What is the prevalence of use of nonprescribed and medically unapproved weight-loss products in adolescents?

By Dr. Liji Thomas, MDReviewed by Danielle Ellis, B.Sc.Jan 10 2024

The availability of weight loss products over the counter (OTC) in many countries has been exploited by adolescents. However, the associated health impacts are non-negligible, making it an area of concern in public health. A new study on JAMA Network Open explores the prevalence of such use.

Background

Eating disorders are particularly problematic among teenagers and children since the bulk of growth and development of the human body occurs during these periods. Moreover, these disorders often signal other psychological issues that hinder social functioning. Thirdly, they often play a part in abnormal weight gain with a subsequent negative impact on health.

Adolescent weight control behavior may cross the line into abnormality when they use potentially unhealthy or dangerous methods, one of which is weight control medications without prescription. The use of such drugs is linked to abnormal adult weight gain and a higher risk of being diagnosed with an eating disorder down the line.

Adolescents who display such behavior often have low self-esteem, eat poorly, and are at risk for depression. Substance use risk is increased as well.

Worldwide, adolescents may have used such products without prescription within the last week at prevalences ranging from less than 2% in Australia to past-month use at 2-6%, and past-year use hovering around 3.5%. The current study was motivated by the lack of a global prevalence study in this area.

What did the study show?

The researchers used four major databases to collate relevant studies on the use of nonprescribed weight loss aids by teenagers around the world. They obtained 90 studies, of which 50 were from North America. Most studies were of moderate or good quality.

Over 75% of studies described the use of such products by boys and girls, the rest among girls only. About two-thirds reported prevalence in the whole adolescent population, the remaining exploring groups with risk factors such as diabetes, substance use, or previously diagnosed eating disorders.

Over three out of four studies reported on the use of diet pills. A little less than half looked at laxative use, and a fifth on diuretics.

The findings show that about 6% of adolescents use OTC weight loss products. Girls were at greater risk for use than boys.

Prior week use amounted to 2% of the whole population, but more than doubled when the period of inquiry was extended to the last month. Over 6% reported using such products over the past year, and 9% reported having used them at least once over their lifetime.

Diet pills were significantly more heavily used at 6%, compared to either laxatives (4%) or diuretics (2%), especially among girls, compared to boys.

About a tenth of girls reported ever-use of nonprescription weight loss products. Importantly, girls with such a history also have higher chances of low self-esteem, are under parental pressure to lose weight, have a poor self-image of their body, and usually have friends who put importance on being thin. They also report being influenced by media or social media posts that exalt unhealthy and unrealistic ideals of good looks.

Moreover, the use of nonprescription weight loss medications was higher in North America than in Asia or Europe. Asian studies indicated a higher past-year prevalence of use than European studies. These indicate risk factors at work in these subgroups.

The “ease of access of these products without a prescription, without a physician’s orders, and without restrictions or regulations for those 18 years or younger” is a matter of great concern and emphasizes the need to introduce strict regulation of such products, particularly among children and adolescents.

What are the implications?

Such weight loss products are not meant for use by children, are dangerous to health, are associated with excessive adult weight gain, and do not induce long-term or healthy weight loss. Moreover, they have been linked to a high risk of being diagnosed with eating disorders in adult life or with depression.

An abnormally low intake of food is also associated with individuals who consume such products in adolescence, along with substance use.

“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.”