Diet Pill Use Research Articles

Imported Fenproporex-based Diet Pills from Brazil: A Report of Two Cases

Banned amphetamine-based anorectics are illicitly imported into the United States (US), but little is known regarding the harm these diet pills pose to US residents. A 26-year-old woman using imported diet pills presented with a two-year history of intermittent chest pains, palpitations, headaches and insomnia. Urine toxicology screen detected amphetamines and benzodiazepines. Fenproporex and chlordiazepoxide were detected in her pills. Her symptoms resolved after she stopped using diet pills. A 38-year-old man using imported diet pills presented after his occupational urine screen was significantly positive for amphetamine. Fenproporex and fluoxetine were detected in his pills. These cases illustrate the potential harm from imported prescription diet pills that combine fenproporex with benzodiazepines, antidepressants, diuretics, laxatives and other substances. Increasing physicians' awareness of imported diet pill use may improve care of patients suffering from the pills' many adverse effects.

Sexual Victimization and Health-Risk Behaviors

The present study utilizes the National College Health Risk Behavior Survey to examine the relationship between health-risk behaviors and sexual victimization among a sample of college women. A prospective design is utilized to examine the relationship between health-risk behaviors as measured at baseline and sexual victimization during a 3-month follow-up period. After controlling for age and parents' education, a history of adolescent sexual victimization was associated with the following health-risk behaviors as measured at pretest: increased likelihood of cigarette smoking, marijuana use, suicidal ideation, experience of physical violence within a dating relationship, use of diet pills and vomiting or laxatives to lose weight, multiple sexual partners, and early sexual intercourse. Prospectively, women's history of adolescent sexual victimization was the strongest predictor of sexual victimization during the 3-month follow-up. Implications of univariate associations between early sexual intercourse, suicidal ideation, and problematic weight loss behaviors and subsequent experience of sexual victimization are discussed.

Imported Compounded Diet Pill Use Among Brazilian Women Immigrants in the United States

In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18-50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.

Geographical clustering of eating disordered behaviors in U.S. high school students

The aim of this study was to determine if eating disorder behaviors geographically clustered among U.S high school students. Our sample consisted of 15,349 high school students who responded to the 1999 Youth Risk Behavior Study (YRBS). Weight control and eating disordered behaviors under investigation included dieting, exercising, fasting, using diet pills, and purging to control weight in the last 30 days. We calculated pairwise odds ratios (PWORs) to determine the degree of within-county clustering. Among all participants, adjusted analyses revealed that having any weight control or eating disorder symptom, severe restricting, dieting, exercising, and diet pill use each showed significant clustering (p < .05). Purging did not significantly cluster by county. The magnitude of clustering was stronger for female students than male students. The significant clustering of weight control and eating disorder behavior in U.S. high school students confirms evidence of a social contagion effect of eating disorders.

School-Based Overweight Preventive Intervention Lowers Incidence of Disordered Weight-Control Behaviors in Early Adolescent Girls

To determine the effect of a school-based intervention to promote healthful nutrition and physical activity on disordered weight-control behaviors (self-induced vomiting or use of laxatives or diet pills to control weight) in early adolescent girls and boys. Using a group-randomized, controlled-trial design, we randomly assigned middle schools to an intervention or control condition. Multivariate logistic regression analyses were used to assess the effect of the intervention on the odds of reporting a new case of disordered weight-control behaviors at follow-up, adjusting for sex, school-level prevalence of disordered weight-control behaviors at baseline, and school clusters. Students reporting these behaviors at baseline were excluded from the analyses. Thirteen middle schools. At baseline, 749 girls and 702 boys in grades 6 and 7. Intervention The 5-2-1 Go! intervention (Planet Health obesity prevention curriculum plus School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide, Middle/High School Version) was implemented during 2 school years, from November 2002 through May 2004. Main Outcome Measure Self-reported disordered weight-control behaviors in last 30 days at follow-up. At follow-up in girls, 3.6% (15 of 422) in control schools compared with 1.2% (4 of 327) in intervention schools reported engaging in disordered weight-control behaviors (P = .04). Multivariate analyses indicated that the odds of these behaviors in girls in intervention schools were reduced by two thirds compared with girls in control schools (odds ratio, 0.33; 95% confidence interval, 0.11-0.97). No intervention effect was observed in boys. Results add compelling support for the effectiveness of an interdisciplinary, school-based obesity prevention intervention to prevent disordered weight-control behaviors in early adolescent girls.

Cross-sectional Study of Female Students Reporting Anabolic Steroid Use

To determine the characteristics of female US high school students reporting anabolic steroid use. Cross-sectional assessment using the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. Nationally representative sample of US high schools. Female students in grades 9 through 12 (n = 7544). Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation. Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics. Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors.

Features associated with diet pill use in individuals with eating disorders

We investigated the relation between diet pill use and eating disorder subtype, purging and other compensatory behaviors, body mass index (BMI), tobacco and caffeine use, alcohol abuse or dependence, personality characteristics, and Axis I and Axis II disorders in 1,345 participants from the multisite Price Foundation Genetics Studies. Diet pill use was significantly less common in women with restricting type of AN than in women with other eating disorder subtypes. In addition, diet pill use was associated with the use of multiple weight control behaviors, higher BMI, higher novelty seeking, and the presence of anxiety disorders, alcohol abuse or dependence, and borderline personality disorder. Findings suggest that certain clinical and personality variables distinguish individuals with eating disorders who use diet pills from those who do not. In the eating disorder population, vigilant screening for diet pill use should be routine clinical practice.

Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status

To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status. General population cross-sectional survey. A total of 4891 young women from the community aged 18-42 years, of which 630 were in the obese weight range. Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10). Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, 'hard' exercise and subjective bulimic episodes also contributed to the model predicting psychological distress. As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.

Prevention of Eating Disorders in At-Risk College-Age Women

Eating disorders, an important health problem among college-age women, may be preventable, given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors. To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders (EDs) in young women at risk for developing EDs. San Diego and the San Francisco Bay Area in California. College-age women with high weight and shape concerns were recruited via campus e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified, of whom 157 were excluded, for a total sample of 480. Recruitment occurred between November 13, 2000, and October 10, 2003. Intervention A randomized controlled trial of an 8-week, Internet-based cognitive-behavioral intervention (Student Bodies) that included a moderated online discussion group. Participants were studied for up to 3 years. The main outcome measure was time to onset of a subclinical or clinical ED. Secondary measures included change in scores on the Weight Concerns Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood. Moderators of outcome were examined. There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention (P < .001), 1 year (P < .001), and 2 years (P < .001). The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group (P = .02). Over the course of follow-up, 43 participants developed subclinical or clinical EDs. While there was no overall significant difference in onset of EDs between the intervention and control groups, the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses: (1) participants with an elevated body mass index (BMI) (> or =25, calculated as weight in kilograms divided by height in meters squared) at baseline and (2) at 1 site, participants with baseline compensatory behaviors (eg, self-induced vomiting, laxative use, diuretic use, diet pill use, driven exercise). No intervention participant with an elevated baseline BMI developed an ED, while the rates of onset of ED in the comparable BMI control group (based on survival analysis) were 4.7% at 1 year and 11.9% at 2 years. In the subgroup with a BMI of 25 or higher, the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group (95% confidence interval, 0% for intervention group; 2.7% to 21.1% for control group). For the San Francisco Bay Area site sample with baseline compensatory behaviors, 4% of participants in the intervention group developed EDs at 1 year and 14.4%, by 2 years. Rates for the comparable control group were 16% and 30.4%, respectively. Among college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.

How Do Children with Eating Disorders Differ from Adolescents with Eating Disorders at Initial Evaluation?

Purpose To compare the clinical presentation of children with eating disorders (ED) to that of adolescents with ED. Methods Demographic, medical, and psychiatric data of all 959 in- and outpatients (85 males, 874 females) 8–19 years of age diagnosed with ED that presented to an academic center between 1997 and 2005 were examined via retrospective record review. Young patients (n = 109) were defined as aged < 13 years at presentation, and older patients (n = 850) ≥ 13 years and < 20 years. Results Compared with older adolescents (mean 15.6 years, SD 1.4), younger patients (mean 11.6 years, SD 1.2) were more likely to be male (χ 2 = 9.25, p < .005) or diagnosed with eating disorder not otherwise specified (EDNOS) (χ 2 = 5.09, p ≤ .05), and less likely to be diagnosed with bulimia nervosa (BN) (χ 2 = 13.45, p ≤ .001). There were no significant differences in anorexia nervosa (AN) diagnoses between groups. Young patients were less likely to report purging (χ 2 = 26.21, p < .001), binge eating (χ 2 = 26.53, p < .001), diet pill (χ 2 = 13.31, p < .001) or laxative use (χ 2 = 6.82, p < .001) when compared with older teens. Young patients weighed less in percentage ideal body weight ( p < .05), had a shorter duration of disease ( p < .001), and had lost weight more rapidly than older adolescent patients ( p ≤ .001). Conclusions There are important diagnostic and gender differences in younger patients. Young ED patients presented at a lower percentage of ideal body weight and had lost weight more rapidly, which may put them at higher risk for future growth sequelae than their older counterparts.

Overweight status and weight control behaviors in adolescents: Longitudinal and secular trends from 1999 to 2004

Background This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents. Methods Project EAT-II followed 2516 adolescents from Minnesota longitudinally from 1999 to 2004. The population included two cohorts allowing for the observation of transitions from early to middle adolescence (junior high school to high school) and from middle to late adolescence (high school to post-high school). Results The prevalence of overweight (females: 28.7%; males: 28.0%) was high in early adolescence and remained high throughout adolescence. In females, between early and middle adolescence, there were steep longitudinal increases in the use of unhealthy weight control behaviors (48.6% to 58.8%, P = 0.001) and extreme weight control behaviors (9.4% to 17.9%, P < 0.001), and between middle and late adolescence, extreme weight control behaviors increased from 14.5% to 23.9% ( P < 0.001). In males, extreme weight control behaviors doubled from middle to late adolescence (3.4% to 6.3%, P = 0.023). Use of diet pills doubled from 7.5% to 14.2% from 1999 to 2004 ( P = 0.004) in high school females. One fifth (19.9%) of females in late adolescence reported taking diet pills. Conclusions Overweight status and unhealthy weight control behaviors in adolescents are major public health concerns that warrant interventions addressing both problems.

Use of diet pills and other dieting aids in a college population with high weight and shape concerns

The current study examines diet aid use among college women at risk for eating disorders and explores characteristics associated with diet aid use. Participants were 484 college women<30 years from 6 universities in the San Francisco Bay Area (SF) and San Diego who were at risk for developing eating disorders. A checklist assessed diet pill, fat blocker, diuretic, laxative, and other diet aid use over the past 12 months. Thirty-two percent of the college women reported using a diet aid. Diet aid use was double the rate in San Diego (44%) compared with SF (22%) (p=.000). Weight and shape concerns were higher among diet aid users than among nonusers across sites. A significant number of college women at risk for eating disorders are using diet aids. We recommend that clinicians inquire about diet aid use among college-aged patients.

Binge eating and purging in a multi‐ethnic community sample

The purpose of the present study is to document the frequency of three eating disorder-related behaviors (binge eating; self-induced vomiting; and use of laxatives, diuretics, and diet pills) among a multi-ethnic community sample. A questionnaire was administered to 1225 Hispanic, Asian, black, and white women and men. Participants responded to items (based on DSM-IV diagnostic criteria for eating disorders) about binge eating and purging behavior. Binge eating and purging were more common among women than among men in Hispanic, black, and white subsamples (frequency rates were similar among Asian men and women). Ethnic differences were found in frequency of purging among women (ethnicity was not associated with behavior rates among men). Fewer Asian than Hispanic, black, and white women induced vomiting and used laxatives, diuretics, and diet pills as weight control methods. The fact that frequency rates differed as a function of participant sex and ethnicity underscores the importance of considering both of these group variables when examining disordered eating and weight control behaviors.

Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later?

Objective To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. Design Population-based 5-year longitudinal study. Participants Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). Main Outcome Measures Weight status, binge eating, extreme weight control, and self-reported eating disorder. Statistical Analysis Multiple linear and logistic regressions. Results Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. Conclusions Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Definition and Outcome of a Curriculum to Prevent Disordered Eating and Body‐Shaping Drug Use

Almost one half of male and female students participate in high school-sponsored athletics, and high school also is a time when classroom health promotion curricula are less effective. The Athletes Training and Learning to Avoid Steroids is a sport team-centered drug-use prevention program for male high school athletes, which has been shown to reduce alcohol and illicit drug use. Just as anabolic steroid use is associated with male athletes, female sport participants may be at a greater risk for disordered eating and body-shaping drug use. Extending sport team-centered programs to young women athletes required defining and ranking factors related to developing those harmful behaviors. Survey results from a cross-sectional cohort of female middle and high school student athletes were used to identify and prioritize potential curriculum components, including mood and self-esteem, norms of behavior, perceptions of healthy body weight, effects of media depictions of women, and societal pressures to be thin. The derived sport team-centered program was prospectively assessed among a second group of female student athletes from 18 high schools, randomized to receive the intervention or the usual care control condition. The Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) intervention is a scripted, coach-facilitated, peer-led 8-session program, which was incorporated into a team's usual training activities. The ATHENA program significantly altered the targeted risk factors and reduced ongoing and new use of diet pills and body-shaping substances (amphetamines, anabolic steroids, and sport supplements). These findings illustrate the utility of a structured process to define curriculum content, and the program's positive results also confirm the sport team's potential as a vehicle to effectively deter health-harming behaviors.

Correlates of the use of Purging and Non-Purging Methods of Weight Control in a Community Sample of Women

To inform the classification of bulimic-type eating disorders, the correlates of purging and non-purging methods of weight control were examined in a large community sample of young adult women reporting recurrent episodes of binge eating. Scores on self-report measures of eating disorder psychopathology, functional impairment and health-service utilization were compared among individuals who reported (recurrent episodes of binge eating and) the use of either purging (self-induced vomiting, laxative or diuretic misuse; n = 41) or non-purging (extreme dietary restriction, excessive exercise, or use of diet pills; n = 62) methods of weight control. Individuals who reported recurrent binge eating in the absence of extreme weight control behaviours (n = 442) were also included in the analysis. Non-purgers tended to be younger and heavier and have higher levels of eating disorder psychopathology and functional impairment than purgers and non-compensating binge eaters, however these differences were not statistically significant. Purgers were more likely than non-purgers to have sought treatment specifically for a problem with eating, however this difference was no longer significant after age and body mass index were statistically controlled. In multivariate analysis, frequency of extreme dietary restriction was the best predictor of functional impairment. These findings call into question the validity of subtyping of bulimia nervosa into purging and non-purging forms as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Correlates of the use of purging and non-purging methods of weight control in a community sample of women

To inform the classification of bulimic-type eating disorders, the correlates of purging and non-purging methods of weight control were examined in a large community sample of young adult women reporting recurrent episodes of binge eating.Scores on self-report measures of eating disorder psychopathology, functional impairment and health-service utilization were compared among individuals who reported (recurrent episodes of binge eating and) the use of either purging (self-induced vomiting, laxative or diuretic misuse; n = 41) or non-purging (extreme dietary restriction, excessive exercise, or use of diet pills; n = 62) methods of weight control. Individuals who reported recurrent binge eating in the absence of extreme weight control behaviours (n = 442) were also included in the analysis.Non-purgers tended to be younger and heavier and have higher levels of eating disorder psychopathology and functional impairment than purgers and non-compensating binge eaters, however these differences were not statistically significant. Purgers were more likely than non-purgers to have sought treatment specifically for a problem with eating, however this difference was no longer significant after age and body mass index were statistically controlled. In multivariate analysis, frequency of extreme dietary restriction was the best predictor of functional impairment.These findings call into question the validity of subtyping of bulimia nervosa into purging and non-purging forms as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Treatment of Eating Disorders in Children, Adolescents, and Young Adults

Treatment of Eating Disorders in Children, Adolescents, and Young Adults

Prevalence of overweight misperception and weight control behaviors among normal weight adolescents in the United States

Weight perceptions and weight control behaviors have been documented with underweight and overweight adolescents, yet limited information is available on normal weight adolescents. This study investigates the prevalence of overweight misperceptions and weight control behaviors among normal weight adolescents in the U.S. by sociodemographic and geographic characteristics. We examined data from the 2003 Youth Risk Behavior Survey (YRBS). A total of 9,714 normal weight U.S. high school students were included in this study. Outcome measures included self-reported height and weight measurements, overweight misperceptions, and weight control behaviors. Weighted prevalence estimates and odds ratios were computed. There were 16.2% of normal weight students who perceived themselves as overweight. Females (25.3%) were more likely to perceive themselves as overweight than males (6.7%) (p < 0.05). Misperceptions of overweight were highest among white (18.3%) and Hispanic students (15.2%) and lowest among black students (5.8%). Females (16.8%) outnumbered males (6.8%) in practicing at least one unhealthy weight control behavior (use of diet pills, laxatives, and fasting) in the past 30 days. The percentage of students who practiced at least one weight control behavior was similar by ethnicity. There were no significant differences in overweight misperception and weight control behaviors by grade level, geographic region, or metropolitan status. A significant portion of normal weight adolescents misperceive themselves as overweight and are engaging in unhealthy weight control behaviors. These data suggest that obesity prevention programs should address weight misperceptions and the harmful effects of unhealthy weight control methods even among normal weight adolescents.

The prevalence of eating disorders and weight-control methods among young women: a Hungarian representative study

The aim of this study is to analyse data concerning 15–24-year-old Hungarian women to estimate the prevalence of anorexia nervosa, bulimia nervosa and subclinical eating disorders. A cross-sectional representative survey was conducted among 3615 young women using a self-report questionnaire. The point prevalence of anorexia nervosa was 0.03%, of bulimia nervosa 0.41%, of subclinical anorexia nervosa 1.09% and of subclinical bulimia nervosa 1.48%. Our results show that 6.3% of the sample were ‘dieting’ daily, 7% exercised daily, 2.7% reported binge eating, and use of laxatives, diet pills and self-induced vomiting at least twice a week was reported by 0.7%, 0.9% and 0.2%, respectively. This study was the first to be conducted on a nationally representative sample of young women in Hungary. The data are also analysed within a cross-cultural perspective, comparing data from other Central–Eastern European and western countries. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.