I N T R O D U C T I O N
According to Pew Research Center, eight out of 10 adult internet users (59% of the adult United States population) use the internet as a source of information on health-related issues, which makes seeking healthcare information the third most popular online activity in the United States. Specifically, 52 percent of internet users seek information on exercise or fitness, and 49 percent seek information on diet, nutrition, vitamins, or nutritional supplements.1
YouTube, a popular and successful website, has up to 1 billion active users every month,2 and 73 percent of adult Americans are said to access YouTube regularly.3 The use of YouTube as a source of healthcare-related information for various disease states has previously been studied.4–7 In a recent study published in The Journal of Clinical and Aesthetic Dermatology,7 researchers examined YouTube for videos directed toward patients with psoriasis, specifically examining the content available via a search for “psoriasis treatment.” What the authors found was that the majority (nearly 80%) of the videos concerning the treatment of psoriasis were not from credible medical sources (i.e., most videos were posted by authors with no medical background). Only 7.1 percent of the videos on psoriasis treatment were posted by medical institutions or by verified physicians.7
For this issue of NHR, we examined YouTube for videos directed toward individuals interested in weight loss, specifically examining the content available using the search term “healthy weight loss plan.”
Our initial search, which was first filtered by “relevance,” resulted in approximately 18,800,000 posts. We narrowed our search to videos posted “this year,” which resulted in approximately 5,120,000 video posts. From here, we restricted our search to the first 100 videos displayed in the list of results. We then excluded any video older than May 1, 2017, as well as those that were not in the English language. After excluding videos that did not meet our inclusion criteria (i.e., those that were posted May 1, 2017 or later and were in the English language), we were left with 32 videos for our analysis. We evaluated the 32 videos for the following characteristics: number of page views, thumbs up and down ratings, author profession/ affiliation, the content of the video, if the authors provided scientific evidence for information in video, whether the authors promised results or made product claims, if the video was monetized by advertising, and if a product or service was being offered via the content of the video, the text under the author’s name or profile, or via an affiliated website.
Authors. From our sample of 32 videos, there were 19 authors (i.e., some authors posted several videos within our sample). Only one of the 19 authors gave any indication of having a medical background (“certified as a nutritional therapist”), though we were unable to verify this claim. Two authors claimed to be “certified personal trainers,” one claimed to be a “personal trainer” (did not use the word certified), and one claimed to be a “fitness trainer.” Of the remaining 14 authors, one claimed to be a “health & a beauty blogger by profession,” one simply claimed to be a “blogger,” and the remaining 12 authors did not identify themselves by any qualifications or profession.
Content. Twenty-two of the videos described and provided recipes for either single meals or dishes or meal plans designed for weight loss (most included basic nutrition information [calories, fat, carbs, protein]), three described the benefits of and provided recipes for “detox” or intermittent fasting diets, five videos described the components of healthy living and/or a healthy weight loss plan (no recipes), and two videos provided lists of dos and don’ts of dieting (e.g. “5 foods you should avoid while dieting”). None of the videos provided scientific evidence nor acknowledged a medical institution for the information provided.
Promised results/claims. Eleven of the videos and/or their affiliated websites made promises or claims regarding the information presented either in the video or on the website (e.g., “lose 10kg in 10 days”). Two videos used particularly exaggerated wording: One claimed “A Foolproof, Science-Based Diet Designed to Melt Away Several Pounds of Stubborn Body Fat in just 21 days,” and the other claimed “6 week body transformation, lose 20lbs or 5% body fat or money back.”
Sale of products or services/advertising. Twenty-one of the videos and/or their affiliated websites advertised products or services, including fitness/weight loss plans, cookbooks, clothing/beauty products, detox tea, and oils. All 32 of the videos displayed some type of advertising (i.e., generic ads [cars, tv, food, etc. or specific health/beauty products) that either played before the video started or were displayed as popup ads during video play.
There are several points of interest in our evaluation of these videos. Twelve of the 32 videos, while posted by a variety of authors, appeared to be part of a single entity, though what the entity was, exactly, was unclear. These 12 videos had similar, if not exact, wording in the titles and descriptive text, though the content varied slightly (i.e., different people were featured in the videos presenting separate but similar recipes); the same group of authors were all linked under “other relevant videos;” the videos had very similar production characteristics; the authors and their recipes all appeared to be of Middle Eastern or Southern Asian descent; and they all included links to the same products and services in the text under the author names. None of these authors indicated they were qualified to offer advice on nutrition or fitness, which, for one video in particular, was concerning to us as no scientific evidence was provided to support that the information provided was nutritionally sound advice (a seven-day detox diet in which the user was instructed to eat 25 to 30 bananas a day).
Another author posted six of the analyzed videos. This author was the only one who presented herself as a licensed health professional qualified to give advice on diet/ nutrition (i.e., she identified herself as a nutritional therapist.) A nutritional therapist must complete a course or series of courses on nutrition to become certified. We were unable to establish the validity of her credentials, though a seal that says “certified nutritional therapist” was posted on her website. In our opinion, her videos seemed to be reasonable representation of a healthy lifestyle.
One of the authors, who claimed to be a personal trainer and to be employed by “a leading nutrition company,” also attempts, via her website, to recruit others to sell her fitness programs, which leads us to speculate that her business might be based on a pyramid model. An article on this author’s services that appeared in the Chicago Sun identified this author as being a National Academy of Sports Medicine certified professional trainer, who “confirmed that she works alongside top doctors and scientists — all possessing PhDs.” None of the “top doctors” or “scientists” are identified.
The rest of the videos and authors offered similar types of information, i.e., mainly menu samples of weight loss programs. Generally speaking, the menus seemed reasonably healthy, and most of the authors offered some nutrition facts (i.e., calories, fat, carbs, protein). However, with the exception of one author (discussed above), none of the YouTube authors in our study appeared to be qualified to offer nutritional advice. Following a weight-loss program designed by someone who isn’t a licensed dietitian or other related healthcare professional might be risky for individuals with special dietary needs and/or with comorbidities, such as cardiovascular disease, diabetes, or thyroid issues.
The internet is a popular source of information on a variety of topics, particularly healthcare. Before following medical advice, whether from the internet or social media outlets such as YouTube, it is important to consider the experience and knowledge base of the authors presenting the information. Look for videos that are posted by reputable healthcare organizations and/or licensed healthcare professionals. If an author of a video does not disclose a medical background or certified health training, then one must assume he or she is not qualified to offer healthcare advice. If an author does claim to be a licensed healthcare professional or to be presenting information on behalf of a physician or healthcare facility or company, then a quick internet search on the author might be prudent to establish his or her credentials. And, as with all healthcare needs, consulting first with your physician before trying out a new weight-loss and/or fitness program is recommended.