Non-prescription diet pills, diuretics and laxatives are being widely used by adolescents – especially girls – worldwide, say researchers, who warn that the products can harm both the physical and mental health of children and are not medically recommended for healthy weight loss.
The recent analysis, led by Deakin University, Australia, was based on a review of dozens of studies over the past four decades, with the researchers estimating that about 9% of adolescents have used over-the-counter weight-loss products in their lifetime, about half of whom had used them in the past month.
CNN reports that diet pills were the most common products, used by about 6% of adolescents in their lifetime, followed by about 4% who used laxatives and 2% who used diuretics.
Previous research has linked the use of non-prescribed weight-loss products to eating disorders, low self-esteem, depression and substance abuse in teens. They have also been associated with poor nutritional intake in adolescence and unhealthy weight gain in adulthood.
The lifetime prevalence of non-prescription diet pill use for weight control had a statistically significant (using 95% CIs) higher prevalence compared with both non-prescription use of laxatives and diuretics for weight loss, which the researchers said was concerning because of the mental and physical health risks associated with these products – that are not indicated for weight loss but are often used for that purpose.
Equally alarming, they noted, was the ease of access without a prescription, without a physician’s orders, and without restrictions or regulations for those 18 or younger.
This emphasises the need for increased regulation and restriction to be placed on non-prescription weight-loss products, they added, especially for people under 18.
Six years ago, said Dr Paula Cody, medical director of adolescent medicine at the University of Wisconsin School of Medicine and Public Health, she had started warning bout the dangers of diet pills and supplements after patients continually asked about supplements to lose weight or gain muscle – and the issue has only grown.
The incidence of eating disorders had increased dramatically after the pandemic, she added. “We’ve seen the numbers skyrocket, so I’m even more concerned now.”
Hospital admissions for eating disorders among children in the US grew 10 times faster in the first year of the Covid-19 pandemic than in previous years, and other studies have shown an increase in emergency department visits, too.
Although the new study analysed the use of diet pills and other weight-loss products in more countries than just the US, prevalence was most common in North America.
Cody said when working with patients with an eating disorder, she would sometimes see dramatic changes to their heart rate, blood pressure or sleeping patterns.
“It can be quite significant,” she said. “When you try to figure out the cause, you find the only change has been that they started taking a diet pill that contains caffeine.”
The study authors said interventions “are urgently required to prevent and regulate the use of weight-loss products in this population”.
Study details
Global Prevalence of Adolescent Use of Non-prescription Weight-Loss Products:
A Systematic Review and Meta-Analysis
Natasha Hall, Dhanushi Pathirannahalage, Cathy Mihalopoulos, et al.
Published in JAMA Network on 10 January 2024
Abstract
Importance
Use of non-prescribed weight-loss products in adolescents is a public health concern that is associated with negative physical and psychological consequences. However, the prevalence of non-prescribed weight-loss product use in adolescents is unknown.
Objective
To determine the global prevalence of non-prescription weight-loss product use in children and adolescents.
Data Sources
Four databases, including MEDLINE, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health), and EMBASE, were searched for quantitative studies that reported prevalence data on use of non-prescription weight-loss products with no restrictions on publication date. The search was performed December 1, 2020, and updated March 6, 2023.
Study Selection
Studies were included in the meta-analysis if they reported the prevalence of weight-loss product use, were published in English, and included individuals 18 years or younger.
Data Extraction and Synthesis
Data extraction was completed by two independent reviewers. Data analysis determined the overall pooled proportion of weight-loss product use in total and during the past week, past 30 days, past year, or lifetime. Inverse variance heterogeneity effect models were used.
Main Outcomes and Measures
The main outcome measure was the prevalence of non-prescription weight-loss product use in adolescents for all included studies and over the past week, past month, past year, or lifetime. Subgroup analysis included separation of groups by sex, specific weight-loss product types, geographical location, and study publication time.
Results
A total of 90 articles (604 552 unique participants) were included in the meta-analysis. Of these, 50 studies (56%) were from North America. The reported prevalence of weight-loss product use in adolescents was 5.5% (96% CI, 5.5%-5.6%) overall. When identifying use of weight-loss products in the general population, prevalence was 2.0% (95% CI, 1.9%-2.1%) in the past week, 4.4% (95% CI, 4.3%-4.5%) in the past month, 6.2% (95% CI, 6.1%-6.3%) in the past year, and 8.9% (95% CI, 8.6%-9.2%) in their lifetime. Use of weight-loss products was higher among girls than boys.
Conclusions and Relevance
This meta-analysis found that use of weight-loss products occurs at high levels in adolescents, especially girls. These findings suggest that, given the ineffectiveness of these products for weight loss coupled with their harmful long-term health consequences, interventions are required to reduce use of weight-loss products in this group.
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