Lexi Crouch was 14 years old when she began saving her pocket money to buy as many diet pills and products at the supermarket as she could get her hands on – from celery tablets and appetite suppressants to skinny me tea – influenced by 90s diet culture.
At the same age, during the height of Melbourne’s lockdowns, Rhea Werner witnessed her friends buying over-the-counter diet pills, following the advice of influencers. “It was so scary to see them on the screen, it looked like they were fading away basically,” she says.
Crouch’s and Werner’s experiences reflect the findings of a new global study led by Australian researchers. The study, published on Thursday in the Journal of the American Medical Association, finds nearly one in 10 adolescents have used a medically unapproved weight-loss product.
It finds the prevalence of 12- to 18-year-olds using diuretics, laxatives and diet pills without a prescription from a doctor was 2% in the past week, 4% in the past month, 6% in the past year and 9% in their lifetime.
Unprescribed weight-loss products are not medically recommended for children because they do not work, are dangerous for both their physical and psychological health, associated with unhealthy weight gain in adulthood, and increase the risk of developing an eating disorder, the researchers say.
Natasha Hall, a research fellow at Monash University and the lead author of the study, says previous studies also found that the use of these products were associated with low self-esteem, depression and poor nutritional intake.
The researchers analysed data from more than 90 individual studies from 25 different countries published between 1985 and 2023 on the use of nonprescription weight-loss products in teenagers, capturing more than 600,000 individual participants in total.
The researchers found the prevalence was increasing, rising from 5% before 2000 to 10% after 2000.
Bryn Austin, a professor at the Harvard School of Public Health and co-author of the paper, says the public health issue is commercially driven, with manufacturers aggressively marketing these products to young people through advertising and influencers on social media.
Young people are vulnerable because of the body-image pressures they face, Austin says.
Manufacturers are also taking advantage of the poor regulation of these products in most countries, leading to products being laced with banned and withdrawn pharmaceuticals, excessive stimulants to the point where they can risk heart attack, as well as steroids, Austin says.
“These products have been linked with stroke, heart attack, liver injury, kidney injury, and death, and this has happened around the world. So this global study … is such an important contribution here to be able to see this is not just happening in Australia, or in the United States or in the UK. This is happening in many places around the world.”
The paper advocates for stronger regulation, citing New York state which banned the sale of these products to people younger than 18 in October last year.
Dr Fiona Willer, a dietitian and lecturer at the Queensland University of Technology who was not involved in the study, says there is a lot of overlap in weight-loss product use with severe eating disorder behaviour, including diet behaviour as well as extreme weight-control methods.
“I read this and my heart sinks because that is a lot of adolescents using these products,” she says. “It’s a lot of wasted resources for them, it’s a lot of wasted time, effort, dreams.
“If they’re not in a diagnosable eating disorder state at that point, they’re not far from it by the time they’re using those substances.”
Willer agrees with the paper’s findings that stronger regulations are needed, banning the sale to people under the age of 18, and recommends any adolescent concerned about their weight speak with their GP.
The authors of the study acknowledge limitations, including most of the studies (56%) were from North America, and many of the included studies only implied and did not explicitly state that the weight-loss product use was unprescribed.
Prof Clare Collins, the director of the Food and Nutrition Research Program for Hunter Medical Research Institute, and professor in nutrition and dietetics at the University of Newcastle, says “even though the absolute percentages are not high, they’re still meaningful numbers”.
Because the data in the studies analysed was self-reported data, Collins says the numbers presented in the study are “likely the tip of the iceberg for all the young people who are unhappy with their current weight or feeling like they need help with weight management”.