The usage of non-prescription weight loss products in teenagers, especially girls in North America, is widespread and the trends appear to be increasing, driven by social media influencers and the explosive popularity of prescription weight loss medications, as a meta-analysis found.
„Almost one in ten adolescent girls has used a weight loss product in their lifetime and in the past year,“ the study’s authors reported in this month’s publication in JAMA Network Open.
„Given the individual and public health issues associated with the use of non-prescription weight loss products in adolescents, urgent interventions are necessary to prevent and regulate the use of weight loss products in this population,“ the authors added.
The meta-analysis included 90 global studies from 1985 to 2023, including 50 (56%) in North America and with 604,552 participants aged 18 or younger.
The overall prevalence of consuming weight loss products, including medication and dietary supplements such as diuretics, laxatives, and diet pills, was 5.5%, with 8.9% of teenagers having consumed the products in their lifetime.
Of those who reported using the products, 6.2% reported using them in the past year, 4.4% in the past month, and 2.0% in the past week. Prevalence rates were significantly higher in girls at all time points, and rates were higher in North America than in other regions.
In terms of the type of weight loss product, the lifetime prevalence was 6.0% for the use of diet pills, 4.0% for the use of laxatives for weight loss, and 2.0% for the use of diuretics.
The trends pose „a public health issue as associations between the use of weight loss products in girls with low self-esteem, parental influence on weight loss, or parental dissatisfaction with weight, dissatisfaction with body image, and peers who value slimness have been detected,“ and media or social media influences that promote unrealistic beauty standards,“ the authors noted.
„Examining only studies conducted before the year 2000, the lifetime prevalence of non-prescription weight loss products was 5.1%, while the rate was about twice as high after 2000 (10.3%),“ explained first author Natasha Yvonne Hall, PharmB, from the School of Public and Preventive Health in Victoria, Australia. When including studies conducted after 2010, the prevalence further rose to 13%.
The dynamics of weight loss products through social media have also been fueled by the explosive popularity of the new generation of prescription weight loss medications, including Semaglutide (Wegovy for weight loss, Ozempic for type 2 diabetes) and now Tirzepatide (Zeptabound for weight loss, Mounjaro for type 2 diabetes).
While Wegovy is approved by the US Food and Drug Administration for the treatment of obesity in teenagers aged 12 and older, costs and other factors may prevent access for many, leading to opportunistic, youth-targeted sales pitches for products like „Budget Ozempic“ or the dietary supplement Berberine, marketed as „Nature’s Ozempic.“
„Parents are often not aware of how aggressively over-the-counter diet pills and weight loss supplements are being marketed to adolescents on social media, and so the increasing online advertising of weight loss products has led to increased use of these products,“ Hall said.
„Influencers, often paid by companies, make all kinds of misleading claims about these products to earn money off their children,“ she added.
„Companies also recruit other adolescents to market their products because they know that young people may be more influenced by youth brand ambassadors, as they are called in the industry, than by traditional advertising. But the products they sell do not work and are dangerous.“
In their first comprehensive guide to the assessment and treatment of obesity in 15 years, the American Academy of Pediatrics (AAP) published recommendations in a press release in 2023, including that doctors „should offer adolescents aged 12 and older with obesity pharmacotherapy for weight loss, depending on medication indication, risks and benefits, as an adjunct to health behavior and lifestyle treatment.“
However, when it comes to non-prescription weight loss products, the AAP warns against the use of over-the-counter diet pills, regardless of a child’s weight status.
Likewise, the American Medical Association (AMA) concluded in a report detailing the risks associated with unregulated dietary supplements, including those claiming to promote weight loss, that „a physician cannot ethically recommend an over-the-counter dietary supplement for weight loss, as safety and effectiveness are compromised. The actual ingredients are not known, potentially the entirety of the ingredients.“
In addition to concerns about the risks associated with weight loss supplements themselves and the risks of future eating disorders, „it is equally concerning that these products are easily accessible without a prescription, without a doctor’s order, and without restrictions or regulations for those 18 years or younger,“ the authors emphasized.
„This underscores the need for greater regulation and restriction of over-the-counter weight loss products, especially for individuals under 18.“ The authors had no disclosures to report.