Unlike pharmaceutical drugs, over-the-counter diet pills and muscle-building supplements are barely regulated. Yet Americans spend more than $30 billion on supplements each year. These supplements are sold over-the-counter and available to customers of all ages despite research suggesting they can be harmful. Minors with a history of eating disorders are especially vulnerable to the harms of diet pills and muscle-building supplements. Feeling pressure to look a certain way, teenagers often acquire these products to lose weight or bulk up.
The apparent association between diet pills and eating disorders among young people has raised significant concern among Massachusetts residents and legislators. The state legislature is considering a bill that would ban the sale of diet pills and muscle-building supplements to persons under the age of 18. Many argue that unfettered access to these products can exacerbate eating disorders among young people. During state house testimony, women shared tearful stories of how they used diet pills to starve themselves from a young age, to the point that they were no longer able to conceive children. Young people shared stories of feeling helpless to stop using these products, given their easy access and promised results. Parents, too, reported feeling at a loss to protect their children from products widely available and well-marketed.
The proposed law requires retail establishments to keep these products out of sight by placing them behind the counter or in a lock-box, where customers are unable to access them without help from an employee. But these measures only get at one component of the problem. The other concern is that the US Food and Drug Administration does not regulate diet pills and muscle-building supplements. Numerous reports indicate undisclosed pharmaceutical drugs are often present in diet pills, suggesting that diet pills should be held to the same standard as pharmaceuticals.
Minors with a history of eating disorders are especially vulnerable to the harms of diet pills and muscle-building supplements.
The process for regulating pharmaceuticals is rigorous. By the time drugs are placed on the market, they’ve undergone a long series (sometimes years-long) of tests required by the FDA to make sure they’re safe for consumption. The FDA also requires all pharmaceuticals to list all ingredients on the label and provide evidence to back up marketing claims. The same process isn’t required for dietary and muscle-building supplements. It’s also impossible for consumers to know what they’re consuming, how it will affect them, or the potential risks of mixing diet pills and supplements with other medications.
To identify unsafe or adulterated supplements containing unapproved ingredients in diet pills and supplements, the FDA relies on post-market surveillance efforts. The FDA is responsible for reviewing adverse event reports and consumer complaints, the inspection of dietary supplement firms, and screening imported products. Although the FDA doesn’t clear products before they hit store shelves, they are supposed to remove unsafe ones from the market.
Regulatory recourse doesn’t always work. Last October, researchers discovered 746 adulterated supplements and reported them to the FDA, but the FDA only announced recalls for 360 (48%). This means the majority of adulterated supplements discovered and reported to the FDA remain on the market for sale. Supplements cause 23,000 emergency room visits every year and 2,000 of those are serious enough to warrant hospitalization. Herbal supplements – especially those promising weight loss and improved energy and sex drive – account for 65% of ER visits from these quasi-unregulated products.