Ads for a slimming and therapeutic massage chair and programme:
a. An advertorial in the local press, in August 2011, was headlined "NHS Hospital Trial 'Proves Sit & Slim Chair Works' and featured before and after pictures of a woman who had lost weight. Text in the article stated "The results of a trial at NHS Hellesdon hospital show weight loss, increase in self esteem & reduction in blood pressure, Nasreen knows it works as she lost 4 stone 7lb on the Sit & Slim Chair ... [and] a stone after just five weeks". Text below, in the form of an article stated "[Nasreen] says ' When I went along the first time I didn't know what to expect but I was so unhappy with myself I was prepared to try anything. I spoke to Caroline who explained that it's the combination of the Sit & slim chair which gives a therapeutic massage at the same time as listening to the audio programme that changes the way you think about food. For the first 5 minutes of the massage I was thinking this feels odd but then I started to relax and that's when I started to enjoy it. I had a 30 minute treatment which left me feeling totally relaxed, something I hadn't felt in years. I felt energised when I got home and I noticed I felt more positive about being about to lose weight and keep it off. I couldn't wait to have my second treatment and enjoyed it more than the first one. For the first time in years I was looking after myself, it was my, me time. I lost a stone after just 5 weeks and the more I lost the better I felt. I have now lost 4 and a half stone and gone from size 20 to a size 12. My friends don't recognise me when they see me in the street. They only know it's me when I start talking to them. When I tell them I've lost all this weight by sitting on the Sit & Slim chair they don't believe me. I say to them just go and try it, you can have a free treatment. I definately [sic] recommend anyone to try it. You will love it I'm sure".
Text under the heading "NHS TRIAL HAILED A SUCCESS" stated "Hellesden hospital pct trust [sic] have been piloting the Sit & slim and Sit and de-stress programmes for the past 6 months to assess the benefits of the programmes on staff at the hospital. The results are truly remarkable with 60% of people on the trial losing weight. Some people lost over a stone in the first month. 90% of the participants recorded an increase in self esteem and another benefit that wasn't anticipated was a reduction in blood pressure in 60% of the people on trial. The health benefits of losing weight, increasing your self esteem and reducing blood pressure are huge. If Sit & Slim was widely available to the general public the benefits to the NHS would be massive. The cost to the NHS as a result of obesity is 5 billion pounds a year".
b. An ad in the local press, in July 2011, was headlined "Nasreem and Sue lost over 8 stone sitting down!". Text below stated "'The Sit & Slim is a godsend. I've lost over 4 stone and FEEL FANTASTIC!". The ad featured Polaroid pictures of two women. Handwritten text stated "Nasreem Lost 4 stone 7lbs" beneath the first picture and "Sue Lost 4 stone" beneath the second. Text in a blue box under the title "MEDICALLY PROVEN BY THE NHS" stated "The NHS has carried out a clinical trial to assess the validity of the Sit & Slim chair. The results so far are: 60% have lost weight; 90% increase in wellbeing; 60% reduction in blood pressure Other health benefits include reduces stress; increases confidence; reduces aches and pains; feeling happier; improves sleep; improves relationships". Testimonials under the heading "What people say:" stated "Dr. Paul Gardener says 'I was so impressed with the quality of the massage that I have purchased a chair and put it in my study' Sue McColl says 'I've lost 4 stone on the Sit & Slim chair and my self esteem and confidence have gone through the roof. I know it sounds corny but I've got my life back. Dr James Kingsland was so impressed with the Muruji chair he bought one for the surgery."
c. An advertorial in the local press, in August 2011, was headlined "How Sue McColl lost 4 stone on the sit & slim chair! NHS hospital trial proves sit & slim works". The ad featured pictures of Sue McColl before and after her weight loss and included the same claims about the product and the NHS trials featured in ad (a).
d. Claims on the Sit & Slim website, in August 2011, stated "In order to prove that the fundamental principal behind Sit and Slim actually works, Miruji Health and Wellbeing recently approached the Hellesdon Hospital NHS Trust with a view to initiating a pilot programme to test the effects of the programme ... The study is on-going but so far, the results are positive and can be summarised as follows. Participants have experienced an average weight loss of 11 and 1/2 lbs., or 4% of a subject's total body weight. Using the chair also increases a person's self-esteem with 44% of the participants seeing a significant improvement. Other benefits were a decrease in waist measurement and lowering of blood pressure. The physiotherapists conducted the trial at no cost to help staff to improve their wellbeing and to decrease stress, which has been shown to impact on sickness absence rates. This has the additional benefits of facilitating the healing and prevention of injuries which can be compromised by increased stress hormones in the body.
e. The e-mail, received in September 2011, was titled "Miruji Health and Wellbeing". Headline text stated "MEDICALLY PROVEN BY NHS Could Sit & Slim be the answer to the obesity epidemic?". Text below stated "Earlier this year Hellesden NHS Hospital Hospital in Norwich began a trial to assess the benefits of the Miruji Health and Wellbeing Sit & Slim Programme. The results have been truly amazing with 60% of the participants in the trial reporting loss of weight, 90% had an increase in self esteem and 60% saw their blood pressure fall. Other health benefits of the Sit & Slim programme are increased energy, better quality of sleep, elimination of aches and pains, reduction in stress levels and a more positive outlook on life". The ad included various claims about the trial and a testimonial from the one of Hellesdon Hospital's directors which stated "The results were largely positive with an average weight loss of 11.5lbs or 4% of a subject's body weight". Text at the bottom of the e-mail, under the heading "Win a Miruji Massage Chair worth £10,000!" stated "Refer a friend to Miruji Health and Wellbeing and for every friend who has a free treatment we will give you a prize draw ticket worth £10 to win your very own Miruji Massage Chair."
The ASA received five complaints. Four complainants challenged whether:
1. the efficacy claims made for the Sit & Slim chair; and
2. the claim that the Sit & Slim chair had undergone an NHS clinical trial, were misleading and could be substantiated.
3. One complainant challenged whether the claim, in ad (e), that the chair was worth £10,000 was misleading and could be substantiated.
The ASA challenged whether:
4. the references to blood pressure reduction in all the ads discouraged essential treatment for a condition for which medical supervision should be sought;
5. the implied claims that the product could treat obesity in ads (a), (c) and (e) breached the Code because the treatment was not administered under medical supervision;
6. the testimonial attributed to Nasreen, in ad (a) was genuine; and
7. the ads breached the Code by implying that weight could be lost without effort.
1., 4., 5.&7. Miruji Health & Wellbeing (Miruji) provided the results of the trial referred to in the ads, in support of the efficacy claims. They also provided a number of user testimonials.
2. Miruji said the trial that had been conducted at Hellesdon was not a medical trial. They said it had been pointed out to them by the hospital that is was not a clinical trial that had been undertaken and they had therefore ceased to use the term "clinical" in their advertising and now used claims such as "NHS Trial Hailed a Success".
3. Miruji said the cost of the chair with all the audio programmes was £9,895.
6. Miruji provided a mobile telephone number for Nasreen.
The ASA understood that the Sit and Slim programme (Sit and Slim) involved users sitting in a massage chair while simultaneously listening to audio which encouraged them to change their lifestyle and nutritional habits in a way that promoted weight reduction over time and also caused the additional benefits described in the ads. We considered that, in order to substantiate those claims Miruji needed to be in possession of rigorous trials, conducted on people, which proved the programme's efficacy.
We noted the trial submitted by Miruji in which 29 employees at Hellesdon Hospital with a BMI of over 28, had volunteered to use the chair on an ad hoc basis over a three-month period, without any randomisation or blinding. We also noted that the trial was not controlled to measure the influence of other factors. We therefore considered that the trial had not been carried out in a way that was capable of showing whether or not the programme was effective in weight reduction and we understood that neither Miruji nor the hospital where it had been conducted regarded it as a formal piece of research.
Because we considered that the trial submitted did not show that Sit and Slim could result in weight reduction, improve self-esteem, increase confidence, reduce or eliminate aches and pains, facilitate the healing and prevention of injuries or improve sleep, we concluded that those claims and the specific claim "Sit and Slim", had not been substantiated and were misleading.
On this point the ads breached CAP Code (Edition 12) rules 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising), 3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation. (Substantiation), 13.1 13.1 A weight-reduction regime in which the intake of energy is lower than its output is the most common self-treatment for achieving weight reduction. Any claim made for the effectiveness or action of a weight-reduction method or product must be backed, if applicable, by rigorous trials on people; testimonials that are not supported by trials do not constitute substantiation. and 13.4 13.4 Before they make claims for a weight-reduction aid or regimen, marketers must show that weight-reduction is achieved by loss of body fat. Combining a diet with an unproven weight-reduction method does not justify making weight-reduction claims for that method. (Weight control and slimming).
We considered that claims such as "NHS Hospital Trial 'Proves Sit & Slim Chair Works'" and "The NHS has carried out a clinical trial to assess the validity of the Sit & Slim chair" and the other references to NHS research would be interpreted by readers to mean that the study was a formal NHS clinical trial. Although we noted Miruji's willingness to remove the term "clinical" in future, we considered that even a revised claim which referred to an NHS trial was likely to be interpreted by readers as relating to formal clinical research with a very high level of robustness.
We understood that Hellesdon Hospital (Hellesdon), where the study had taken place, was managed by Norfolk and Suffolk NHS Foundation Trust (NSFT) and we asked NSFT to comment on the complaint. They explained that Hellesdon was a mental health hospital which had been taking part in a free trial of the Sit and Slim chair, which had been provided in their physiotherapy department only as a casual facility for staff. They emphasised that patients had not used the chair and that Hellesdon did not treat obesity. NSFT said they were aware of the stringent and robust nature of a proper clinical trial and that their use of the Sit and Slim Chair did not meet those strict requirements. They said that the use of Sit and Slim at Hellesdon was not an NHS-endorsed or NHS-conducted clinical trial.
Because we understood that the trial referenced in the ads was not NHS-approved or formal research, we concluded that the claims "NHS TRIAL" in ad (a), "MEDICALLY PROVEN BY THE NHS" in ads (b) and (e), "NHS hospital trial proves sit & slim works" in ad (c) and the claim, in ad (d), that Hellesdon Hospital had "initiat[ed] a pilot programme to test the effects of the programme" were misleading.
On this point the ads breached CAP Code (Edition 12) rule 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising) and 3.50 3.50 Marketing communications must not display a trust mark, quality mark or equivalent without the necessary authorisation. Marketing communications must not claim that the marketer (or any other entity referred to), the marketing communication or the advertised product has been approved, endorsed or authorised by any public or other body if it has not or without complying with the terms of the approval, endorsement or authorisation. (Endorsements and Testimonials).
We considered that the claim in ad (e) that the Sit and Slim chair was worth £10,000 required substantiation with evidence that it was generally sold or offered for sale at that price. Although we noted Miruji's assertion regarding its value, in the absence of evidence to show that it was generally sold for £10,000, we considered that the claim had not been substantiated and was misleading.
On this point ad (e) breached CAP Code (Edition 12) rules 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising) 3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation. (Substantiation) and 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Prices).
We considered that the claim in the ads that Sit and Slim had reduced blood pressure would be interpreted by readers to mean that the programme could effectively treat high blood pressure. We considered that high blood pressure was a medical condition for which advice, guidance and treatment should only be conducted under the supervision of a suitably qualified health professional, however we understood that the Sit and Slim programme was not supervised in that way. We considered that the ads' references to that condition could encourage readers to respond to the ad and attempt to use the advertised product to treat themselves instead of seeking appropriate medical advice and therefore discouraged essential treatment for high blood pressure.
On this point the ads breached CAP Code (Edition 12) rule
Marketers must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis of or treatment for such conditions unless that advice, diagnosis or treatment is conducted under the supervision of a suitably qualified health professional. Accurate and responsible general information about such conditions may, however, be offered (see rule 12.11).
Health professionals will be deemed suitably qualified only if they can provide suitable credentials, for example, evidence of: relevant professional expertise or qualifications; systems for regular review of members' skills and competencies and suitable professional indemnity insurance covering all services provided; accreditation by a professional or regulatory body that has systems for dealing with complaints and taking disciplinary action and has registration based on minimum standards for training and qualifications. (Medicines, medical devices, health-related products and beauty products).
We considered that the significant weight reduction claims made in all the ads alongside claims that the treatment was medically proven; the "before" and "after" images in ads (a) and (c) and the overt references to obesity in ads (a) and (c) implied that the Sit and Slim programme was capable of reducing the weight of adults with a Body Mass Index (BMI) of more than 30 kg/m2 and who were therefore obese. While we noted that ad (e) posed the question "Could Sit & Slim be the answer to the obesity epidemic?", we considered that question was likely to be interpreted by readers as a claim that Sit & Slim could treat obesity.
We noted that the Code required that treatments for obesity must not be advertised to the public unless they were used under suitably qualified supervision. Notwithstanding our concerns about the programme's efficacy we noted that we had not seen evidence that the Sit and Slim was appropriately supervised and concluded that the ads breached the Code on this point.
On this point the ads breached 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 and slimming).
We considered that Miruji needed to provide documentary evidence that the testimonial attributed to Nasreen was genuine. We noted that they had provided a mobile telephone number which they said belonged to Nasreen. However, we noted they had not provided a copy of the testimonial itself or evidence, such as signed and dated proof, that it was authentic. In the absence of that, we concluded that ad (a) breached the Code.
On this point ad (a) breached CAP Code (Edition 12) rule 3.45 (Endorsements and Testimonials).
We understood that the Sit and Slim programme was intended to encourage changes in users' lifestyles that aided weight loss. However, we considered that the claim "Sit and Slim", the significant weight loss claims, the claims that the programme had been successfully trialled by the NHS and, in particular the testimonials in ads (a), (b) and (c) gave the impression that weight loss would be a direct and inevitable consequence of using the programme itself and that it was unlikely to be clear to readers that any weight reduction would have to come entirely from lifestyle changes that they would have to implement themselves. We therefore concluded that the ads implied that users of Sit and Slim could not fail to lose weight and, in doing so, breached the Code.
On this point the ads breached CAP Code (Edition 12) rule 13.8 13.8 Marketing communications for diet aids must make clear how they work. Prominence must be given to the role of the diet and marketing communications must not give the impression that dieters cannot fail or can eat as much as they like and still lose weight. (Weight control and slimming).
The ads must not appear again in their current form.
We told Miruji to ensure that they held robust substantiation before making weight reduction claims and not to claim that their products had undergone formal or NHS trials. We also told them not to claim that they could treat obesity; to ensure that they held documentary evidence that any testimonials used in their ads were genuine; and not to claim that they could treat conditions for which medical supervision should be sought. We also told them to ensure that they held substantiation for any price claims.
We advised Miruji to consult CAP's Copy Advice team before preparing marketing communications for Sit and Slim in future.