The eating disorders medicine cabinet revisited: A clinician's guide to appetite suppressants and diuretics

Roerig, James L.; Mitchell, James E.; Zwaan, Martina de; Wonderlich, Stephen A.; Kamran, Shehzad; Engbloom, Sara; Burgard, Melissa; Lancaster, Kathryn

doi:10.1002/eat.10159

Cited by 31 publications

(21 citation statements)

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“…Keywords Eating disorders; diet pills; weight control behaviors; novelty seeking Abuse of diet pills by individuals with eating disorders is well-documented clinically, with prevalence estimates reported as high as 50% (Celio et al, 2006;Mitchell, Pomeroy, & Huber, 1988;Roerig et al, 2003;Steffen, Roerig, Mitchell, & Crosby, 2006). However, empirical studies of features associated with abuse of diet pills are lacking.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Features associated with diet pill use in individuals with eating disorders

et al. 2008

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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.Correspondence to Dr Bulik, Department of Psychiatry, University of North Carolina at Chapel Hill , 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160, Voice: (919) 843 1689 Fax: (919) 966-5628, e-mail: cbulik@med.unc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptEat Behav. Author manuscript; available in PMC 2009 January 1. Published in final edited form as:Eat Behav. 2008 January ; 9(1): 73-81. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptKeywords Eating disorders; diet pills; weight control behaviors; novelty seeking Abuse of diet pills by individuals with eating disorders is well-documented clinically, with prevalence estimates reported as high as 50% (Celio et al., 2006;Mitchell, Pomeroy, & Huber, 1988;Roerig et al., 2003;Steffen, Roerig, Mitchell, & Crosby, 2006). However, empirical studies of features associated with abuse of diet pills are lacking. Given potential adverse effects associated with abuse of these agents (e.g., side effects, tolerance, withdrawal) (Carek & Dickerson, 1999;Dietz, 1981;Shekelle, Morton, & Maglione, 2003), particularly in populations already at elevated medical risk, it is important to explicate the nature of diet pill abuse and its consequences in individuals with eating disorders.Accordingly, the aim of this study were to report the prevalence of lifetime diet pill use across eating disorder subtypes and identify factors associated with their use. We hypothesized that individuals with the restricting type of anorexia nervosa (RAN) would use diet pills less frequently than those with other subtypes. This may ...

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Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Features associated with diet pill use in individuals with eating disorders

et al. 2008

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“…In addition, the electronic medical record could be a useful tool in reminding clinicians to enquire about weight control products, especially for patients with eating disorder diagnoses or who present with an unexplained metabolic disturbance, by adding into the template prompts regarding communication on use of these products. It is worth noting that the majority of patients using these products may not present with substantial metabolic disturbance, as these problems are most likely to arise primarily in heavy users [9,10,38]. More thorough clinical enquiry is warranted about possible abuse of OTC products for weight control with both female and male adolescents as a whole across the weight-status spectrum in addition to those presenting with suspicious metabolic disturbances.…”

Section: Resultsmentioning

confidence: 99%

Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system

et al. 2013

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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.

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“…Despite their widespread use, dietary supplements for weight loss, muscle building, and sexual function are not medically recommended and have been shown to be ineffective in many cases (Steffen et al, 2007, Roerig et al, 2003, Blanck et al, 2007) and to pose serious health risks to consumers due to adulteration with banned substances, prescription pharmaceuticals, and other dangerous chemicals (U.S. Food and Drug Administration, 2017, U.S.…”

Section: Introductionmentioning

confidence: 99%

Household expenditures on dietary supplements sold for weight loss, muscle building, and sexual function: Disproportionate burden by gender and income

Austin

Liu

et al. 2017

Preventive Medicine Reports

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Dietary supplements sold for weight loss (WL), muscle building (MB), and sexual function (SF) are not medically recommended. They have been shown to be ineffective in many cases and pose serious health risks to consumers due to adulteration with banned substances, prescription pharmaceuticals, and other dangerous chemicals. Yet no prior research has investigated how these products may disproportionately burden individuals and families by gender and socioeconomic position across households. We investigated household (HH) cost burden of dietary supplements sold for WL, MB, and SF in a cross-sectional study using data from 60,538 U.S. households (HH) in 2012 Nielsen/IRi National Consumer Panel, calculating annual HH expenditures on WL, MB, and SF supplements and expenditures as proportions of total annual HH income. We examined sociodemographic patterns in HH expenditures using Wald tests of mean differences across subgroups. Among HH with any expenditures on WL, MB, or SF supplements, annual HH first and ninth expenditure deciles were, respectively: WL $5.99, $145.36; MB $6.99, $141.93; and SF $4.98, $88.52. Conditional on any purchases of the products, female-male-headed HH spent more on WL supplements and male-headed HH spend more on MB and SF supplements compared to other HH types (p-values < 0.01). High-income ($30,000 < annual income < $100,000), compared to low-income (annual income < $30,000) HH, spent more on all three supplements types (p-values < 0.01); however, proportional to income, low-income HH spent 2–4 times more than high-income HH on WL and MB supplements (p-values < 0.01). Dietary supplements sold for WL, MB, and SF disproportionately burden HH by income and gender.

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The eating disorders medicine cabinet revisited: A clinician's guide to appetite suppressants and diuretics

Abstract: Alternative medicines are frequently used in the population of patients seeking treatment for bulimia nervosa. An abundance of products are available with potentially significant toxicities.

Cited by 31 publications

References 98 publications

Features associated with diet pill use in individuals with eating disorders

Features associated with diet pill use in individuals with eating disorders

Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system

Household expenditures on dietary supplements sold for weight loss, muscle building, and sexual function: Disproportionate burden by gender and income

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