California and New York are on the cusp of going further than the FDA in restricting the sale of non-prescription diet pills to minors as pediatricians and public health advocates try to protect kids from extreme weight-loss gimmicks online.
A bill before Gov. Gavin Newsom would bar anyone under 18 in California from buying over-the-counter weight loss supplements 鈥 whether online or in shops 鈥 without a prescription. A similar bill passed by New York lawmakers is on Gov. Kathy Hochul鈥檚 desk. Neither Democrat has indicated how he or she will act.
If both bills are signed into law, proponents hope the momentum will build to restrict diet pill sales to children in more states. Massachusetts, New Jersey, and Missouri have introduced and backers plan to continue their push next year.
Nearly people in the United States will have an eating disorder in their lifetime; 95% of them are between ages 12 and 25, according to Johns Hopkins All Children鈥檚 Hospital. The hospital adds that eating disorders pose the highest risk of mortality of any mental health disorder. And it has become easier than ever for minors to get pills that are sold online or on drugstore shelves. All dietary supplements, which include those for weight loss, accounted for nearly 35% of the over-the-counter health products industry in 2021, according to Vision Research Reports, a market research firm.
Dietary supplements, which encompass a broad range of vitamins, herbs, and minerals, are and don鈥檛 undergo scientific and safety testing as prescription drugs and over-the-counter medicines do.
Public health advocates want to keep weight loss products 鈥 with ads that may promise to and pill names like Slim Sense 鈥 away from young people, particularly girls, since some research has linked some products to eating disorders. A , which followed more than 10,000 women ages 14-36 over 15 years, found that 鈥渢hose who used diet pills had more than 5 times higher adjusted odds of receiving an eating disorder diagnosis from a health care provider within 1 to 3 years than those who did not.鈥
Many pills have been found tainted with banned and dangerous ingredients that may cause cancer, heart attacks, strokes, and other ailments. For example, the FDA Slim Sense by Dr. Reade because it contains lorcaserin, which has been found to cause psychiatric disturbances and impairments in attention or memory. The FDA ordered it discontinued and the company couldn鈥檛 be reached for comment.
鈥淯nscrupulous manufacturers are willing to take risks with consumers鈥 health 鈥 and they are lacing their products with illegal pharmaceuticals, banned pharmaceuticals, steroids, excessive stimulants, even experimental stimulants,鈥 said Bryn Austin, founding director of the Strategic Training Initiative for the Prevention of Eating Disorders, or STRIPED, which supports the restrictions. 鈥淐onsumers have no idea that this is what’s in these types of products.鈥
STRIPED is a public health initiative based at the Harvard T.H. Chan School of Public Health and Boston Children鈥檚 Hospital.
An industry trade group, the Natural Products Association, disputes that diet pills cause eating disorders, citing the lack of consumer complaints to the FDA of adverse events from their members鈥 products. 鈥淎ccording to FDA data, there is no association between the two,鈥 said Kyle Turk, the association鈥檚 director of government affairs.
The association contends that its members adhere to safe manufacturing processes, random product testing, and appropriate marketing guidelines. Representatives also worry that if minors can鈥檛 buy supplements over the counter, on the black market and undermine the integrity of the industry. Under the bills, minors purchasing weight loss products must show identification along with a prescription.
Not all business groups oppose the ban. The American Herbal Products Association, a trade group representing dietary supplement manufacturers and retailers, dropped its opposition to California鈥檚 bill once it was amended to remove ingredient categories that are found in non-diet supplements and vitamins, according to Robert Marriott, director of regulatory affairs.
Children鈥檚 advocates have found worrisome trends among young people who envision their ideal body type based on what they see on social media. According to a study , a nonprofit that seeks to stop harmful marketing practices targeting children, kids as young as 9 were found to be following three or more eating disorder accounts on Instagram, while the median age was 19. The authors called it a 鈥.鈥
Meta, which owns Instagram and Facebook, said the report lacks nuance, such as recognizing the human need to share life鈥檚 difficult moments. The company argues that blanket censorship isn鈥檛 the answer. 鈥淓xperts and safety organizations have told us it鈥檚 important to strike a balance and allow people to share their personal stories while removing any content that encourages or promotes eating disorders,鈥 said Liza Crenshaw, a Meta spokesperson, in an email.
Dr. Jason Nagata, a pediatrician who cares for children and young adults with life-threatening eating disorders, believes that easy access to diet pills contributes to his patients鈥 conditions at UCSF Benioff Children鈥檚 Hospital in San Francisco. That was the case for one of his patients, an emaciated 11-year-old girl.
鈥淪he had basically entered a starvation state because she was not getting enough nutrition,鈥 said Nagata, who provided supporting testimony for the California bill. 鈥淪he was taking these pills and using other kinds of extreme behaviors to lose weight.鈥
Nagata said the number of patients he sees with eating disorders has tripled since the pandemic began. They are desperate to get diet pills, some with modest results. 鈥淲e’ve had patients who have been so dependent on these products that they will be hospitalized and they’re still ordering these products on Amazon,鈥 he said.
Public health advocates turned to state legislatures in response to the federal government鈥檚 limited authority to regulate diet pills. Under a 1994 federal law known as the , the FDA 鈥渃annot step in until after there is a clear issue of harm to consumers,鈥 said Austin.
No match for the supplement industry鈥檚 on Capitol Hill, public health advocates shifted to a state-by-state approach.
There is, however, a push for the FDA to improve oversight of what goes into diet pills. U.S. Sen. Dick Durbin of Illinois in April introduced that would require dietary supplement manufacturers to register their products 鈥 along with the ingredients 鈥 with the regulator.
Proponents say the change is needed because manufacturers have been known to include dangerous ingredients. C. Michael White of the University of Connecticut鈥檚 School of Pharmacy found in a review of a health fraud database.
A few ingredients have been banned, including sibutramine, a stimulant. 鈥淚t was a very commonly used weight loss supplement that ended up being removed from the U.S. market because of its elevated risk of causing things like heart attacks, strokes, and arrhythmias,鈥 White said.
Another ingredient was phenolphthalein, which was used in laxatives until it was identified as a suspected carcinogen and banned in 1999. 鈥淭o think,鈥 he said, 鈥渢hat that product would still be on the U.S. market is just unconscionable.鈥
This story was produced by , which publishes , an editorially independent service of the .
