ACSH Explains: Influencers

Influencers are people with a large following, often across multiple online platforms. They can be movie stars, musicians, or people who have developed a large following because of the content they create for social media. For as long as there have been famous people, there have been influencers, though “influencer” as a profession has only recently been acknowledged. 

Influencers sit at the confluence of marketing, fun, and information, and there is only one qualification for the job: popularity. Influencers sell everything, from clothes to cars, from linens to lifestyles. With no degree requirements or prior work experience, it’s a profession that just about anyone could make money in, and it’s seemingly popular as a potential career for many in the Gen Z and younger Millennial generations. 

The use of influencers is a natural, logical marketing tactic. Popular people sell more products. However, there is a dark and ugly underbelly to this tactic. What happens when what influencers are peddling is detrimental to others’ health? 

Influencers can market their own line of products and services, those of other companies, or both. They might catch the eye of a company because they said they were interested in health or because they are seen as an authority on health. However, the reality of their expertise, or lack thereof, may be extremely different from the perception of it. 

Regulations

Regular readers know I often harp on those speaking out of turn with no education, experience, or evidence to support their claims. I've also been digging into several burgeoning fields like fitness and nutrition influencers and health and life coaches. There is a lot of overlap between these professions and the aforementioned sins.

The idea of regulating influencers is tricky. It is a marketing technique that has been used for hundreds of years. However, those professions that exist only to skirt regulations to sell products and services that a person otherwise has no business selling and pose harm to the public should be regulated. For example, fitness and nutrition influencers know they are leaving money on the table unless they sell supplements.  

There are two ways that these professions could be regulated: through their titles and their offerings (i.e., products and services). 

Titles

Many health influencers (e.g., fitness, nutrition, healthy lifestyle, etc.) will start consulting and/or coaching businesses. “Influencer” doesn’t have the same authoritative ring as other titles. They want to invoke the idea that they are experts in health and health care. So, instead of identifying as an influencer, they’ll claim the title of “coach.” The word “coach” is used because it invokes thoughts of an authoritative figure guiding, advising, and teaching in specific areas. Nutrition coach, health coach, life coach. All these titles invoke assumptions of expertise in these areas. However, lacking a standard, they can be anyone, regardless of knowledge base or experience.

While we’re considering common titles that influencers might use to describe themselves, I would be remiss not to at least mention the word “nutritionist.” Depending upon your state, that title is more or less (usually less) regulated. Yet again, it invokes thoughts of an authoritative figure guiding, advising, and teaching in a specific area. What’s the difference between a registered dietician and a nutritionist? Most people on the street can’t tell you, but there are important differences, and it’s easy to see how the confusion occurs. It’s deliberate. 

Regulating these titles would align with how health care operates. Specific professions and titles come with educational and experience requirements before being claimed. For example, claiming to be a doctor when someone does not have that degree could result in a lawsuit. 

We’re already having a conversation about titles in the healthcare world, especially in the clinical setting. It’s time to broaden that discussion to include individuals acting as healthcare professionals who aren’t. By regulating these titles, we could bring the assumptions of the educational and experiential backgrounds and reality closer together.

Products and Services

While I don’t necessarily think that we should regulate the title of influencer, I do think it should be more apparent, more obvious, when someone is acting as an influencer. Recently, there was a scuff-up around dieticians posting content to social media that was paid for by American Beverage. This has resulted in stricter policies to make it more transparent when a post is sponsored content.

“It’s irresponsible for any trade group to hire influencers to tout its members’ products and fail to ensure that the influencers come clean about that relationship. That’s certainly true for health and safety claims about sugar and aspartame, especially when made by registered dieticians and others upon whom people rely for advice about what to eat and drink.”

Samuel Levin, Director of the FTC’s Bureau of Consumer Protection

While this is a good start, we must go beyond social media policy. The Dietary Supplements Health and Education Act (DSHEA) from 1994 needs to be reformed. This law created a carve-out for supplements that treats them as exceptions to the rules that prescription drugs must follow. But these products are not benign and people without the necessary education and experience can do real harm by recommending and selling them. 

Prescription medications can only be accessed through certain healthcare providers with specific training and education. With many influencers selling their supplement lines, DSHEA provides a way to get around pesky educational and licensure requirements. If the products aren’t regulated or only extremely loosely, then there’s no need for a prescription pad. The perception of expertise is preserved. 

Beware of influencers providing health advice. Approach claims specifically looking asking:
 

• Do they have significant educational and/or experience in this area?
• What are the claims being made?
• What’s the evidence, if any, they provide?
• Do the claims match the evidence?