Adolescents worldwide, especially girls, have used non-prescribed drugs, dietary supplements and other weight-loss products at a “high level,” according to a new analysis.

Based on a review of dozens of studies over the past four decades, researchers estimate that about 9% of adolescents in the general population have used over-the-counter weight-loss products in their lifetime, about half of whom had used them in the past month. Diet pills were the most common products, used by about 6% of adolescents in their lifetime, followed by about 4% who used laxatives and 2% who used diuretics.

These products are risky to both the physical and mental health of children, and they’re not medically recommended for healthy weight maintenance. Previous research has linked the use of non-prescribed weight-loss products to eating disorders, low self-esteem, depression and substance abuse in teens. They have also been associated with poor nutritional intake in adolescence and unhealthy weight gain in adulthood.

Dr. Paula Cody, medical director of adolescent medicine at the University of Wisconsin School of Medicine and Public Health, warned about the dangers of diet pills and supplements more than six years ago after hearing enough patients ask about supplements to lose weight or gain muscle — and the issue has only grown.

“The incidence of eating disorders has increased pretty dramatically after the pandemic. We’ve seen the numbers skyrocket,” she said. “So I do think that the concern I had before, which was not a small matter then — I’m even more concerned now.”

One study from 2022 found that hospital admissions for eating disorders among children in the US grew 10 times faster in the first year of the Covid-19 pandemic than in the years prior, and other studies have shown an increase in emergency department visits, too. The new study analyzed the use of diet pills and other weight-loss products in more countries than just the US, but prevalence was most common in North America.

When Cody is working with patients who have an eating disorder, she said she’ll sometimes see dramatic changes to their heart rate, blood pressure or sleeping patterns.

“It can be pretty significant,” she said. “And you’re trying to figure out, ‘What is the cause of this?’ And the only change has been that they started a diet pill that contains caffeine.”

Some patients are able to stop taking the pills when they understand the negative health consequences they’re causing, she said. But for others, the eating disorder convinces them that their health is less important than the number they see on the scale.

“In a population who feel like they will do whatever it takes to get to lose weight, diet pills can be a very, very intriguing thing to add to the arsenal,” Cody said.

Childhood obesity is increasing worldwide. About 39 million children were obese in 2022, according to the World Health Organization. In the US, childhood obesity is a “serious problem,” according to the US Centers for Disease Control and Prevention, affecting nearly one in five children ages 2 to 17.

But weight loss programs within the formal health care system are built to protect against some of the risks; that doesn’t happen when teens turn to diet pills or other non-prescribed weight-loss products, experts say.

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