Youth use of over-the-counter weight-loss drugs concerns doctors

Shameka Glover was 15 when she started taking over-the-counter diet pills. She used her babysitting money to buy diuretics—also called “water pills”—and the diet pill Lipozene. She even tried apple cider vinegar. “I was in high school and felt peer pressured due to all of my friends being smaller than me,” Glover, who graduated high school in 1997, told me.

Glover is not alone. Nearly 1 in 10 children and adolescents worldwide have used nonprescription weight loss supplements in their lifetime, according to a new review of existing studies. Medical experts warn that, unlike prescription medications used under a doctor’s supervision, these nonprescription drugs are unsafe.

The study, published Jan. 10 in JAMA Pediatrics, evaluated 90 articles reporting on weight loss products used by individuals 18 years or younger from 1985 to 2023. “This is the first meta-analysis completed on this topic,” lead author Natasha Yvonne Hall, a research fellow at Monash University in Melbourne, Australia, told me in an email. Over 600,000 participants from 25 countries and 6 continents were included in the review. Participants used either diet pills, laxatives, or diuretics. In the study, 8.9 percent of participants had used nonprescription dieting drugs in their lifetime, while 6.2 percent did in the past year.

Hall described the study’s findings as “staggering.” Girls used the drugs in far higher numbers than boys. Nearly 10 percent of girls used a weight loss product in their lifetime and nearly 9 percent did in the past year, whereas a little over 3 percent of boys did across both time periods.

Hall noted that these drugs are ineffective. “Few people realize that the array of pills, powders, and potions sold over the counter with claims to lead to healthy weight do no such thing,” she said. According to the Obesity Medicine Association, the Food and Drug Administration has approved only one over-the-counter weight loss drug, orlistat, for youth 12 and older. The rest, which legally can only be labeled as weight loss dietary supplements rather than weight loss drugs, sometimes make weight loss claims backed by little to no research.

Prescription weight loss drugs are a different matter. The American Academy of Pediatrics began in 2023 to include prescription weight loss drugs in its guidelines, noting that pediatricians should offer these only to children age 12 and older with obesity.

Study co-author S. Bryn Austin, professor of social and behavioral sciences at Harvard T.H. Chan School of Public Health and professor of pediatrics at Harvard Medical School, described how over-the-counter dieting drugs can be medically risky. Overuse of diuretics can cause electrolyte imbalances, which could result in kidney dysfunction. Long-term, high-dose laxative use can cause permanent gastrointestinal damage.

Some of the ingredients in diet pills sound healthy but are actually harmful. For example, companies advertise green tea extract as a “fat burner” and a “fat metabolizer.” “Green tea extract is a liver toxin,” said Austin, pointing to a study that linked the ingredient to serious liver injuries. Over 100 clinical cases have been attributed to green tea extract use, but a 2016 review found no serious liver-related events associated with green tea extract.

Glover remembers feeling bloated and sick to her stomach after taking dieting supplements. She continued to dabble with the pills for several years, but eventually quit after reading about the long-term effects Lipozene can have on an individual’s digestive system. Glover’s sister used Lipozene, too, and eventually required surgery to remove part of her bowels. Glover thinks her sister’s abuse of Lipozene contributed to her health issues.

Hall and Austin said that dieting supplements are often marketed toward minors with ads on TikTok, Instagram, and other popular social media platforms. “We have a responsibility to push back, to put controls on this industry,” said Austin. She lauded New York’s recent legislation banning the sale of dietary supplements to minors.

Vivienne Hazzard, a researcher in epidemiology and community health at the University of Minnesota, agreed with Austin. “Increased regulation is a huge thing,” she said.

Hazzard also said it’s important for parents to know how to discuss body image concerns with their children in a healthy way. She explained that children are more likely to try diet pills as an “easy fix” when they feel like they don’t have anyone to talk to.

Dr. Rosemary Stein, director of the International Family Clinic in Burlington, N.C., and a member of the Christian Medical and Dental Associations, agreed that parental engagement is key. Stein noted that girls especially want to be beautiful and are at risk of feeling like they won’t be loved if they don’t have what they feel is the perfect body. She said being in constant communication with children, especially daughters, will increase the likelihood of them opening up about their body image concerns. “Nobody’s as interested in the welfare and the outcome of your kid as you are,” she said.

Stein added that pursuing good health as a family can help to deter teens and children from resorting to diet pills or other unhealthy behaviors. If a child is struggling with their weight, Stein recommended creating exercise and healthy eating challenges to do together. “Instead of using pills to lose weight, we’re going to use a healthier lifestyle, because we’re a Christian family,” she said. “It gives glory to the Lord, and we’re glorifying Him with our bodies.”