Diet Pill and Laxative Use for Weight Control and Subsequent Incident Eating Disorder in US Young Women: 2001–2016

Jordan A. Levinson, BA; Vishnudas Sarda, MBBS, MPH; Kendrin Sonneville, RD, ScD; Jerel P. Calzo, PhD, MPH; Suman Ambwani, PhD; S. Bryn Austin, ScD

Disclosures

Am J Public Health. 2020;110(1):109-111. 

In This Article

Abstract and Introduction

Abstract

Objectives. To investigate the prospective association of diet pill and laxative use for weight control with subsequent first eating disorder diagnosis in young women.

Methods. We used longitudinal data from 10 058 US women spanning 2001 through 2016. We used multivariable logistic regression models, adjusting for age, race/ethnicity, and overweight status to estimate the association between weight-control behaviors and subsequent eating disorder diagnosis.

Results. Among those who had not previously received an eating disorder diagnosis, women who reported diet pill (adjusted odds ratio [AOR] = 5.6; 95% confidence interval [CI] = 3.0, 10.5) or laxative (AOR = 6.0; 95% CI = 4.2, 8.7) use for weight control had higher odds of receiving a subsequent first eating disorder diagnosis within 1 to 3 years than those who did not report using these products.

Conclusions. Use of diet pills or laxatives for weight loss can be dangerous and may be a warning sign that warrants counseling and evaluation for the presence of or risk of developing an eating disorder.

Public Health Implications. Policymakers and public health professionals should develop and evaluate policy initiatives to reduce or prohibit access to diet pills and laxatives abused for weight control.

Introduction

Research shows that unhealthy weight-control behaviors, including use of diet pills and laxatives for weight control, can put individuals at risk for the development of eating disorders.[1] Use of over-the-counter diet pills or laxatives is not recommended by health care providers as a healthy way to manage weight and can have severe health consequences.[2] Despite these risks, use of these products for weight control persists in people of all genders, ages, races/ethnicities, and socioeconomic statuses.[3,4] An estimated 15%[3] of adults report lifetime use of diet pills for weight control. Lifetime use of laxatives for weight control among adults is estimated at 5%[5] and from 15%[5] to 62% in those with eating disorders.[2]

Although use of diet pills and laxatives for weight control is common in people with eating disorders,[2,6] the prospective association of use of these products and subsequent diagnosis with an eating disorder is not known. Use of these products could indicate an incipient eating disorder or the presence of a full, yet undiagnosed eating disorder. Alternatively, a causal relationship may exist, as using diet pills and laxatives for weight control could serve as a "gateway" behavior to escalating weight-control practices,[7] dysregulate normal digestive functioning leading to more disordered eating,[8] and exacerbate emotion dysregulation through dependence on unhealthy and ineffective coping (i.e., diet pill and laxative use).[9]

We examined whether use of these products for weight control predicts subsequent clinical diagnosis with an eating disorder among young women who have not previously received an eating disorder diagnosis. We hypothesized that those who reported past-year use of diet pills or laxatives for weight control would be more likely than would those who did not to receive a first diagnosis of an eating disorder on the next wave of data collection (1–3 years later).

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