California and New York seek to restrict the sale of diet pills to minors

California and New York are on the verge of going further than the FDA in restricting the sale of over-the-counter weight loss pills to minors, as pediatricians and public health advocates try to protect children from extreme weight loss gimmicks on the Internet.

A bill before Governor Gavin Newsom bans people under 18 in California from buying over-the-counter weight loss supplements - both online and in stores. A similar bill passed by New York lawmakers is on Governor Kathy Hochul's desk. Neither Democrat has said how he or she would proceed.

If both bills are signed into law, supporters hope that momentum will be created to limit the sale of diet pills to children in more states. Massachusetts, New Jersey and Missouri have already introduced similar bills, and supporters plan to continue their efforts next year.

Nearly 30 million people in the U.S. will experience an eating disorder in their lifetime; 95 percent of them are between the ages of 12 and 25, according to the Johns Hopkins All Children's Hospital. The hospital adds that eating disorders pose the highest mortality risk of any mental disorder. And it has become easier than ever for minors to get pills sold online or on pharmacy shelves. According to Vision Research Reports, a market research firm, all dietary supplements, including those for weight loss, accounted for nearly 35% of the $63 billion over-the-counter health products industry in 2021.

Dietary supplements, which include a wide range of vitamins, herbs and minerals, are classified as food by the FDA and are not scientifically tested for safety like prescription and over-the-counter drugs.

Public health advocates want weight loss products -- with ads promising "Lose 5 pounds in a week!" and names like Slim Sense pills -- to stay away from young people, especially girls, because some studies have linked some products to eating disorders. A study published in the American Journal of Public Health, which followed more than 10,000 women ages 14-36 for 15 years, found that "those who used weight loss pills had an adjusted chance of receiving a diagnosis of an eating disorder from a health care provider within 1-3 years was more than 5 times higher than those who did not use them."

Many pills have been found to be tainted with banned and dangerous ingredients that can cause cancer, heart attack, stroke and other diseases. For example, the FDA advised the public to avoid Dr. Reade's Slim Sense because it contains lorcaserin, which has been found to cause mental disorders and impaired attention and memory. The FDA ordered the drug to be taken off the market, and the company could not be contacted.

"Unscrupulous manufacturers are willing to risk consumers' health-and they slip illegal pharmaceuticals, banned pharmaceuticals, steroids, over-stimulants, even experimental stimulants into their products," says Bryn Austin, founding director of the Strategic Learning Initiative to Prevent Eating Disorders (STRIPED), which supports restrictions. "Consumers have no idea what exactly is in those products."

STRIPED is a public health initiative founded at Harvard's T.H. Chan School of Public Health and Boston Children's Hospital.

An industry trade group, the Natural Products Association, claims that diet pills cause eating disorders, citing no consumer complaints to the FDA about side effects from their members' products. "According to the FDA, there is no connection between the two phenomena," said Kyle Turk, the association's director of government relations.

The association claims that its members adhere to safe manufacturing processes, random product testing, and appropriate marketing guidelines. Association representatives also fear that if minors can't buy supplements without a prescription, they could buy them from black-market "scammers" and undermine the integrity of the industry. Under the bills, minors who buy weight loss products must show identification along with a prescription.

Not all business groups oppose the ban. The American Herbal Products Association, a trade group representing manufacturers and retailers of dietary supplements, dropped opposition to the California bill after it was amended to exclude categories of ingredients found in non-dietary supplements and vitamins, according to Robert Marriott, director of regulatory affairs.

Child advocates have found troubling trends among young people who imagine their ideal body type based on what they see on social media. According to a study commissioned by Fairplay, a nonprofit organization that seeks to stop harmful marketing practices targeting children, it found that children as young as 9 were following three or more eating disorder accounts on Instagram, compared to an average age of 19. The authors called this an "eating disorder supporter bubble."

Meta, which owns Instagram and Facebook, said the report lacks nuance, such as recognizing the human need to share difficult moments in life. The company argues that universal censorship is not the answer. "Experts and safety organizations tell us it's important to find a balance and allow people to share their personal stories while removing any content that encourages or promotes eating disorders," Liza Crenshaw, a spokeswoman for Meta, said in an email.

Dr. Jason Nagata, a pediatrician who treats children and young adults with life-threatening eating disorders, believes that easy access to diet pills is exacerbating the condition of his patients at UCSF Benioff Children's Hospital in San Francisco. Such was the case with one of his patients, an emaciated 11-year-old girl.

"Basically, she went into a state of starvation because she wasn't getting enough nutrition," said Nagata, who testified in support of the California bill. "She was taking these pills and using other extreme behaviors to lose weight."

Nagata says the number of patients he sees with eating disorders has tripled since the pandemic began. They are desperate to take diet pills, some of which produce modest results. "We've had patients who were so addicted to these products that they were hospitalized and they still ordered these products on Amazon," he said.

Public health advocates have turned to state legislatures in response to the federal government's limited authority to regulate diet pills. Under a 1994 federal law known as the Dietary Supplement Health and Education Act, the FDA "cannot intervene until there is a clear question of harm to consumers," Austin says.

Unable to withstand the powerful lobbying of the supplement industry on Capitol Hill, public health advocates have shifted to a state-by-state approach.

Nevertheless, the FDA is trying to improve oversight of what goes into diet pills. U.S. Sen. Dick Durbin of Illinois introduced a bill in April that would require dietary supplement manufacturers to register their products -- along with the ingredients -- with the regulator.

Proponents say the changes are needed because manufacturers have been known to include dangerous ingredients. C. Michael White of the University of Connecticut School of Pharmacy found that 35% of tainted health products came from weight-loss supplements, in an analysis of the Health Care Fraud Database.

Several ingredients were banned, including sibutramine, a stimulant. "It was a very commonly used weight loss supplement that was eventually withdrawn from the U.S. market because of the increased risk of things like heart attacks, strokes and arrhythmias," White said.

Another ingredient was phenolphthalein, which was used in laxatives until it was recognized as a suspected carcinogen and banned in 1999. "To think," he said, "that this product is still being sold on the American market is just unconscionable.

KHN (Kaiser Health News) is a national newsroom that does in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of KFF's (Kaiser Family Foundation) three major operating programs. KFF is a nonprofit, endowment-based organization that provides health information to the entire country.

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