Big Findings, Big Implications
Weight loss is big business, and this is certainly the case for companies that make weight loss supplements. According to the National Institutes of Health, Americans spend about $2.1 billion per year on these products, with around 15 percent of adults saying they’ve used them at some point.  That’s a lot of people, but what’s truly alarming is that, as reported in a recent study published in JAMA Internal Medicine, some of these supplements contain ingredients that were banned by the US Food and Drug Administration (FDA) for years. 
Clearly, regulation of this industry is not where it should be. And this is especially shocking because the prohibited substances found in these pills, powders, and formulas were experimental stimulants that had adverse side-effects in users. This being the case, it’s worth breaking down what these are as well as the research conducted.
There were four ingredients assessed: DMAA, DMBA, BMPEA, and oxilofrine, all of which act in a way similar to amphetamines.  The first three share a very similar molecular structure, and the fourth has been banned in professional sports by the World Anti-Doping Agency. Noting an increased risk for cardiac effects, the FDA banned them from use in weight loss supplements between 2013 and 2016. Given that this agency is tasked with determining what can and cannot be in such products, that should’ve been the end of the story.
Not Enough Done
Unfortunately, Dr. Pieter Cohen and his collaborators at Somerville, MA’s Cambridge Health Alliance found otherwise. Interested in learning how well this prohibition was working, they assessed the ingredients of 12 popular supplements in 2014 and then in 2017 to see if required changes were in effect.  The idea was to find out not only how accountable the companies producing the supplements were, but how well the FDA was doing in preventing these dangerous substances from entering the market.
The results were a surprise to the researchers. While all 12 weight loss supplements had at least one of the four banned ingredients in 2014 (effectively before the ban), in 2017, a robust 75 percent still included at least one.  Oxilifrine was present in nine of the 12 tested, with DMBA found in four, DMAA in two, and BMPEA in one. Notably, fully half of the supplements still had two or more of these in 2017. As the researchers put it, current regulation is “insufficient to ensure the safety of dietary supplements.” 
So what sorts of dangers do supplements that contain these ingredients pose? The main concern has to do with heart health. Since these substances work a lot like amphetamines, they end up exciting the cardiovascular system. This leads to higher blood pressure and increased heart rate, which are not only harmful on their own but can be especially dangerous for those who already have cardiac issues.  Certainly, such risks aren’t worth it if the aim is to achieve healthy, sustainable reduction in weight.
An Informed Consumer
Regulating an industry like the one that makes weight loss supplements is not easy. Currently, there are approximately 90,000 of these products on the market, and, as two of the study’s co-authors, Dr. Michael Incze and Mitchell Kats noted, “it is hard to imagine how, without many more resources, the FDA could regulate such a large and amorphous entity as the dietary supplement industry.”  Even the safest regulations are only as effective as the ability to enforce them.
This is why it’s imperative that anyone considering weight loss supplements consult their doctor and spend time learning as much as possible about their choices. No matter what approach is taken to shedding excess pounds, the onus is on the consumer to be critical, careful, and informed. Take claims made by companies about their own products with a grain of salt. Being overweight and obese is undoubtedly dangerous, but the solution to these health issues shouldn’t be.
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- National Institutes of Health. “Dietary Supplements For Weight Loss”. 2018. Od.Nih.Gov. Accessed October 24 2018. https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/.
- Rettner, Rachael. 2018. “Weight-Loss Supplements Contain Dangerous Stimulants Years After Being Prohibited”. Live Science. https://www.livescience.com/63887-dangerous-stimulant-drugs-supplements.html?utm_source=twitter&utm_medium=social.
- Cohen, Pieter, Anita Wen, and Roy Gerona. 2018. “Prohibited Stimulants In Dietary Supplements After Enforcement Action By The US Food And Drug Administration”. JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2707947.