Lessons for Local Policy Initiatives to Address Dietary Supplement Use Among Adolescents: A Qualitative Study of Stakeholders' Perceptions

The regulation on the use of supplements for weight control: Case studies from Australia, the United States of America, and the United Kingdom

Background

Overweight and obesity have become more prevalent worldwide which has led to an increase in the demand for non-prescribed weight loss supplements. Given that these products are loosely regulated, they are often misused by adolescents and young adults.

Objective

This study aims to review regulatory policies for weight loss supplements in Australia, the United States, and the United Kingdom to identify areas for improvement.

Method

Peer-reviewed literature was retrieved from EMBASE, OVID, and EBSCOhost databases. Grey literature was identified using Google Advanced Search with 32 targeted keywords and region-specific government domains (.gov.au, .gov, .gov.uk). A narrative synthesis was employed to analyze and compare regulatory policies.

Results

A total of 34 articles (7 peer-reviewed and 27 grey literature documents) were included. In Australia, weight loss supplements are classified as low-risk medicines and are not subject to pre-market regulation. In the United States, the Food and Drug Administration primarily enforces regulations post-market. In contrast, the United Kingdom has implemented proactive measures through collaborations between government organizations. These include restrictions on the sale and packaging of over-the-counter laxatives and mandatory pharmacist consultations to assess patient needs.

Conclusions

The findings highlight significant regulatory gaps in Australia and the US compared to the UK. Adopting similar policies to those implemented in the UK could help reduce the accessibility of weight loss supplements among at-risk populations like adolescents and young adults. This study also discusses the implications of these findings for developing effective policies and regulations for non-prescribed weight loss supplements.

Economic costs associated with unhealthy weight control behaviors among Australian adolescents

OBJECTIVE

This study explored the relationship between unhealthy weight control behaviors (UWCBs) and their associated economic costs among adolescents using the 2014-2018 Longitudinal Study of Australian Children (LSAC).

METHODS

LSAC data in Wave 6 (n = 3538 adolescents aged 14-15 years), Wave 7 n = 3089 adolescents aged 16-17 years), and Wave 8 (n = 3037 adolescents aged 18-19 years) were derived from a representative sample of Australian adolescents. UWCBs were measured using the self-reported Branched Eating Disorder Test questionnaire. UWCBs were sub-classified into having fasting behaviors, using weight loss supplements or purging behaviors. Economic costs include healthcare and productivity costs to caregivers. Healthcare costs were measured using data from the Medicare and Pharmaceutical Benefits, which includes both medical and pharmaceutical costs. Productivity losses were measured using caregivers' lost leisure time due to UWCBs among adolescents.

RESULTS

The mixed effect model identified statistically significant higher economic costs (mean difference = $453, 95% CIs $154, $752), higher health care costs (mean difference = $399, 95% CIs $102, $695), and higher productivity costs (mean difference = $59, 95% CIs $29, $90) for adolescents with UWCBs compared to their peers with no UWCBs. Subgroup analysis revealed that higher costs were associated with fasting and purging behaviors.

DISCUSSION

UWCBs were associated with increased economic costs during adolescence. Our finding suggests there should be a policy focus on tackling UWCBs to reduce the economic burden on the healthcare system and society.

PUBLIC SIGNIFICANCE

The study contributes to existing knowledge by investigating the direct healthcare costs and productivity losses associated with unhealthy weight control behaviors in Australian adolescents (14-18 years old) using a dataset that follows Australian adolescents over time. We found that engaging in unhealthy weight control behaviors such as fasting, using weight loss supplements, and purging was linked to higher costs among adolescents, suggesting policies should focus on addressing these behaviors.

Cost-Effectiveness of 5 Public Health Approaches to Prevent Eating Disorders

INTRODUCTION

Eating disorders cause suffering and a high risk of death. Accelerating the translation of research into implementation will require intervention cost-effectiveness estimates. The objective of this study was to estimate the cost-effectiveness of 5 public health approaches to preventing eating disorders among adolescents and young adults.

METHODS

Using data from 2001 to 2017, the authors developed a microsimulation model of a closed cohort starting at the age of 10 years and ending at 40 years. In 2021, an analysis was conducted of 5 primary and secondary prevention strategies for eating disorders: school-based screening, primary care‒based screening, school-based universal prevention, excise tax on over-the-counter diet pills, and restriction on youth purchase of over-the-counter diet pills. The authors estimated the reduction in years lived with eating disorders and the increase in quality-adjusted life-years. Intervention costs and net monetary benefit were estimated using a threshold of $100,000/quality-adjusted life year.

RESULTS

All the 5 interventions were estimated to be cost-saving compared with the current practice. Discounted per person cost savings (over the 30-year analytic time horizon) ranged from $63 (clinic screening) to $1,102 (school-based universal prevention). Excluding caregiver costs for binge eating disorder and otherwise specified feeding and eating disorders substantially reduced cost savings (e.g., from $1,102 to $149 for the school-based intervention).

CONCLUSIONS

A range of public health strategies to reduce the societal burden of eating disorders are likely cost saving. Universal prevention interventions that promote healthy nutrition, physical activity, and media use behaviors without introducing weight stigma may prevent additional negative health outcomes, such as excess weight gain.