Abstract
BackgroundAbuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. Yet only a small percentage of youth with disordered weight control behaviors receive treatment. The objective of this study was to examine how often clinicians communicate with youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products.We used electronic medical records and administrative claims for services for 53,229 12 to 17 year old patients receiving care from an integrated health system in the U.S. Northwest from August 2007 to December 2010. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and then assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control.ResultsWe identified 130 (0.2% of sample) patients with clinical notes indicating one or more of the metabolic conditions. In clinical notes for only four (3.1%) of these patients did clinicians document suspicion or communication about possible abuse of the OTC products. All four had a previous eating disorder diagnosis. In the 12 months subsequent to the clinical encounter in which a metabolic disturbance was identified, medical notes for only three (2.3%) of the 130 patients indicated clinician suspicion or communication about possible abuse of these products or an eating disorder.ConclusionsClinicians are missing a critical window of opportunity to query adolescents when presenting with suspicious metabolic disturbances about possible abuse of OTC products for weight control. Clinicians may need more training to detect OTC product abuse, and electronic medical records should prompt more thorough enquiry.
Highlights
Abuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions
Other studies with representative school-based samples of adolescents have found in both males and females that obese compared to nonoverweight youth reported higher past-week prevalence of use of diet pills and laxatives for weight control [4]; whereas, underweight males were more likely and underweight females were less likely than samegender healthy weight youth to report use of diet pills, laxatives, or vomiting for weight control [5]
Using a large medical claims database, we examined how often clinicians documented communicating with youth with metabolic disturbances consistent with abuse of OTC products for weight control about their possible use of these products
Summary
Abuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control. It is well-documented that adolescents abuse over-thecounter (OTC) products such as diet pills, laxatives, and diuretics in attempts to control their weight [1,2]. Even when there are restrictions, as with orlistat, which is not approved for sale OTC to minors in the United States, access is fairly unfettered [15]
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