Background
Summary of Council decision:
Three issues were investigated, all of which were Not upheld.
Ad description
A poster in a London Underground train seen on 19 October 2015 for Alevere, a weight loss and contouring programme, featured a 'before' and 'after' photo of a patient. It stated "I lost 4st 6lbs in just 14 weeks! Alevere London. Medical Weight Loss and Body Contouring WITHOUT SURGERY! [website address]. Text: SLIM to [shortcode]".
Issue
The complainant challenged whether:
1. the ad promoted a treatment for obesity which was advertised to the public and therefore, challenged whether it was to be used under suitably qualified supervision;
2. the claim "I lost 4st 6lbs in just 14 weeks!" was a weight loss compatible with good medical and nutritional practice; and
3. the claim "medical weight loss ... without surgery" was misleading and could be substantiated because it implied Alevere was as effective as weight loss surgery.
Response
1. Alevere Ltd said they employed their own in-house team of medical doctors, all of whom were fully registered with the General Medical Council (GMC) and all of whom also held current NHS General Practice posts. They explained that all of their patients had a one-hour consultation and examination with one of Alevere’s medical doctors, before they were accepted for treatment. During their treatment programme, patients were reviewed and examined by their designated doctor, in person, once every two to four weeks. Furthermore, they said their doctors closely monitored each of their patients' health; both before treatment and at regular intervals during their treatment, by analysis of patients’ blood samples that were sent for laboratory testing of many different physiological and biochemical parameters.
During treatment, Alevere said patients attended their clinics on a weekly basis and when they were not seen by a doctor, they were examined by one of their clinical therapists. They confirmed that the patient saw the same clinical therapist at each consultation and when the patient had an examination with the doctor, it was with the same doctor for the duration of the programme. Their clinical therapists had been trained by their doctors to the required standard to allow them to medically monitor Alevere’s patients under a doctor’s close supervision. Every week, the clinical therapists followed a detailed health monitoring protocol that had been written by Alevere’s doctors for the purpose of monitoring patients’ health.
Alevere explained that where any symptoms, issues or concerns arose from the weekly assessment, they were passed on to one of their doctors. The doctor would then immediately consult with the patient, in person or, if appropriate, initially by telephone.
2. Alevere understood that there was not, and had never been, a consistent opinion regarding how to practice medicine or what constituted good or best practice amongst all doctors. Furthermore, they understood there was no requirement for doctors practising in the UK to follow guidance issued by the National Institute of Clinical Excellence (NICE). They said that NICE guidance was the opinion of only a very small number of doctors appointed to a government clinical practice advisory panel.
Alevere said that the GMC required doctors to ensure that their practice was supported by ‘a responsible body’ of medical opinion, which they said was not required to be a majority of doctors or that of a very small number appointed to a government advisory panel. They explained that the GMC considered ‘a responsible body’ to be sufficient of a doctor’s colleagues, peers and closely related independent medical and scientific professionals practising in the same way. In addition, the aforementioned group of professionals could otherwise be in support of any given method of practice, such as to make that method of practice reasonable, responsible, credible and ethical in order for that group of professionals to amount to a ‘responsible body’.
3. Alevere said the claim was simply an accurate statement of fact. It reflected what they offered to their patients, a highly effective weight loss treatment programme without any surgery. They said the programme had been designed by their own medical doctors and each patient on the programme was closely supervised in person by those doctors.
Alevere said the ad did not make any claim that their treatment programme was as effective as weight loss surgery. The claim simply stated that their treatment and its results were achieved without surgery and made no comparative claim regarding its efficacy to that of surgery. Nevertheless, they said they held data from thousands of patients who they had treated and which they were confident would show equivalent or better efficacy of their treatment in comparison with weight loss surgery, if compared with a similar cohort of such patients.
Assessment
1. Not upheld
The ASA understood from Alevere that before treatment, the patient’s body mass index (BMI) would be considered as obese for the purposes of the Code. We noted that the CAP Code explained that obesity was frequently associated with a medical condition, and specified that a treatment for it must not be advertised to the public unless it was to be used under suitably qualified supervision.
We understood that all of the medical doctors at Alevere were registered with the GMC and also held posts General Practice posts within the NHS. We understood patients had a consultation with the same medical doctor every two to four weeks and the remaining weeks, they were seen by the same clinical therapist who had been trained by and was under the close supervision of one of Alevere’s medical doctors. When a patient had a consultation with a clinical therapist, they were subjected to a monitoring questionnaire that had been written by the doctors to ensure careful examination of the patient’s health during the programme. We understood that any concerns which arose from a patient’s consultation with a clinical therapist were immediately referred to a doctor who then consulted with the patient.
It was our understanding from previous expert advice sought by the ASA on this point, that in primary care, overall responsibility rested with GPs and they could delegate continuing care to another appropriate member of the primary care team, usually a practice nurse. That expert considered that would be appropriate medical supervision because the practice nurse would have access to a patient’s records and a consultation with the nurse would be recorded in the patient’s notes. The GP could therefore oversee the supervision. The expert also noted that some larger practices might include other health professionals, such as nutritionists or pharmacists, who were full members of the medical team. He considered that supervision by these other health professionals would provide the same continuity of care in instances where the GP considered referral to them was appropriate. It was the expert’s view further that in rare instances when a private practitioner was involved, provided the practitioner was essentially providing continuing care and had full knowledge of the patient, then that could be considered appropriate medical supervision.
We considered that an adequate level of supervision for obese clients on the Alevere programme would be that of the client's GP, or under the direct authority of their GP. However, we did consider that where obese patients with co-morbid conditions continued medical supervision from their prescribing physician or practice nurse at their registered surgery while on the Alevere programme, that this also represented suitably qualified supervision. We understood that patients had weekly consultations with a designated clinical therapist and had regular consultations and examinations with the same doctor for the duration of their time on the programme. While Alevere patients were not under the supervision of their GP, we considered that Alevere had demonstrated that their doctors and clinical therapists were providing continuous care and had full knowledge of the patient while on the Alevere programme. We therefore considered that the programme was to be used under suitably qualified supervision and concluded that the Alevere programme could be advertised to the public.
On this point, we investigated the ad under CAP Code (Edition 12) rule 13.2 13.2 Obesity in adults is defined by a Body Mass Index (BMI) of more than 30 kg/m2. Obesity is frequently associated with a medical condition and, except where stated in 13.2.1, a treatment for it must not be advertised to the public unless it is to be used under suitably qualified supervision. Non-prescription medicines that are indicated for the treatment of obesity and that require the involvement of a pharmacist in the sale or supply of the medicine may nevertheless be advertised to the public. (Weight control & slimming), but did not find it in breach
2. Not upheld
We noted that Alevere understood that there was not a consistent opinion as to what constituted good medical practice. However, the CAP Code stated that claims for an individual to have lost an exact amount of weight must be compatible with good medical and nutritional practice and that those claims must state the period involved and must not be based on unrepresentative experiences.
In addition, the Code specified that for those who were normally overweight, a rate of weight loss greater than 2 lb a week was unlikely to be compatible with good medical and nutritional practice and that those who were considered obese, a rate of weight loss greater than 2 lb a week in the early stages of dieting could be compatible with good medical and nutritional practice. For the purposes of this Code rule, ‘overweight’ referred to individuals with a BMI between 25 and 29 kg/m2 and ‘obese’ referred to those with a BMI of 30 kg/m2 or more.
The rate of weight loss for the patient in the ad was 4 st 6 lb over 14 weeks. We had seen evidence that his weekly weight loss in the first four weeks of the programme was significantly more than 2 lb. Furthermore, we noted that when calculated, the average weekly weight loss was just over 4 lb. However, as set out in further detail above in point 1, we understood that those on the programme were medically supervised and we considered that the programme was used under suitable supervision. We acknowledged the patient’s weight loss was more than 2 lb a week; however, because the patient and his weight loss were medically supervised during his time on the programme, we considered the weight loss he experienced was compatible with good medical practice. Consequently, we concluded the ad did not breach the Code on this point.
We investigated the ad under CAP Code (Edition 12) rule 13.10 13.10 Claims that an individual has lost an exact amount of weight must be compatible with good medical and nutritional practice. Those claims must state the period involved and must not be based on unrepresentative experiences. For those who are normally overweight, a rate of weight loss greater than 2 lbs (just under 1 kg) a week is unlikely to be compatible with good medical and nutritional practice. For those who are obese, a rate of weight loss greater than 2 lbs a week in the early stages of dieting could be compatible with good medical and nutritional practice. (Weight control & slimming), but did not find it in breach.
3. Not upheld
We understood the complainant was concerned that the ad implied that the Alevere programme was comparable with weight loss surgery. However, we considered that consumers were likely to interpret the claim to mean that Alevere offered a programme which resulted in weight loss and did not involve surgical intervention, rather than one which implied that any weight loss would be comparable to that seen with weight loss surgery. We had seen evidence which demonstrated significant weight loss could be achieved on the programme and in that regard, we considered the claim went no further than reflecting the nature of the programme. Therefore, we concluded the claim was not misleading.
On this point, we investigated the ad under CAP Code (Edition 12) rules 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising), but did not find it in breach.
Action
No further action necessary.
