'On the Web' is an internet-based supplement that provides additional web content to supplement the material in Concepts of Fitness and Wellness. Browse through the whole document to explore web content related to this concept. If you know the specific 'On the Web' number or page number of the web icon in the text you can click on the direct link you are looking for below.

The material available here is for the exclusive use of students and instructors using the Concepts-based textbooks. All rights reserved (McGraw-Hill Higher Education

On the Web - Concept 23

Web23-01: Susceptibility to Quackery

Web23-02: Quackery in Physical Activity

Web23-03: Choosing a Health Club

Web23-04: Issues with the Use of Dietary Supplements

Web23-05: Herbal Supplements

Web23-06: Tanning and Tips to Being Safe in the Sun

Web23-07: Health Information on the Internet

Web23-08 Issues with Consumerism

Web23-09: Web Resources

Web23-10: Supplemental Readings

Web23-01: Susceptibility to Quackery

Quackery is rampant within the commercial fitness and nutrition marketplace. A variety of quack products are available that promise weight loss or improved fitness with little or no effort. Research has demonstrated that these products generally do not work and if they do, they may not be safe. There are also a large number of supplements and pills that are marketed at people worried about the effects of stress on their body. For example, a variety of vitamins are marketed with the name "stress formula" to imply that the components in the pills may be extra beneficial for individuals who perceive themselves to be overstressed. While vitamin and mineral supplements may be beneficial, there is no evidence that extra supplements can help a person with stress.

The number of products available to help with health can be overwhelming so many people rely on their pharmacist to help them make choices regarding products. Documentation from the Quackwatch web site (www.quackwatch.com) reveals that even pharmacists cannot always be trusted to provide sound advice on treatments for stress. Two cases studies are described based on more detailed accounts provided by Dr. Steven Barrett.

• In 1985, reporters from Consumer Reports magazine visited 30 drugstores in Pennsylvania, Missouri, and California. The reporters complained of feeling tired or nervous, and asked whether a vitamin product might help. Seventeen were sold a vitamin product and one was sold an amino acid preparation. Only 9 of the 30 pharmacists suggested that a doctor be consulted (The vitamin pushers. Consumer Reports 51:170-175, 1986).
• In 1987, two pharmacy school professors sent a questionnaire to 1000 pharmacists in the Detroit metropolitan area and received 197 responses. Among the 116 who identified their five most-common reasons for recommending vitamins or minerals, 66 (56%) listed fatigue and 57 (49%) listed stress. Neither reason is valid. (Journal of Clinical Pharmacy and Therapeutics 15:131-139, 1990)

Many quack products relate to nutrition. Read the ADA position on nutrition misinformation.

A number of non-profit consumer organizations have developed websites to better inform the public of various forms of quackery in the health and fitness industry. These are some recommended ones that are worth browsing whenever you have a question about quackery.

Quackwatch.com (www.quackwatch.com)

National Coalition Against Health Fraud (http://www.ncahf.org)

Center for Science in the Public Interest – CSPI (http://www.cspinet.org/)

Web23-02: Quackery in Physical Activity

Dateline stings infomercial industry.

NBC's Dateline has broadcast the results of an undercover investigation in which an infomercial producer was asked to create an infomercial for an alleged skin moisturizer called "Moisturol." Even though the producer was told that there was no scientific evidence that the product worked, he agreed to create an infomercial complete with a medical endorser and testimonials from allegedly satisfied users. After the infomercial was completed, the investigators confronted the participants, most of whom (including the doctor) had not even tried the product. Six of the seven "satisfied customers" were actresses who received $50. Margaret Olsen, M.D., a dermatologist who practices in Los Angeles, received $5,000 for her endorsement. The participants did not know that the product was a fake that had been made from Nestle's Quick (a powdered chocolate drink mix). The text and video of the investigation are posted on NBC's Web site. [From the inside out: If you had a questionable product, how hard would it be to find someone to make an infomercial and sell your product to millions? Dateline decided to find out. Dateline, Sept 15, 2006] http://www.msnbc.msn.com/id/14856571/

Web23-03: Choosing a Health Club

The International Health, Racquet and Sportsclub Association (IHRSA) is an association serving the health and fitness club industry. They provide information about health clubs to the general public including a health club locator. They recommend a health club that is close to a person's work or home will most likely be the best choice as convenience is a key to continued attendance and use.

They offer the following checklist when considering which health club to choose:

• Are staff members friendly and helpful?
• Is the club clean and well maintained?
• Do fitness staff members have appropriate educational backgrounds and/or certification from nationally recognized certifying agencies?
• Are new members provided with a club orientation and instruction on how to use equipment?
• Does the club have the cardiovascular resistance equipment you want and need to achieve your fitness goals?
• Does the club offer sufficient number and variety of programs for you to achieve your fitness goals (aerobic, racquet sports, basketball, etc.)?
• Does the club offer instruction in a sport or activity that you might want to learn (tennis, squash, swimming, etc.)?
• Does the club offer a sufficient number and variety of programs for you to achieve other goals (stress management, weight management, smoking cessation, social activities, etc.)?
• Are there long lines at the equipment, or crowded aerobics classes, at the time that you would be using the club?
• Is child care available if you need it?
• Is there adequate parking available if you need it?

For more information visit: http://www.healthclubs.com which is provided by IHRSA.

Web23-04: Issues with the Use of Dietary Supplements

Americans are always looking for something for nothing. Within the health and fitness realm, there are over 3,400 different dietary supplements on the market that make a wide variety of claims. While some of the products have legitimate benefits, the majority of them are sold with little or no research. These loopholes were created with the passage of the Dietary Supplement Health and Education Act in 1994. While the name of the law sounds like it provides protection against quackery, it actually has made it harder to stop and regulate. With the new law, the burden is essentially on the Food and Drug Administration (FDA) to prove that a product is bad rather than on the manufacturer to prove that a product works. Consumers should be aware of the following issues when deciding on a supplement.

• Safety: The U.S. FDA does not require manufacturers to prove a product is safe. They intervene only after evidence accumulates. The herbal stimulant Ephedra (Ma Huang) was common in many supplements but studies found it to increase risks of stroke and psychosis. These results prompted the FDA to ban its use. Consumers should take responsibility to consider the safety of other products before using them.
• Efficacy: As long as a company doesn't make unjustified claims, there is no requirements on manufactures to prove that their products actually work.
• Product Claims: Claims of specific health benefits are not allowed without proof but products can make general claims about how product may alter structure or function without any proof.
• Manufacturing Standards: There is little or no quality control in the dietary supplement industry. The United States Pharmacopeia organization has released standards for purity and potency for vitamins that are similar to those used for medicine; however manufacturers are under no obligation to follow them.

Source: Consumer Reports on Health, April 1998.

The FDA has recently proposed stricter guidelines to provide better quality control over the content of dietary supplements (http://www.fda.gov/bbs/topics/NEWS/2003/NEW00876.html). Read the Fact Sheet and the Background document from the FDA for more information. The Center for Science in the Public Interest has indicated that these steps by the FDA are in the right direction but indicated that they do not go far enough to protect consumers. They point out that the new proposal would not require supplements to prove that they are safe or effective--only that they do not contain dangerous impurities and the dosage amounts promised on the label are accurate. Read the press release on the CSPI website: http://www.cspinet.org/new/200303071.html

There are likely to be additional changes in these rules and policies over time. Consumers are encouraged to follow the ongoing developments regarding this issue.

Web23-05: Herbal Supplements

In the United States, herbs are typically marketed as "foods" or "dietary supplements." Since herbs are not regulated as drugs, no legal standards exist for their processing, harvesting, or packaging. A number of herbal products contain no useful ingredients, and some even lack the principal ingredient for which people buy them. Herbs may seem safe because they are purported to be "natural". However, it is important to recognize that a large percentage of medicines are extracted from plants. The fact that it comes from nature does not imply that it is safe. Like with any medication, the improper use of herbs may lead to a number of harmful side-effects and even death. Click here to see a review of potentially harmful effects of herbs by the American Academy of Family Physicians.

Check with your doctor, a registered dietician or a similarly licensed health professional before taking any medication, supplement, or herbal treatment. There are many who make claims to be experts in nutrition and health so it is important where the source of information is from.

As described elsewhere in the book (see also web25-05), the Internet cannot always be trusted to provide appropriate information. To examine this visit some websites devoted to herbs such as the Herb Research Foundation and determine if they have provided appropriate information about the potential health risks from herbs.

The National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) is a federal agency that seeks to determine the viability of many alternative treatments, including various herbal remedies. Many herbs are currently being investigated in clinical trials but consumers need to be aware of the possible risks associated with these treatments and understand that the scientific basis for most of these approaches has not been established.

To get good facts about herbal treatments and other alternative medical therapies, visit the Treatment Information link on the NCCAM web site. This site allows users to look up different alternative therapies and determine possible effectiveness and / or safety. Users can also search by disease or condition and receive information on possible alternative therapies that may have promise.

For other examples of safety with herbs read the following critique of some alternative medicine approaches.

Web23-06: Tanning and Tips to Being Safe in the Sun

Our society has come to associate the appearance of tanned skin as an indicator of health and vitality. Unfortunately, getting tanned requires frequent exposure to harmful ultraviolet radiation (UV) from the sun. The amount of UV exposure depends on the strength of the light, the length of exposure, and whether the skin is protected. With long-term exposure, the sun causes prematurely aged skin, wrinkles, loss of elasticity, dark patches (lentigos that are sometimes called "age spots or liver spots"), scaly growths called actinic keratoses and actual skin cancers. According to the American Cancer Society – ACS (www.cancer.org) – most of the more than one million cases of skin cancer diagnosed yearly in the US are considered to be sun-related. In 1998, melanoma, the most serious type of skin cancer, accounted for about 41,600 cases of skin cancer and most of the deaths due to skin cancer. The number of new melanomas diagnosed in the United States is on the rise. In fact, the rate of rate of new melanomas diagnosed per year has doubled from 6 new cases per 100,000 people to 12 per 100,000. Fortunately, if treated early, most skin cancers are curable. Information on risks of tanning is also available from the American Academy of Dermatology website (http://www.aad.org).

Contrary to popular belief, there are NO safe forms of UV rays. Many tanning salons advertise that they use long wave (UV-A) rays and that these are safer than UV-B rays. While UVA rays may be less likely to cause burning than UVB rays, UV-A rays are suspected to have links to malignant melanoma and immune system damage. It is also important to note that sunscreen currently do not provide protection against UV-B rays. Therefore, there is no way to screen out harmful UV-A rays. A document published by the Federal Trade Commission provides clear warnings against the use of tanning beds to obtain a tan. Click here to read the report. The FDA provides a detailed website with additional information about suntan products, sunscreens, and tanning –http://www.cfsan.fda.gov/~dms/cos-sun.html.

To increase awareness in the public, the Environmental Protection Agency (EPA) and the National Weather Service developed a UV Index to help inform the public about particularly harmful conditions. The UV index number, ranges from 0 to 10+ and indicates the amount of UV radiation reaching the earth's surface during an hour around noon. It is forecasted daily based on locally predicted conditions. The higher the number, the greater the exposure to UV radiation. They point out that the ozone layer provides protection against UV rays but as this layer gets depleted there is increased risk. Click here to see the website. Some guidelines for being safe in the sun are listed below.

• Limit your time in the sun between 10 a.m. and 4 p.m.
• Whenever possible, seek shade.
• Use a broad spectrum sunscreen with an SPF of at least 15.
• Wear a wide-brimmed hat and if possible, tightly woven, full-length clothing.
• Wear UV-protective sunglasses.
• Avoid sunlamps and tanning salons.

Web23-07: Health Information on the Internet

Many consumers turn to the Internet to learn more about health and nutrition. The topic of 'Health' has continued to be the most actively searched topic on the Internet over the past 5 years. Unfortunately, consumers cannot always trust all information that they might find on the web. A review published in the Journal of the American Medical Association (JAMA) reports that health information on the Internet is inefficient, incomplete, and incomprehensible to many Americans. A separate article in JAMA provides guidelines for patients searching the Internet for health information. The main recommendation was for patients to use the Internet to complement (not replace) his/her consultation with a doctor. To read a summary of the article click here.

Click here to see summaries presented by WebMD on the accuracy of information on the Internet.

A number of excellent online resources are also available to help consumers obtain reliable health information on the Internet. Visit these sites:

Internet Healthcare Coalition Tips For Health Consumers; Finding Quality Health Information on the Internet

Guidelines for Medical and Health Information Sites on the Internet Principles Governing AMA Web Sites American Medical Association

How to Spot a "Quacky" Web Site, by Stephen Barrett, M.D. provided by Quackwatch Your Guide to Health Fraud, Quackery, and Intelligent Decisions

Criteria for Assessing the Quality of Health Information on the Internet - Policy Paper Health Summit Working Group

How To Evaluate Health Information on the Internet – The National Cancer Institute

The best way to ensure good information on the Internet is to start with good sources. WebMD (www.webmd.com) provides valuable consumer information. Another excellent resource is Medline Plus (http://medlineplus.gov/). Medline Plus is an educational division of the National Library of Medicine which is a division of the National Institutes of Health. Researchers rely on Medline to search for the latest research information and Medline Plus is a consumer oriented service that provides updated information on a variety of topics. Start your internet search for health information with credible sources to ensure that you receive accurate information

Web23-08 Issues with Consumerism

Consumers are influenced by a variety of marketing and advertising strategies. These strategies often lead consumers into buying things they don't need or to make poor choices about what they buy. In a book called Compliance, Dr. Robert Cialdini outlines the common sources of influence on consumers (known as the "Rules of Compliance". The different sources of illogic are briefly described below but interested readers should refer to the complete book for more information.

• The Old Give-and-Take:
  A natural tendency to return favors often leads consumers to buy things they don't need after someone gives them something.
• Sticking to Your Guns:
  The desire to be consistent in our actions causes consumers to stick with a decision even when it may no longer be a good deal (e.g. car dealers adding on costs after you commit to buy)
• Monkey See-Monkey Do:
  Consumers frequently buy things because they hear that it is popular or a leading seller.
• A Friend in Deed:
  Saying "Yes" to people we know and like is common and salespeople are good at making us feel like old friends that we wouldn't want to disappoint.
• Expert Worship:
  Consumers tend to buy things that are advertised by "experts" , celebrities and athletes even if these individuals no little about the product and were paid promoters.
• "If I can't have it, I want it":
  Consumers often believe if something is rare, it is more desirable and salespeople use this technique to get us to buy ("limited time offer, last chance, get them while they last")

By paying head to these influences, you can avoid making bad decisions regarding how they spend their money. Click here to see links to Cialdini's book on Influence

Web23-09: Web Resources

Agency for Health Care Policy and Research www.ahrq.gov

American Dietetics Association (ADA) - www.eatright.org

American Medical Association (AMA) - www.ama-assn.org

American Psychological Association, Psychology Matters – http://www.psychologymatters.org/

Center for Science in the Public Interest - www.cspinet.org

Federal Trade Commission – www.ftc.gov

Food and Drug Administration – www.fda.gov

Healthfinder – www.healthfinder.gov

Medwatch - www.fda.gov/medwatch

National Center for Complementary and Alternative Medicine - www.nccam.nih.gov

National Council Against Health Fraud - www.ncahf.org

Office of Dietary Supplements - http://dietary-supplements.info.nih.gov/

Quackwatch - http://www.quackwatch.com/

Tufts University Nutrition Navigator – http://navigator.tufts.edu

U.S. Consumer Information Center – http://www.pueblo.gsa.gov

Web23-10: Supplemental Readings

References new to 7e/14e

Barrett, S. et al. 2007. Consumer Health: A Guide to Intelligent Decisions (8^th ed.). New York: McGraw-Hill Higher Education.

Clegg, D. O. et al. 2006. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine. 354(8):795-808.

FDA Consumer Magazine. Available online at www.fda.gov/FDAC

Ioannidis, J. P. A. 2005. Contradicted and initially stronger effects in highly cited clinical research. American Medical Association. 29(2):218-228.

Markel, H. 2005. Why America needs a strong FDA. Journal of the American Medical Association. 294(19)2489-2491.

National Institutes of Health. 2006. Multivitamin/mineral supplements and chronic disease prevention: A draft report. Available online at http://consensus.nih.gov/2006/MVMDRAFT051706.pdf

Radley, D. C. et al. 2006. Off-label prescribing among office-based physicians. Archives of Internal Medicine. 166(9):1021-1026.

Strom, B. L. 2006. How the US drug safety system should be changed. Journal of the American Medical Association. 295(17):2072-2075.

Winker, M. A. eet al. 2000. Guidelines for medical and health information on the internet. Log on to www.ama-assn.org, use keywords internet guidelines.

References from Past Editions:

Angel, M & J. P. Kassirer. Alternative Medicine: The Risks of Untested and Unregulated Remedies. New England Journal of Medicine. 339(12)(1998): 839.

• Armsey, T. D. & G. A. Green. Nutrition Supplements: Science vs Hype. Physician and Sportsmedicine. 25 (6)(1997):76.
• "Athletes Find Health Food Supplements Big Trouble." Toronto Star, Nov. 15, 1995.
• Barrett, S., & V. Herbert. "How Athletes are Exploited" in The Vitamin Pushers. Prometheus, 1994.
• Barrett, S., & W. Jarvis. Eds. The Health Robbers: A Close Look at Quackery in America. Buffalo, NY: Prometheus Books, 1993.
• Califano, J. A. Jr. "The Wrong Way to Stay Slim." New England Journal of Medicine 333(1995):1214.
• Cardinal, B. J. "Rating the Clubs: A Health and Fitness Center Consumer Checklist."American Fitness Sept./Oct. 1994.
• Clark, N. "Protein Myths: The Meat of the Matter." Sportcare and Fitness 2(1989):53.
• Clark, N. "Water: The Ultimate Nutrient." Physician and Sportsmedicine 23(1995):21.
• Clarkson, P. M. "Minerals, Exercise Performance and Supplementation." Journal of Sport Sciences 9(1991):91.
• Clarkson, P. M. The Skinney on Weight Loss Supplements and Drugs: Winning the War Against Fat. ACSM's Health and Fitness. 2(4)(1998):18.
• Consumer Reports, "Health Clubs: The Right Choice." 61(1996):27.
• Consumer Reports. The Mainstreaming of Alternative Medicine. Consumer Reports. 65(5), 17-25, 2000.
• Cornacchea, J., & S. Barrett. Consumer Health 5th ed. C.V. Mosby, 1993.
• Cowart, V. "Dietary Supplements." Physician and Sportsmedicine 20(1992):189.
• Eisnenberg, D. M. Trends in Alternative Medicine in the US 1990-1997. Journal of the American Medical Association. 280(18)(1998):1569.
• Farley, D. "Making Sure Hype Doesn't Overwhelm Science." FDA Consumer, 56(1996):1.
• Fetrow, C. W. and Avila, J. R. Professional's Handbook of Complementary and Alternative Medicines. Springhouse, PA: Springhouse Publications, 1999.
• Fontanarosa, P. B. Alternative Medicine Meets Science. Journal of the American Medical Association. 280(18)(1998):1618.
• "Foods, Drugs or Frauds?" FDA Consumer, May, 1985 (reprint).
• Hankinson, S.E. "All That Glitters is NOT Beta Carotine." Journal of the American Medical Association 272(1994):1455.
• Jonas, W. B. et al. Alternative Medicine: Learning from the Past, Examining the Present, Advancing to the Future. Journal of the American Medical Association. 280(18)(1998):1616.
• Laitner, B. "Doctors Criticize Tanning Salons." Santa Ana, CA: Orange County Register (Mar. 18 1991):E6.
• Kuntzleman, C. T. & R. Wilkerson. A Primer to Recommending Home Aerobic Equipment. ACSM's Health and Fitness Journal. 1(6)(1997):24.
• McCarthy, P. "How Much Protein Do Athletes Really Need?" Physician and Sportsmedicine 17(1989):170.
• Miller, R.W. "Critiquing Quack Ads." FDA Consumer. November 1982 (reprint).
• National Council for Reliable Health Information Newsletter. Published every other month it contains articles that give objective information about health products and food supplement. NCRHI, P. O. Box 1276, Loma Linda, CA 92354.
• National Council for Reliable Health Information. FDA Guide to Supplements. NCRHI Newsletter. 22 (2), 1-4, 1999.
• National Council for Reliable Health Information. FTC Targets Internet Health Fraud. NCRHI Newsletter . 22 (6), 1-2, 1999.
• National Council for Reliable Health Information. National Sureys Produce Remarkable findings on Alternative Health Practices and Dietary Supplement Misuse. NCRHI Newsletter. 23 (2), 1-4, 2000.
• NCAHF Newsletter The New Dietary Supplement Laws. NCAF Newsletter 17(1994):1.
• NCAHF Asks FTC to Stop Antioxidant Supplement Advertising." National Council Against Health Fraud Newsletter 17(July–August 1994):1.
• Park, R. L. Voodoo Science: The Road from Foolishness to Fraud. New York: Oxford University Press, 2000.
• Porcari, J. P. Pump up your walking. ACSM's Health and Fitness Journal. 3(1), 25-29, 1999.
• Philen, R., et al. "Survey of Advertising for Nutritional Supplements in Health and Body Building Magazines." Journal of the American Medical Association 268(1992):1008.
• Questioning 40/40/30: A guide to understanding sports nutrition advice. A 22 page booklet published jointly by the American College of Sport Medicine, The American Dietetics Association, The Women's Sports foundation and the Cooper Institute for Aerobics Research, 1997.
• "Shearing the Suckers." Consumer Reports (February 1986):87.
• Slavin, J.L., et al. "Amino Acid Supplements: Beneficial or Risky?" Physician and Sportsmedicine 16(1988):221.
• Stamford, B. "Saunas, Steam Rooms and Hot Tubs." Physician and Sportsmedicine 17(1989):188.
• "The Supplement Story: Can Vitamins Help?" Consumer Reports 57(1992):12.
• "Thigh Cream Fails Test." National Council Against Health Fraud Newsletter 18(1995).
• Thomas, D. Q. et al. Nasal Strips and Mouthpieces Do Not Effect Power Output During Anaerobic Exercise. Research Quarterly for Exercise and Sport. 69(2)(1998):201.
• University of California at Berkeley Wellness Letter, "Thin Thighs in a Bottle." University of California at Berkeley Wellness Letter 10(1994):1.
• University of California at Berkeley Wellness Letter, "The Breathtaking Promises of Melatonin." University of California at Berkeley Wellness Letter 12(1996):1.
• University of California at Berkeley Wellness Letter, "Strength in One Third the Time." University of California at Berkeley Wellness Letter 12(1996):3.
• USA Today. Supplements Dodge Regulation. USA Today. November 23, 1998, p. 22A.
• Voy, R.O. "Water-Soluble Vitamins Not Safe in Megadoses." Physician and Sportsmedicine 14(1986):52.
• Walker, L. S. et al. Chromium Picolinate Effects On Body Composition and Muscular Performance in Wrestlers. Medicine and Science in Sports and Exercise, 30(12),(1998):1730.
• Willis, J. "About Body Wraps, Pills and Other Magic Wands for Losing Weight." FDA Consumer,
• November 1982 (reprint).
• Willis, J. "Diet Books Sell Well But..." FDA Consumer, March 1985 (reprint).