Evaluating the Content of Advertisements for Dietary Supplements in Malaysian Women’s Magazines

Abstract

Advertising in printed media, including magazines, has become a vital source of information about dietary supplements for consumers. Within this context, the extent to which the manufacturers of these dietary supplements adhere to the standards and guidelines of good advertising practices remains relatively unexplored in Malaysia. The current study aimed to identify the purported health benefits of the advertised dietary supplements from selected women’s magazines and to evaluate the compliance of the advertisement contents with the Malaysian Advertisements Board (MAB) guidelines. The contents of 18 issues of popular women’s magazines in Malaysia were analyzed during a 1-month period in 2010. A total of 157 dietary supplement advertisements were analyzed and classified into 4 categories based on the ingredients, functional claims, the presence or absence of a Ministry of Health Advertising Approval Number (KKLIU), and violation of the MAB regulations. Chi-square analyses were used to investigate the association between the scores for MAB regulation violations and the advertised contents in the magazine. A total of 157 dietary supplement advertisements were analyzed. Malay herbs such as kacip fatimah (Labisia pumila), mas cotek (Ficus deltoidea), and tongkat ali (Eurycoma longifolia) were frequently advertised herbal products. Additional advertised substances included vitamins (n = 28, 17.8%), proteins (n = 16, 10.2%), and minerals (n = 15, 9.6%). The majority of the products (n = 21, 19.8%) declared cosmetic/beauty or antiaging functions, and 13.3% of the advertisements claimed to restore, improve, or enhance the sexual health of men or women. Overall, approximately 74.2% of the advertisements did not have KKLIU/MAL numbers. With regard to language, it was clear that the Malay-language magazines significantly violated the advertisement criteria of the MAB (P < .05). Nearly all of the selected magazines in some way did not fulfill the advertising ethics outlined by the MAB.

Keywords

women’s magazines dietary supplement advertisement Malaysia

Introduction

Dietary supplements are products used to (1) improve the supply of vitamins, minerals, or amino acids or (2) herbs or other botanical extracts, concentrates, or metabolites, used alone or in combination with any ingredient described in (1).¹ In recent years, the global market for dietary supplement products has vastly increased, and approximately 40% of the sales are in the Asia Pacific region.² Specifically, it has been reported that Malaysians spend an average of US$17 per month on vitamins and dietary supplements.³ Within the context of marketing these products, it is widely accepted that commercial advertising through print and electronic media is an important means of influencing the purchasing power of consumers.⁴

Moreover, it has been reported that approximately 60% of regular dietary supplement users believed the claims made by supplement manufacturers in advertisements to be generally true.⁵ Although the pharmaceutical advertising industry has become a potent force that can directly influence their target group, the advertisements are commonly misleading, inaccurate, or loaded with unbalanced information.^{6

–9} Advertisements containing misleading information and exaggerated claims should be screened, or there should be a national legislative system that monitors the advertisements to provide evidence-based information to the consumers. For example, in Malaysia, dietary supplements are categorized under the over-the-counter (OTC) product category or as traditional products if they contain any herbal components.¹⁰ According to the Malaysian Control of Drugs and Cosmetics Regulation 1984, OTC and herbal supplements must be registered with the National Pharmaceutical Control Bureau (NPCB) of the Ministry of Health.^11,12 All manufacturers, importers, and wholesalers must be licensed by the NPCB, and they should strictly adhere to the Good Manufacturing Practice (GMP) requirements. In addition, therapeutic claims to cure, treat, or prevent diseases are not allowed for dietary supplements. However, functional claims, such as increased strength and vitality, are permitted.^3,13,14

In the context of print media, the Advertising Standards Authority (ASA) of Malaysia functions to provide guidance via the Malaysian Code of Advertising Practice to promote and enforce high ethical standards in advertising.¹⁵ The Medicine Advertisement Board (MAB) of the Ministry of Health regulates the advertisement of pharmaceutical products, including vitamins and dietary supplements, under the Medicines (Advertisement & Sale) Act of 1956 (revised in 1983). The Medicine Advertisements Board Regulation of 1976 was implemented to ensure responsible advertising of medicines, appliances, and remedies that can be purchased by the public without a prescription.¹⁶ It is essential for all manufacturers and approved distributers to request an approval number or Kementerian Kesihatan Lembaga Iklan Ubat (KKLIU) prior to publication, and this number must be clearly displayed in the advertisement.^3,5,10,11,17

In recent years, the use of dietary supplements, traditional herbs, and nutraceuticals has markedly increased in Malaysia. Women have been reported to be more inclined to use dietary supplements.^18,19 Women’s magazines have been identified as a vital source for the advertisement and publicity of dietary supplements, and a majority consider published advertisements to be a reliable source of information.^{20

–23} It has also been noted that print advertising can provide more detailed information to consumers.²⁴ However, few studies have examined the ethical concerns regarding advertisements for medicinal and health supplements in women’s magazines.^{25

–28} Therefore, analyzing the messages in advertisements for health supplements in these magazines is a timely endeavor, especially in Malaysia, where no study has been previously carried out on this subject. This deficiency in the Malaysian literature highlights the need to verify the quality of the advertised dietary supplements in selected women’s magazines and to identify the health claims in the advertisements to evaluate the compliance of the advertisements with the MAB guidelines. Therefore, the current study aimed to evaluate the dietary supplement advertisements in the published women’s magazines available on Malaysian shelves.

Methods

This study is perhaps first of its kind to be conducted in Malaysia. Content analysis of the 18 best-selling women’s magazines published between July 24 and August 20 of 2010 was performed to achieve the study objectives. All of the issues published during this period were reviewed page by page for dietary supplement advertisements. All of the advertisements mentioning more than 1 type of supplement were counted as separate advertisements. All of the written contents of the advertisements were analyzed. The advertised products were examined and classified based on the following categories: ingredients, the specific active ingredients, the type of functional claim, and the presence of a KKLIU/MAL number. Last, the advertisements were evaluated for discrepancies from the MAB regulations by assigning 1 mark for each violated item. Table 1 lists the criteria used to evaluate the contents of the advertisements.

Table 1.

Malaysian Medicine Advertisements Board (MAB) criteria for advertisement of dietary supplements.

	Yes	No
KKLIU/MAL number provided in the advertisement
The advertisement offers any products for a condition that must be evaluated by a qualified medical practitioner
The advertisement highlights the need for consultation from a physician before using the product
The advertisement contains any claims for the rejuvenation or prevention of the aging process
The advertisement contains any claims to enhance/improve the sexual health or resolve sexual health issues for men and women
The product is recommended to be used for slimming purposes a. Claims to reduce the weight and body physical appearance b. Claims that the product reduces X kilograms in X number of days
Evidence from the literature or clinical trials
Misuse of scientific literature or clinical trials
Precaution for the use among pregnant ladies/breastfeeding mothers

Data Analysis

The Statistical Package for the Social Sciences (SPSS) version 18.0 software (SPSS Inc, Chicago, Illinois) was used for data analysis. Chi-square analyses were used to test for significant differences in the discrepancy between MAB regulations and the language used in the magazine. The remaining information is displayed descriptively. Significance for all data is defined as P < .05.

Results

A total of 157 dietary supplement advertisements were analyzed in the study (Table 1). Mingguan Wanita was found to be the top-rated magazine advertising dietary supplements. Most of the advertisements were for agents containing herbal and collagen products as the specific active ingredients (Table 2). In most of the herbal preparations, Malay herbs such as kacip fatimah (Labisia pumila), mas cotek (Ficus deltoidea), and tongkat ali (Eurycoma longifolia) were the most frequently advertised. In terms of the ingredient categories, vitamins (n = 28, 17.8%), proteins (n = 16, 10.2%) and minerals (n = 15, 9.6%) were the most frequently advertised ingredients.

Table 2.

Top-selling women’s magazines and dietary supplements advertised.

	n (%)
Top-selling women’s magazines
Mingguan Wanita	89 (56.7)
Remaja	4 (2.5)
Rapi	4 (2.5)
Harmoni	9 (5.73)
Women’s Weekly	3 (1.91)
Women’s Health	11 (7.01)
Health and Beauty	21 (13.4)
CLEO	3 (1.9)
Shape	3 (1.9)
Cinefashion	1 (0.6)
Health Today	9 (5.7)
Category of ingredients^a
Herbs	115 (73.2)
Vitamins	28 (17.8)
Amino acids	21 (13.4)
Mineral	15 (9.6)
Fibers	5 (3.2)
Probiotics	4 (2.7)
Carbohydrates	3 (1.9)
Fish oils	3 (1.9)
Enzymes	2 (1.3)
Collagens	1 (0.6)
Not specified	2 (1.3)
Specific active ingredient
Marine polysaccharide	1 (0.6)
Chondroitin sulphate	2 (1.2)
Herbs or botanicals	112 (65.5)
Vitamin D3	1 (0.6)
Omega3 fish oil	4 (2.3)
Vitamin C	9 (5.3)
Gluthathione	1 (0.6)
Collagen	14 (8.2)
Glucosamine	3 (1.7)
Vitamin E	3 (1.7)
Other	15 (8.8)
Not specified	6 (3.1)

^a. As one product contained multiple ingredients, the sum for this category does not total 100%.

Reviewing the functional claims indicated that most of the products declared cosmetic/beauty or antiaging functions (21 products, 19.8%). Overall, we observed that the Malay-language magazines advertised these supplements more often than did the English-language magazines (Table 3). An analysis of the magazines based on the advertising approval number (KKLIU/MAL number) revealed that the number was displayed in 42 (26.8%) advertisements. Of these, over one-third (n = 18, 35.3%) were found in English-language magazines, and the rest (n = 24, 22.6%) were from Malay-language magazines. Overall, approximately 74.2% of the advertisements did not have KKLIU/MAL numbers. Similarly, it was noted that approximately 144 (91.7%) of the product advertisements involved conditions that require professional advice before self-administration. Only 17 (10.8%) of the advertisements contained a statement instructing consumers to consult a registered practitioner before using the product. Of these, 10 (6.4%) were products directly advertised by national and multinational pharmaceutical firms. It was noted that approximately 21 (13.3%) of the advertisements contained claims about restoring, improving, or enhancing the sexual health of men or women. Detailed results of the evaluation of the advertisements using MAB criteria are presented in Table 4. Overall, it was found that the Malay-language magazines significantly (P < .05) violated the advertisements criteria of the MAB.

Table 3.

Functional claims of the advertisements and the language of the magazines.

	Number of Advertisements (%)
Claim	In English-Language Magazines (n = 51)	In Malay-Language Magazines (n = 106)
Promotes beauty, antiaging	6 (11.8)	21 (19.8)
Aids sexual weakness	1 (2.0)	16 (15.1)
Promotes weight loss	4 (7.8)	14 (13.2)
Improves daily performance	6 (11.8)	10 (9.4)
Lowers blood sugar level	0 (0.0)	9 (8.5)
Improves memory, sleep, rest	0 (0.0)	6 (5.7)
Reduces menstrual pain and flow	2 (4.0)	4 (3.8)
Antioxidant	2 (3.9)	3 (2.8)
Boosts immune system	5 (9.8)	2 (1.9)
Improves bone, muscle, joint health	5 (9.8)	2 (1.9)
Improves gastrointestinal tract function	5 (9.8)	2 (1.9)
Maintains cholesterol level	2 (3.9)	1 (0.9)
Other	13 (25.5)	12 (11.3)
None	0 (0.0)	4 (3.8)

Table 4.

Evaluation of the advertisements using Medicine Advertisements Board criteria.

	Number of Advertisements (%)
	Yes	No
KKLIU/MAL number provided in the advertisement	47 (30.0)	110 (70.0)
The advertisement offers any products for a condition that must be evaluated by a qualified medical practitioner	144 (91.7)	13 (8.3)
The advertisement highlights the need for consultation from a physician before using the product	17 (10.8)	140 (89.2)
The advertisement contains any claims for the rejuvenation or prevention of the aging process	7 (4.5)	150 (95.5)
The advertisement contains any claims to enhance/improve the sexual health or resolve sexual health issues for men and women	21 (13.3)	136 (86.7)
The product is recommended to be used for slimming purposes
a. Claims to reduce the weight and body physical appearance	18 (11.5)	139 (88.5)
b. Claims that this product reduce X kilograms in X number of days	3 (1.9)	154 (98.1)
Evidence from the literature or clinical trials	3 (1.9)	154 (98.1)
Misuse of scientific literature or clinical trials	1 (0.6)	0 (0.0)
Precaution for use among pregnant ladies/breastfeeding mothers	0 (0.0)	157 (100.0)

Discussion

Magazines are one of the easiest methods for advertising a product directly to the customer, and with this direct-to-customer marketing, manufacturers can increase product sales dramatically.²⁷ Dittrich²⁹ reported that women read an average of approximately 400 to 600 advertisements from different types of magazines, and by the age of 17 years, a teen girl has received over 200,000 advertisement messages through the media.³⁰ In other words, it would be accurate to state that women are an important market segment, and advertising in women’s magazines is an easy direct-to-customer advertising approach to increase the sale of a variety of products.

High demand and intense interest from the public push companies to come out with various herbal supplements with a variety of claims (evidence based/non–evidence based), and they use different marketing and advertising tactics to promote their products. As a major market segment, women are more often exposed to these advertisements and are more likely to use these supplements/products.^{31
–33} This high demand then automatically results in an increase in the supply, which results in an increase in the advertisements to promote the products. Most manufacturers often advertise in women’s magazines because the majority of women refer to these magazines as their main source for health and nutrition information.²⁷ There are no requirements for the advertisers for vitamin, herbal, and dietary supplements in women’s or other magazines, except that the advertisements follow the advertisement ethics or rules and regulations documented by the national advertising board. In Malaysia, the MAB monitors the advertisements for vitamins and herbal and dietary supplements and has outlined strict criteria.³⁴ The first step for advertisers of vitamins and herbal and dietary supplements is to obtain a KKLIU number, which was missing in 74.2% of the advertisements. In the absence of the KKLIU number, it can be assumed that the contents of 74.2% of the advertisements do not adhere to the code of advertising ethics defined by the MAB and are misleading to the consumers. Furthermore, the MAB and the Malaysian code of advertising practice, the ASA of Malaysia, 2008 condemns the advertisement of products for medical conditions that require a professional consultation or checkup before taking the advertised product. For example, conditions including obesity, sexual disorders, hormonal imbalance, skin conditions, menstrual complications, joint pain, diabetes mellitus, high cholesterol, and mental function and performance require professional medical advice before use of a product. In this content analysis, only 17 (10.8%) of the advertisements contained a statement advising consumers to consult a medical expert before taking the supplement. Professional advice is essential for preventing complications and drug interactions; in the screened advertisements, only precautionary information was provided. Furthermore, important issues such as the side effects, use among special populations (eg, pregnant/nursing mothers), and contraindications for comorbid medical conditions (Ca+/Mg+ supplements can interact with cardiac medicines)³⁵ were also missing from the ads, representing a major violation of the MAB and the Malaysian code of advertising practice, the ASA of Malaysia in 2008.

In addition to the other violations noted in the advertisements were the testimonials by the experts, for example beginning “This product is traditionally used. . . .” This violation was even more prominent in the advertisements without KKLIU numbers. This finding highlights the negligence on the part of the advertising authorities to approve misleading ads for publication. Similarly, the products used to relieve fever, cough, and pain never included the statement “If symptoms persist, please consult your doctor.” Furthermore, the advertisements for weight reduction did not include the statement “This is a traditional preparation, should be taken with a balanced diet and regular exercise.” Thus, these findings highlight the negligence of the advertisement regulatory bodies (MAB and the Malaysian ASA) to perform their fundamental role in scrutinizing the advertisements before approving them for publication. Another possibility is that the advertisements contained altered or fake advertising KKLIU approval numbers³⁶ and that no actual advertisement was submitted to request a KKLIU approval number. As the study results showed, approximately 70% of the ads did not contain KKLIU numbers, and almost all (n = 155, 98.7%) of the advertisements contained claims or statements of product effectiveness that were unsupported by clinical or other scientific evidence. Therefore, these publications cannot be relied on to provide readers with all of the information that they need to use the supplements safely, and the advertisements should be withdrawn immediately.^16,37 Notably, more violations were also noted among the Malay-language magazines compared to the English-language magazines.

Conclusions

Our findings indicate that a majority of the ads in Malaysian women’s magazines were concerned with slimming and beauty, followed by products claiming to restore or improve sexual or hormonal function in men and women. Overall, nearly all of the selected magazines were revealed to not fulfill the advertising ethics outlined by the MAB. Moreover, the Malay-language magazines were more often found to be in violation of the MAB advertising guidelines.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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