Is it ethical for dietitian influencers to take money for posts? Not everyone agrees

Like a life raft in a sea of misinformation, health-care providers have popped up across social media platforms, correcting bad health information and pointing to credible research.

But as they've joined the influencer sphere, a subset of practitioners — including a number of registered dietitians in Canada — have taken up the influencer business model: doing sponsored content or "paid partnerships" with brands and industry groups.

So far, dietitian colleges that act as regulators have largely allowed members to take money from industry, as long as they follow guidelines for advertising.

But some experts say the current level of oversight is insufficient, or argue that it's not possible for a licensed health-care practitioner to take money from industry without having a conflict of interest.

A recent joint investigation by the Washington Post and health journalism outlet The Examination found a number of American dietitians had posted videos on Instagram where they criticized headlines that questioned the safety of aspartame. It was revealed that the dietitians had been paid by the beverage industry to make the posts, and that in some cases the payment wasn't disclosed.

The same article highlighted paid posts some Canadian dietitians had done for the Canadian Sugar Institute — a non-profit industry group funded by private companies.

However, the institute says on its website that it operates at arms length from its funders and is not involved in those companies' marketing efforts.

CBC News reached out to 11 Canadian registered dietitians who post sponsored content on their Instagram accounts, including two who were interviewed by the Washington Post, but none agreed to an interview.

Jessica Penner and Nita Sharda, Winnipeg-based registered dietitians and business partners, declined an interview, but said in an email that they're open to brand partnerships that align with their goal of supporting nutrition and a positive relationship with food.

"Our audience always knows if something is gifted or sponsored and we pride ourselves with our transparency."

Professionals used as 'marketing tool'

But transparency is not enough to avoid conflicts of interest, says Alison Thompson, a bioethicist who teaches ethics to pharmacy and public health students at the University of Toronto.

"It's not whether you were actually influenced by that conflict. It's the perception of a conflict of interest that can undermine public trust in the profession itself," Thompson said, adding that studies have shown that research funded by industry ends up having a positive bias.

"We know that industry pays health-care professionals to share their opinions because it works. It's a marketing tool."

Thompson says financial connections with industry are becoming increasingly frowned upon — such as physicians having relationships with pharmaceutical companies — but that there is less public awareness about how this happens on social media.

Thompson said clearer disclosure is a good first step, and that she'd like to see a public registry where Canadian practitioners must openly share all relationships with industry.

Regulations and standards

In Canada, dietitians are overseen by regulators at the provincial level.

Regulatory colleges in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario all shared copies of their policies and other resources provided to members that relate to social media and advertising, which shared similar principles in varying degrees of detail.

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As many licensed health-care practitioners become social media influencers, some critics are raising questions about the ethics of making content paid for by industry groups and private companies.

The College of Dietitians of Ontario warns dietitians that they should "carefully consider" endorsing any specific brand or product.

"Principles of transparency, honesty, evidence-informed practice, professional judgment, and ethics should be considered," Ontario's social media standards and guidelines state.

The College of Dietitians of B.C. cites Ad Standards Canada recommendations about disclosing brand partnerships, recommending disclosures be "upfront, conspicuous and unambiguous" — the disclosure should be made at the beginning of the video and in the first few lines of the post.

The college recommends using widely accepted hashtags like #ad and #sponsored and avoiding hashtags that don't clarify if monetary connections are present. "Simply tagging the brand is insufficient," the B.C. guidelines advise.

While regulators have the ability to discipline members that violate their standards, the colleges in Ontario, B.C. and the Prairies all said they haven't received any public complaints about dietitians doing paid social media posts.

Preserving trust a concern

A few complaints have landed at the doorstep of Quebec's regulator, the Ordre des diététistes nutritionnistes du Québec.

So far, none of the complaints have resulted in sanctions, president Joelle Emond said in an interview, adding that only a minority of Quebec dietitians are on social media, and an even smaller number do sponsored posts.

The code of ethics for Quebec dietitians is currently under review, and Emond says they're trying to work out the best way forward.

"Our main concern is trust and is to preserve the public's trust in our health-care professionals and registered dietitians," she said. "If we lose the link of trust, we lose everything."

Emond said that while the public likes it when dietitians are on social media providing credible information, there is much less public approval of paid partnerships.

Meanwhile, she says dietitians who make paid content argue it allows them to devote time to sharing reliable information on platforms like Instagram and TikTok, and that their professional codes of conduct ensure that information is evidence- based and free of influence.

"But the question that we are asking ourselves is, is that enough?" Emond said.

'Be skeptical'

Dietitians aren't alone in having their credibility leveraged by private companies — doctors and physiotherapists do it, too, says Timothy Caulfield, a Canada Research Chair in health law and policy at the University of Alberta who studies online misinformation.

On platforms crowded with wellness and health influencers eager to work with companies of all stripes, he says licensed health-care providers are particularly appealing to advertisers.

According to Caulfield, there's been a "massive erosion of trust" with institutions and professionals. "But health-care providers are still among the most trusted voices out there."

Like Thompson, Caulfield wants to see regulatory bodies do more to enforce clear and obvious disclosures from their members. He doesn't think simply adding "#ad" to an Instagram caption is enough.

Until there are better standards, Caulfield said people should assume that if a product is being pushed, there may be a commercial connection.

"Pause and look at those disclosures, and if you see that it's an ad — be skeptical," he said.