Misinformation and health: How can you help your clients find the right answers to their health questions

Highlights:

• Misinformation can pose a threat to the overall health of your client
• Sources with credible information that can be suggested to your clients include government-endorsed websites, non-profit organization sites, and scientific bodies and associations web pages
• Combating misinformation can potentially contribute to the longevity of your clients

Introduction

Health misinformation is defined as false, inaccurate, or misleading health-related claim due to misinterpretation of actual evidence or lack of scientific data supporting it. The widespread availability of information resources has led to the emergence of influencers, websites, and media sources that spread misinformation, both intentionally and unintentionally. This has been evident in the past five years, especially with the emergence of social media platforms like Tiktok and Facebook, where non-professionals provide health advice, including nutritional tips. While some are valid, giving nutritional tips to people suffering from medical conditions could threaten their life.    

How big is the problem?

The growth of social media has been accompanied by an increase in the number of people who seek and share health-related information. This applies to individuals of various demographic backgrounds (1). Recent research has highlighted that misinformation spreads quicker than scientifically-sound advice on social media (2). A study by Vosoughi et al. that examined about 126 thousand stories shared by approximately 3 million Twitter users found that the top 1% of misinformation and false news reach up to 100 times more users compared to truthful information (2). Additionally, the study found that automated robots connected to social media platforms facilitated the spread of these false claims. The latter was fueled by user behavior who tended to share misinformation in a broader scope. It is important to note that misinformation extends to several health domains and fields, such as vaccines, medications, nutrition, non-communicable disease, and others (1). One prominent example for the spread of misinformation is the novel coronavirus 2019 (COVID-19) disease (3). During the pandemic, misinformation regarding the disease, its treatment, and the vaccines dominated social media platforms. According to a systematic review by Gabarron et al. who assessed 22 studies to identify COVID-19 misinformation on social media, up to more than 1 in every 4 posts spread false information related to COVID-19 (4). According to research, diet and nutritional information rank second among the most sought information online, just behind disease-related content (5).

To better recognize and understand the prevalence of misinformation in different social media platforms, Suarez-Lledo and Alvarez-Galvez performed a systematic review on 69 studies (1). The authors categorized misinformation into six groups: vaccines, drugs or smoking, noncommunicable diseases, eating disorders, and others. Shockingly, the researchers found the prevalence of misinformation in certain studies reached a staggering 87%. When analyzed via the suggested methodological approaches such as social network analysis and content evaluation, the authors found that the prevalence of misinformation on diets and eating disorders reached 36%. This highlights that a considerable number of nutritional advice available on social media are misleading and could lead to adverse health outcomes. The authors of this study concluded that misleading information was primarily present on Twitter.

Pseudoscience and misinformation

Pseudoscience, also known as pretended science, is a science that claims a factual basis for erroneous methods and theories (6). Throughout time, pseudoscience has managed to find its way even to the most reputable scientific journals. One such famous example is the Lancet article which allegedly linked the measles, mumps, and rubella (MMR) vaccine to autism (7). The article was later retracted and criticized for its questionable methodology. However, the damage from that pseudoscience publication is still continuing to this day, where measles outbreaks occur in the United States after decades of being eliminated in the country (8). This shows how pseudoscience can undermine trust in established medical and scientific procedures meant to protect and save lives.

Currently, a new variant of COVID-19 is sweeping through the planet. The only thing spreading faster than the virus itself is the misinformation about it, its treatment, and vaccines (9). To provide the best possible outcomes, it is important to combat pseudoscience in different domains of the healthcare system, because misinformation carries a direct risk to your clients, as highlighted earlier and will be discussed later on (10).  

Good sources of health information

There are plenty of dietary and health information resources available online through websites, social media, or other means. Your clients need to understand that not all information is reliable or trustworthy (11). To make this simple, explain to your clients that evidence-based practice has a hierarchical system of information reliability. At the top of the evidence pyramid is the systematic reviews and meta-analysis, which contain evidence that has been rigorously reviewed by multiple techniques to derive evidence-based conclusions (12). This is followed by what is called double-blind randomized control trials and peer-reviewed sources, case studies, and at the bottom expert opinion and case reports. The latter is evidence that is derived from a single case or a number of cases (12).

With regard to internet-based sources, encourage your clients to look for information on websites that end with the extensions of .edu (educational institution), .org (non-profit organization), and .gov (governmental websites). In most instances, websites ending with .com (stands for commercial) or .net (stands for networks) provide information that might need careful assessment, even if the provided information appears valid (11, 13). It is important to convey to your clients that there are .com websites that provide credible information, such as those of health associations and professional bodies.

One good example of a governmental website with good information about nutrition is Nutrition.gov (14). This website is supported by the United States Department of Agriculture. It provides various information that ranges from nutritional tips and healthy recipes to exercise and fitness tips and videos. Additionally, it links the user to other useful government websites related to nutrition and other beneficial health activities. This website also categorizes nutritional requirements by age and provides resources and printable material that support healthy eating. Another good source of dietary information is the United Kingdom’s National Health Services (NHS) website. Nhs.uk provides a variety of information on numerous health conditions (15). The Live Well subsection (nhs.uk/live-well/) can guide your clients to numerous health tips and lifestyle changes that positively influence their lives. This subsection has information and useful tips about nutrition, sleeping, smoking, and other healthy lifestyle promoting activities. The World Health Organization (WHO) offers a website that provides plenty of useful information that your clients can utilize. Who.int offers information about different health topics, like nutrition, diseases, and more (16). The website has several languages and is categorized in several ways to facilitate the navigation process.

Regarding organizational website nutrition.org, nutritionfacts.org, and nutrition.org.uk stand among the best organizational websites that offer plenty of dietary advice that your clients can utilize. These websites’ content and material tend to be organized and highly categorized to make navigation easier. Your clients can have dietary information for a specific age group, different medical conditions, sustainable diets, and much more. NutritionFacts.org has a section dedicated to longevity that provides videos with information about boosting lifespan and discusses many topics connected with the subject (17).

Misinformation and longevity

Social media posts discuss a variety of topics that have the potential to influence the lifespan of your clients. Examples include diet, physical fitness and activity, and health and wellness tips (18). To better understand how misinformation can negatively impact health and eventually the lifespan of your client, it is important to examine the link between longevity and the examples mentioned earlier.

Research has highlighted that nutrition, among other factors, influences the lifespan of individuals (19). According to the literature, malnutrition contributes to shortened longevity (20). This is of particular importance to your clients due to the availability of many weight loss tips and diets online that promise quick solutions that could eventually lead to malnutrition and subsequently influence the lifespan of your clients.

Regarding physical activity, literature has highlighted its connection with longevity (12), as moderate physical activities, such as brisk walking, have been associated with increased life expectancy. Social platforms have been shown to be a medium for exercise misinformation (18). The problem with this kind of misinformation is that it could lead to real-life consequences such as injuries, therefore affecting your clients’ lives. To avoid such issues, recommend your clients to exercise with professionals and to use trustworthy sources for information. One good example is the National Center on Health, Physical Activity and Disability website (nchpad.org), which has plenty of tips and information that your clients can utilize in their exercise and physical activity (21).

Tips

• Advise your clients to assess all the nutritional information they see on social media before considering them. Especially these by influencers and celebrities.  
• Encourage your clients to deal only with professionally accredited nutritionists. Highlight that nutrition experts, such as registered or licensed dietitians, have specialized education that allows them to provide nutritional advice. 
• Refer your clients to trustworthy sources such as official governmental websites, renowned organizations or associations, and educational institutions for health-related information.
• Highlight to your clients that most scientific organizations and bodies have a presence on social media. 
• Educate your clients about basic logical fallacies that are used to spread false information. For example, using names of reputable organizations or scientists to give credibility to the false information.
• Warn your clients about nutritional and health recommendations that provide a quick fix for a health problem. For example, a diet that offers a short-term weight loss solution or a “miracle cure” for a serious condition that has no cure.
• If your clients are in the development phase, be sure to explain to them that they should be careful with applying everything they see, read, or hear because it could negatively affect their development.
• If your clients are athletes, highlight that they should be careful with the products and diets that promise a “power boost”.
• Educate your clients about unrelatable conclusions drawn from specific studies. For example, extrapolating results from preclinical studies to humans.
• Highlight to your clients that nutritionists have credentials because their practice is based on science rather than “life experience”. Warn your clients from dietitians with degrees or certifications from questionable sources.
• Establish an online presence to help provide your clients with relevant information and updated sources to help them achieve their goals.
• Be sure to highlight that just because a product claims “all-natural” does not make it automatically safe. Some natural products could be toxic, fatal, or adulterated with synthetic components.
• It is important to highlight to your clients that inter-individual variations in phenotypes, genes, and microbiomes exist. Therefore, in order for your clients to have the best outcomes, it is important to use diagnostics and observe the outcomes of the approaches or diets they implement.  

Conclusion

The internet is full of information resources that are readily accessible to people. This widespread availability gave rise to misinformation, which could negatively influence your clients’ lives. Studies have shown that in most instances, misinformation spreads fast due to user behavior. You can support your clients and help combat misinformation by promoting credible sources.

References

1.            Suarez-Lledo V, Alvarez-Galvez J. Prevalence of Health Misinformation on Social Media: Systematic Review. J Med Internet Res. 2021;23(1):e17187.

2.            Vosoughi S, Roy D, Aral S. The spread of true and false news online. Science. 2018;359(6380):1146-51.

3.            Ali S. Combatting Against Covid-19 & Misinformation: A Systematic Review. Human Arenas. 2020:1-16.

4.            Gabarron E, Oyeyemi SO, Wynn R. COVID-19-related misinformation on social media: a systematic review. Bulletin of the World Health Organization. 2021;99(6):455-63A.

5.            Levy JA, Strombeck R. Health benefits and risks of the Internet. J Med Syst. 2002;26(6):495-510.

6.            Callaghan C. Pseudoscience in medicine: cautionary recommendations. Afr Health Sci. 2019;19(4):3118-26.

7.            Eggertson L. Lancet retracts 12-year-old article linking autism to MMR vaccines. Canadian Medical Association Journal. 2010;182(4):E199.

8.            Hotez PJ. Anti-science kills: From Soviet embrace of pseudoscience to accelerated attacks on US biomedicine. PLOS Biology. 2021;19(1):e3001068.

9.            Garett R, Young SD. Online misinformation and vaccine hesitancy. Translational behavioral medicine. 2021;11(12):2194-9.

10.          Wansink B. Position of the American Dietetic Association: food and nutrition misinformation. J Am Diet Assoc. 2006;106(4):601-7.

11.          Nutrition Misinformation: How to Identify  Fraud and Misleading Claims Colorado: Colorado State University;  [Accessed January 2022]

12.          Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evidence Based Medicine. 2016;21(4):125.

13.          Pollard CM, Pulker CE, Meng X, Kerr DA, Scott JA. Who Uses the Internet as a Source of Nutrition and Dietary Information? An Australian Population Perspective. Journal of medical Internet research. 2015;17(8):e209-e.

14.          Main Page: United States Department of Agriculture; 2022 Available from: https://www.nutrition.gov/. [Accessed January 2022]

15.          Live Well: National Health Servcies; 2022 Available from: https://www.nhs.uk/live-well/. [Accessed January 2022]

16.          Homepage: World Health Organization; 2022 Available from: https://www.who.int/. [Accessed January 2022]

17.          Longevity: Nutritionfacts.org; 2022 Available from: https://nutritionfacts.org/topics/longevity/. [Accessed January 2022]

18.          Marocolo M, Meireles A, de Souza HLR, Mota GR, Oranchuk DJ, Arriel RA, et al. Is Social Media Spreading Misinformation on Exercise and Health in Brazil? Int J Environ Res Public Health. 2021;18(22).

19.          Ekmekcioglu C. Nutrition and longevity - From mechanisms to uncertainties. Crit Rev Food Sci Nutr. 2020;60(18):3063-82.

20.          Shibata H, Shibata N. Malnutrition in Japan is threatening longevity in the future. J Gerontol Geriatr Med. 2017;3:12.

21.          Homepage: The  National Center on Health, Physical Activity and Disability; 2022 [Available from: https://www.nchpad.org/. [Accessed January 2022]