A bad influence?

When Kim Kardashian posted a sponsored advert for appetite-suppressant lollipops on Instagram last year¹, she most likely thought it was just another day in the life and career of a social media influencer; after all, it wasn’t the first post she had made promoting a weight-loss product, and she was far from the only influencer to do so. This time, however, she was met with heavy criticism – most notably from Jameela Jamil, British actress and founder of the ‘I Weigh’ body positivity movement – because it was felt that this particular product targeted children. 

To date, Kardashian has over 150 million followers on Instagram, so most popular news outlets spent days reporting on her lollipop-themed saga. Three months prior, much less media attention was paid to the publication of NHS data showing that hospital admissions for eating disorders increased by 191% over the previous six-year period². With the biggest increase shown in teenage patients, and with research demonstrating that social media affects body image in adolescents, it is understandable and justified that diet products aimed at such at-risk groups receive this kind of condemnation. It begs the question, however – when eating disorder rates are increasing for adults too, why don’t adverts targeting this demographic receive the same level of contempt? 

Perhaps it’s assumed that adults have the capability to make completely informed and independent decisions, free from the effects of marketing campaigns. This ignores the strong effects of popular media culture on our choices, even on those who believe themselves to be unaffected³. As modern technologies such as TiVo and Adblocker allow users to bypass more traditional advertising methods, marketers have sought out new ways to reach target audiences, leading to the rise of influencer promotions. While traditional marketing sells a product, social media influencers essentially sell a lifestyle. They share so much of their lives online that followers feel as if they know them. This makes their promotions feel like recommendations from a trusted friend. The result is that whilst traditional adverts are seen as an annoyance to be avoided, 1 in 4 people in the UK have purchased something based on an influencer’s promotion and 1 in 5 say they actually like seeing sponsored posts from influencers⁴.

On the other hand it’s perhaps assumed that since they are being publicly advertised, these products are safe to use. Unfortunately, that’s not necessarily the case. Here in the UK, over-the-counter anorectic drugs (also commonly known as appetite suppressants) are not regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA) and their history as a prescription product highlights their potential dangers.

Until 2010, anorectic drugs were prescribed by the NHS to people over a certain BMI. Doctors were able to look at patients’ existing conditions and medications: they understood when it was appropriate to offer a prescription and when it wasn’t. This practice stopped entirely upon the discovery that sibutramine hydrochloride monohydrate, the active ingredient in the most popular anorectic drug of the time, was associated with increased risk of heart attack and stroke. Products containing this active ingredient were promptly banned by the European Medicines Agency (EMA) and were withdrawn from NHS prescription as a result. It was an example of regulatory bodies working well to ensure product safety and suitability. 

In comparison, people purchasing products via social media adverts are rarely fully informed about the potential risks associated with their personal circumstances. With a correlation established between depression and poor body image⁵, one concern is that people taking antidepressants may be more likely to purchase these products, not realising the risk attached to combining their medication with weight-loss supplements.

Many anorectic drugs work via what is known as a serotonergic effect: they work to inhibit the reuptake of the neurotransmitter serotonin, leading to increased serotonin levels in the brain. Serotonin has been associated with an increased feeling of satiation; the higher the amount of this neurotransmitter in your system, the longer you feel full on a smaller portion of food. This isn’t its only effect however. Higher levels are also linked with feelings of happiness and calm, which is why antidepressants called selective serotonin reuptake inhibitors (SSRIs) work to achieve the same result. Many people will not think to mention over-the-counter supplements or diet products to their doctor as they don’t think of them as medicine. This unintentional withholding of information can lead doctors to prescribe a higher dosage of SSRIs than is safe and may potentially increase a patient’s risk of serotonin syndrome, a set of worrying symptoms linked to an overproduction of serotonin. While rarely observed, in some extreme cases it can be fatal. 

These are just the occasions where anorectic drugs interact with other drugs or existing conditions. It doesn’t touch on the many potential side effects that can occur based purely on anorectic drugs taken by a healthy individual, which include pulmonary hypertension, vision loss and increased risk of stroke. Most people don’t expect these to be the risks when purchasing a publicly advertised product.

Some progress has been made, albeit very slowly. The Advertising Standards Authority (ASA) recently banned promotional posts made by reality stars Lauren Goodger and Katie Price, stating that photoshopping their body shape in images whilst promoting weight loss products was irresponsible and misleading. It’s a positive step forward to see the harmful and disingenuous effects of photoshopping being formally addressed. However, the product being promoted by Goodger and Price contained the active ingredient glucomannan. This has been found to have no real effect on weight loss and has been linked to pulmonary hypertension. In fact, it is specifically not recommended for diabetics as it may interfere with blood sugar control. Interestingly enough, even though neither of the banned promotions had thought to mention that, that wasn’t a factor in their ban. 

Unfortunately, regulation of social media promotions seems limited. The ASA will crack down on promotions making unfounded health claims (such as saying a product will promote weight loss when there is no research to demonstrate that) and they insist that if an influencer is being paid for a  promotion, this must be disclosed. However, the only disclosure required is the inclusion of a small “#ad” at the end of each post. With no official regulation addressing the issue, it is common for promotions to be posted without warnings of potential side effects. 

Perhaps this is where the real change needs to begin: with stricter regulations of social media advertising. If diet supplement advertisements on social media were required to state the side effects clearly, it might not only make the followers think twice about buying it, but also make influencers reconsider their promotions; because after all, if readers aren’t getting the whole story from brands, who’s to say the influencers are? Further, if the sponsored nature of influencer posts had to be declared clearly at the start of the post, rather than via a two letter hashtag nestled in amongst multiple others, it would prevent people from assuming these are personal recommendations that can be blindly and wholly trusted.

This article was specialist edited by Evita Muller and copy-edited by Elle Lindsay.

1. https://www.bbc.co.uk/news/newsbeat-44137700
2. https://www.theguardian.com/society/2018/feb/12/eating-disorders-nhs-reports-surge-in-hospital-admissions
3. https://digest.bps.org.uk/2018/05/01/even-those-participants-who-claimed-pop-culture-is-unimportant-suffered-psychological-ill-effects-from-feeling-out-of-the-loop/
4. https://www.campaignlive.co.uk/article/influencers-persuade-one-four-brits-buy-products-says-golin-research/1463729
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843362/