Anne, a college student from Massachusetts, has struggled with food and body image for most of her life. When the coronavirus pandemic hit, she turned to her disordered eating habits to cope, “just need[ing] more control,” as she told Forbes. “I was acutely aware that I wasn’t moving [exercising] as much… I needed to compensate,” Anne recounted. 

The isolation and heightened anxiety prompted by the coronavirus pandemic led to the dramatic rise of eating disorders, specifically among teens. The coronavirus pandemic aggravated teenagers’ pre-existing disordered eating habits and even sparked newly-developed eating disorders. Now, as the world slowly returns to normalcy, the pandemic’s consequences on young individuals’ body image linger.

Although Anne has been able to receive treatment for her eating disorder, her situation is not unique. During the first 12 months of COVID-19, hospital admissions for adolescents with existing or newly-developed eating disorders at the University of Michigan Medical School more than doubled. Similarly, throughout the pandemic, the National Eating Disorder Association helpline reported an increase in call volume by 40%. 

Supplement regulation

With the increase in eating disorders and negative body image comes the intensified danger of weight loss supplements in the hands of minors. Although it is not recommended young individuals utilize over-the-counter diet and muscle-building supplements, the use of such products is not rare among teenagers. 

Over-the-counter diet and muscle-building supplements are often accessible for individuals under eighteen in stores and online sites. Most food products and medicines must be approved by the U.S. Food and Drug Associating (FDA) before they become available to the public. However, the sale of supplements does not call for the same intense review and evaluation. 

The Dietary Supplement Health and Education Act of 1994 did not require dietary supplement companies to register their products with the FDA, leaving the agency without sufficient information to properly gauge the safety of each product. Illinois Senator Dick Durbin’s office has reported in 1994, there were 4,000 dietary supplements available on the market. Today, there are between 50,000 and 80,000 supplements. With loose restrictions surrounding dietary supplements, medical professionals are unsurprised by the growth of the industry. 

Yet, teenagers utilizing dietary supplements to lose weight, gain weight, or build muscle could be putting themselves at risk for severe, permanent medical consequences. 

Health problems caused by supplements

A study published in the Journal of Adolescent Health investigated health problems occurring after kids and teenagers took vitamins or supplements. The study reviewed and identified 977 cases that had been reported to the FDA between the years 2004 and 2015 where vitamins or supplements were suspected to have majorly contributed to individuals’ health issues. Forty percent of the 977 cases involved visits to an emergency room, hospitalization, disability, or death as a result of using vitamins or dietary supplements not prescribed by a medical professional. 

Although both vitamins and dietary supplements were included in the study, the authors discovered supplements were to blame for the majority of the cases. 

“Compared with vitamins, dietary supplements sold for weight loss, muscle building or an energy boost were associated with nearly triple the risk of serious health problems,” Flora Or, a researcher at the Harvard T.H. Chan School of Public Health and the lead author of the study, told NBC News. 

The study also recognized the two main ways that dietary supplements could cause harm to young individuals. When dietary supplements contain unsafe ingredients not listed on the label, users may be negatively affected. Secondly, when users combine dietary supplements with other supplements or prescription medications, they can potentially be harmed.

Meet creatine

According to experts, one dietary supplement in particular that can cause great harm to youth is creatine. Creatine, marketed as a nutritional supplement for muscle growth, is particularly high in use among male high school athletes hoping to build muscle. Available at drugstores, health food stores, gyms, and online retailers, there are currently no legal restrictions on the sale of creatine to those under the age of 18. In fact, children of any age can purchase the supplement without their parent’s knowledge or consent. 

A recent study conducted by the American Academy of Pediatrics revealed health food store employees frequently recommend creatine and testosterone boosters for boy high school athletes. Out of 244 health food stores contacted, a total of 67.2% of sales attendants recommended creatine: 38.5% recommended creatine without prompting, and 28.7% recommended creatine after being asked specifically about it. 

Since creatine is considered a nutritional supplement, federal regulations are not required for products such as tablets, drink mixes, and energy bars containing creatine. Manufacturers of such products advertise creatine to teen athletes wishing to increase their athletic performance or increase their muscle mass.

Additionally, due to the FDA not having analyzed creatine in the way most drugs are reviewed, there is limited research regarding creatine’s impact on kids and teens. While some argue creatine is fairly safe for adults and has been safely used by athletes for many years, the use of creatine among teens remains a pressing issue, as the supplement’s effect on youth remains unknown. 

“It’s not illegal to sell these products to kids under age 18,” said Dr. Ruth Lynn Milanaik, a specialist in developmental and behavioral pediatrics at Cohen Children's Medical Center in Hewlett, New York, in an interview. 

Since the FDA does not strictly regulate dietary supplements, the purity of products with creatine is not always a given. 

“The biggest concern for teens is the potential impurity of the supplement,” explained Dr. Michelle LaBotz, a pediatrician in private practice who specializes in sports medicine, in an interview with NPR News. 

Weight loss supplements

Creatine is not the only dietary supplement in the hands of teenagers. The use of weight-loss supplements can be directly tied to the increase in eating disorders. A report on the sale of diet and muscle supplements and its impact on youth eating disorders in the United States found that 23.3%, 22.1%, and 34.6% of the 1518 youth surveyed have used over-the-counter diet pills, detox teas, or other weight loss supplements in Massachusetts, New York, and California, respectively. What is more worrying to medical professionals is the evidence demonstrating youth who use over-the-counter diet pills are four times more likely to be diagnosed with an eating disorder compared to non-users. 

While weight-loss supplements are often available to teens in stores similar to muscle-building supplements such as creatine, several studies have discovered diet supplements put teens at serious health risks. The Journal of Adolescent Health found youth using weight-loss supplements were three times more likely than individuals using ordinary vitamins to experience severe medical harm. Moreover, studies have linked weight-loss supplements to organ failure, heart attacks, stroke, and even death. The CDC estimates teens’ use of supplements leads to 23,000 emergency room visits annually, with 25% of visits due to teenagers’ attempts to lose weight.

The global weight loss supplements market size was valued at 33.4 billion in 2020 and is projected to expand at a compound annual growth rate of 16.6% until 2028. Companies selling diet pills and muscle-building supplements deliberately take advantage of teenagers’ vulnerability for their own profit. By selling harmful supplements early on, companies hope to get teens hooked, guaranteeing their consumership for years. 

Legislation surrounding supplements

Over the course of the last year, a few bills have been introduced across the United States that look to restrict teens’ access to dietary supplements. AB-1341, which would prohibit the sale of dietary supplements for weight loss or over-the-counter diet pills to those under the age of 18 in California, has passed the Assembly and is in the process of being looked over in the Senate. 

Similarly, Senator Durbin of Illinois has presented The Dietary Supplement Listing Act of 2022 which would require companies to provide the FDA with all the necessary information about their products before entering the market. 

Most lawmakers can agree dietary supplements do not belong in the hands of minors. Yet, the question remains: How long will companies continue to profit and benefit from teenagers’ use of products threatening their well-being?

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