registered lost weight by a wide variety of methods. However, 98 percent modified their food intake, while 94 percent increased their exercise. After losing weight, almost all the participants ate breakfast and weighed themselves regularly, most commonly once per week.

About 45 percent lost weight on their own, while 55 percent received help from some type of program. Also, the majority watched less TV than average and engaged in about sixty minutes per day of moderate-intensity physical activity, or the equivalent.30 As Dr. McKnight says, “It’s not easy, but it’s doable!”

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