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Diet Pill Addiction Explained

What Are Diet Pills?

Diet pills are medications that are used as aids to help people lose weight. They have been around for approximately 200 years and have been the subject of various controversies. (1, 2, 3) While they were prescribed arguably too freely in previous years, there has been a steady decline in their official availability in the United Kingdom since the 1980s. There is currently only one type of diet pill that is licensed for prescription in the United Kingdom, orlistat, and this is only offered in extreme cases. (4)

The diet industry is nonetheless worth $2 billion in the United Kingdom alone and celebrity endorsements, Instagram culture and constant advertising drive these sales. In spite of a growing drive to obtain physical perfection, 64% of adults in the country are overweight or obese. (5) Fast-food adverts, celebrity endorsements for exercise regimes and relentless marketing campaigns have encouraged a confused consumer culture that exploits human beings’ most fundamental desires.

Healthcare providers are fairly consistent in their message that regular exercise and a healthy diet are the safest and most effective ways to induce weight loss. (6) Manufacturers of diet pills are taking increasingly deceptive measures to sell their products — labelling them as ‘medical devices’ as opposed to drugs or food supplements to avoid EU regulations. (7)

Many people do not see diet pills as drugs and don’t comprehend that they can be harmful substances. The seemingly benign nature of diet pills has led to a large proportion of people, predominantly women, buying them from the Internet.

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Unsupervised use of any kind of diet pill is not recommended by any medical professional in the United Kingdom. If a person or their loved one is aware of this type of use, a serious conversation with an expert should take place.

History of Diet Pills

Evidence that humans have practised dieting goes back to the Ancient Greek times. Diets up until industrialisation, however, were focused primarily on maintaining a healthy lifestyle and living longer. It was around Victorian times that image became the primary driving force behind the pursuit of weight loss. The poet, Lord Byron was an early proponent of thinness as a fashion statement.

Some extra weight had, up until that time, been a sign of prosperity due to the implication that heavier people could afford a richer diet. Obesity-related illnesses and death were the preserve of the wealthy, and poorer people often ate far healthier diets than their richer counterparts. This wasn’t due to choice, and as global trade grew, a greater proportion of the population had access to a wider range of foods.

In the 18th century, sugar consumption increased twentyfold and by the 19th century, diet pills had become big business. Newspapers and chemists advertised a plethora of pills and tinctures, all hailed as weight-loss solutions. These concoctions were sold as miracle cures that negated the need for refraining from food or undertaking regular exercise. This started an unhealthy trend that capitalised on how difficult some people find it to resist their favourite foods.

Many of these drugs had marketable names such as Bile Beans, Slim, Corpu-lean, Figuroids and Gordon’s Elegant Pills. While most of them were some form of laxatives and completely harmless, some of the products on the market could cause blindness and death. By the 1920s, the US government grew concerned about slimming mania and a possible negative impact that picture-perfect celebrities were having. (8)

Throughout the 20th century, the use of barbiturates and amphetamines for weight loss resulted in widespread abuse and health problems for those involved. Doctors and pharmacies were fined and put in prison to put a halt to what had become an epidemic by the 1960s. During this time, teenagers could easily find these types of medications in their families’ drug cabinets. By the 1980s, drug manufacturers and suppliers were forced to find more creative ways to escape legislation. (9)

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Common Diet Pills

There is only one diet pill that is licensed for doctors to prescribe as a treatment for obesity. It is very rare that someone with a body mass index below 30 would be offered medical treatment for weight loss, unless they suffered from type 2 diabetes, high blood pressure or any other disease that can cause weight gain. Many of these drugs can, however, be legally accessed online or in health stores.

  • Lorcaserin
  • Sibutramine
  • Orlistat
  • Rimonabant
  • Mazindol
  • Metformin
  • Benzphetamine (Didrex)
  • Diethylpropion
  • Amylin/pramlintide
  • Phentermine/topiramate
  • Exenatide/liraglutide/semaglutide
  • Bupropion/naltrexone

Diet Pills and Addiction

Diet pills are generally perceived as harmful to those who are not undergoing a medically supervised course of treatment for obesity. Doctors ascertain whether someone is overweight or obese by calculating their body mass index (BMI). This is worked out by dividing a person’s weight in kilograms by their height in metres squared. A healthy BMI ranges from 18.5 to 24.9, a person with a BMI of between 25 and 29.9 is considered overweight and over 30 is obese. (10)

Diet pills cannot be prescribed to anyone other than people who are considered obese unless they have a comorbid disease such as diabetes or high blood pressure. Although chemists and health shops may brand their products as harmless, using diet pills in a way other than what has been directed by a physician is considered abuse. People can easily develop a dependence on these substances because of the perceived positive effects and relatively respectable reputation.

Many women find that constant exposure to aesthetically beautiful, often surgically and digitally enhanced images of celebrities in the media causes them insecurity about their looks. Anxiety and insecurity are seldom positive catalysts for change and can cause people to seek quick fixes rather than making lifestyle changes that would produce better, longer-lasting results. There are a multitude of side effects associated with misuse of most diet pills. (11)

Are Diet Pill Addictions Physical or Process Addictions?

A process addiction is also known as a behavioural addiction. It refers to an addiction that is not predominantly characterised by the effect of the substance on the brain and body. Instead, the individual feels a compulsion to carry out a behaviour repeatedly in spite of negative consequences. It is widely accepted that drugs that affect certain neurotransmitters, such as heroin or alcohol, cause the most intense symptoms of a physical and mental addiction due to their direct action.

However, any process or action that gives people pleasure can lead to an addiction. Alcohol, heroin and other substances act by causing an increase in the neurotransmitters that cause pleasure. As these supplies are depleted by overstimulation, the user requires the drug in increasing quantities in order to receive the same results or even just maintain a baseline level.

Addiction to sex, food or other processes causes the brain to crave the pleasure experienced when carrying out these behaviours. The brain becomes disproportionately fixated on undertaking the action that gives it the most pleasure, and the individual loses a certain control over their motivation. Other process addictions include shopping, gaming, the Internet and gambling, and their effects can have a catastrophic impact on the lives of those affected. (12)

Understanding the Chemical Composition of Active Ingredients in Diet Pills

The only drug that is approved for use in treating obesity and weight management in the United Kingdom is orlistat. This medication prevents around a third of ingested fat to be absorbed into the body. This extra fat is eliminated in the faeces. It works in the gastrointestinal tract by inhibiting dietary fat absorption. Many of the other diet pills that have been formulated act on parts of the brain responsible for hunger and fullness.

Mysimba is the brand name of one such drug, a combination of naltrexone and bupropion. Buproprion is related to amphetamines, while naltrexone is an opioid receptor agonist. It was widely hinted that it was the cost of the medication that led the National Institute for Health and Care Excellent to reject it for use in the United Kingdom. (13) However, research surrounding the drug consistently states that the substance carries too many health risks compared to benefits. (14)
Drugs such as lorcaserin, sold under the brand name Belviq in the United States and elsewhere, act on the 5-HCT receptors that affect the release of serotonin. As an agonist of these receptors, the drug causes proopiomelanocortin to be released by the hypothalamus, which causes satiety or fullness. This type of medication has not been approved for use in the United Kingdom, in part due to its interaction with essential neurotransmitters and the potential for abuse. (15)

Why Some Diet Pills Have the Potential to Be Addictive

Arguably, diet pills can cause a physical or a process addiction depending on the active ingredient in the drug, the previous medical history of the individual using the drug and the quantity used. The process of taking a pill and it inducing the desire of weight loss is enough for a person to develop a dependence on the substance. If the diet pill acts on neurotransmitters in the brain, this can exacerbate the body’s habit response to the drug.

Diet pills that have a similar stimulant effect in the body to amphetamines can cause a feeling of euphoria when taken in higher doses. This feeling can lead to abuse, more regularly seen in young people or those with a previous history of substance abuse. Likewise, diet pills that cause serotonin or dopamine release can result in a depletion of these neurotransmitters that leads to the individual requiring more of the substance to achieve the desired effects. (16)

It is generally accepted that individuals who are suffering from an eating disorder are more prone to diet pill addiction. The neurological issues associated with eating disorders can distort the judgment of the drug user into believing that their behaviour is healthy and constructive. Diet pills are mostly used concurrently with other dangerous methods of weight control such as laxative use, vomiting and other forms of purging. (17)

How long does it take to become addicted to diet pills?

In the United States, the Food and Drug Administration (FDA) permits the use of most diet pills that affect neurotransmitters for short-term use only. (18) In the UK, none of these types of drugs are licensed for medical use. However, across both sides of the Atlantic, companies are selling diet pills as weight-loss supplements that can bypass the regulations set by the FDA in America and NICE in the United Kingdom.

In the UK, it is thought that even short-term use carries a risk of dependence and abuse. Certain genetic and environmental factors can predispose people to forming addictions. These risk factors are key components in the general reluctance to use supplements or drugs to manage weight loss.

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Who Is Prone to Diet Pill Dependence?

Various studies have shown that women have a higher incidence of resorting to non-prescription medications than men. (19, 20) It is argued, however, that while images in the media disproportionately depict representations of women that perpetuate an unhealthy body image, this phenomenon is increasingly affecting men. (21) Women are nonetheless at a significantly higher risk of developing a dependence on these types of medications.

Studies have found that adolescents are at a higher risk of developing a dependence on substances than adults. This has been put down to young people finding some addictive drugs more rewarding than adults, as well as a marked decrease in adverse effects noted in adolescents.

Reduced inhibiting factors lead young people to take substances in higher quantities than adults. This may lead to an increase in euphoric effects, and the fact that young people experience less severe withdrawal symptoms may encourage them to take substances more. (22) The majority of data available suggests that young women are more prone to diet pill addiction than any other demographic.

Genetic factors

Genetic factors are thought to play a key role in the development of all kinds of addictions. It is generally accepted by psychiatrists that people who suffer from substance abuse disorders or addictive behaviour patterns have a genetic predisposition to addiction. Environmental factors then interact with genes to determine whether a person realises their genetic potential. In the same way, a person can participate in a lifestyle that activates a genetic predisposition to type 2 diabetes. (23)

There is very little data to suggest that people are genetically predisposed to become addicted to specific diet pills. This is largely due to many of them not being licensed by the government and therefore not subject to the rigorous testing procedures that the process entails. It is accepted that factors such as minuscule variances in taste receptors can have a huge impact on a person’s propensity to addiction. (24)

Environmental and social factors

Evidence that has suggested a connection between genes and addiction often cites word-of-mouth suggestions that family members are also addicted to food or alcohol. (24) While this could definitely be evidence of a genetic predisposition, it could also indicate that these behaviours are learned. Parents exercise almost full control over the diet of their children, and if they demonstrate an unhealthy relationship with food, the child is more likely to imitate this.

Another major social factor that influences a person’s propensity to forming a diet pill habit, especially young women, is the media. In particular, the prevalence of social media in young people’s lives currently causes immense pressure to appear physically attractive. (25) The compulsive drive to look a certain way and continue losing weight is characteristic of an eating disorder. Anyone who behaves this way or knows a loved one who does should seek professional help straight away.

Diet pills and eating disorders

Forming an addiction to diet pills can be a precursor to an eating disorder, and any individual who is worried about the way they are using dieting medication should seek advice. The misuse of diet pills often occurs in individuals who suffer from eating disorders alongside other unhealthy weight-loss methods. (17) The diet pill industry is seen as dangerous due to a concern that it promotes disordered ideas about eating. (26)

Research has shown that up to 50% of those who are diagnosed with an eating disorder are also abusing diet pills. Diet pills can represent a physical deterrent against meals, help to suppress appetite and trick the mind into feeling full. These are all effects that are strongly desired by an individual with an eating disorder. It has been hypothesised that individuals who suffer from anxiety or impulsivity disorders are at a greater risk of developing an addiction.

There can be extreme consequences for people who are suffering from an eating disorder and also abuse diet pills, as the two can be an immense strain on the body. Side effects such as convulsions, hallucinations, gastrointestinal distress, headache, stroke, renal failure, heart attack, heart failure, palpitations, fatigue, high blood pressure, insomnia and nervousness have been reported. (27)

Diet pill abuse and co-occurring mental disorders

Evidence has shown a clear link between people who are predisposed to addiction and those who are predisposed to mental health conditions. As many as 72% of people suffering from borderline personality disorder also suffer from a substance abuse disorder. (28) Substance misuse is found in around 40% of those suffering from bipolar I and II disorders. (29) Recent studies have ascertained that, overall, as many as 27% of individuals with a severe mental health disorder misuse substances. (30)

Why Is Diet Pill Abuse Dangerous?

The most threatening aspect of diet pill abuse is the lack of research available on the long-term impact of many supplements that are currently on the market. The government in the United Kingdom perceives a dangerous potential for abuse in medications that alter neurotransmitters in order to regulate appetite or stimulate the metabolism. There is also a concern about the dangers of using drugs to try to solve a problem that should be approached from a lifestyle perspective.

There have been a host of unpleasant and harmful side effects with pretty much every type of diet pill available. Orlistat, which is legal in the UK, can cause highly embarrassing gastrointestinal symptoms. Amphetamine-like diet pills that increase metabolism can cause heart problems and lead to addiction while also causing side effects such as palpitations, anxiety and depression. (31)

The messages that are sent out in order to promote these products can be extremely dangerous to society as a whole. The healthiest and longest-lasting method for weight loss is leading a healthy lifestyle and making constructive choices where diet and exercise are concerned. While these things are easier said than done, the risks associated with using diet pills are seen to outweigh their benefits.

Therapy is advised for anyone who is struggling with an issue with their image or weight. Working with a qualified counsellor can help people to form lifelong habits that work for them.

Dangers of mixing diet pills with other drugs

Many diet pills work by affecting neurotransmitters in the central nervous system. These types of medications should never be used in conjunction with alcohol, other prescriptions or illicit substances. The lack of evidence about the risks of over-the-counter medication means that anyone who is taking supplements that claim to promote weight loss should proceed with caution and seek professional advice as soon as possible.

Signs and Symptoms of Diet Pill Abuse

The demographic at the highest risk of developing an addiction to diet pills is adolescent females. Due to the secretive nature of teenage girls, it is important that parents are vigilant to signs that their child may be a victim of drug abuse. It is important to note that anyone, including boys, is subject to develop an addiction to diet pills. Overall, women do show a greater propensity to forming addictions to prescription medication. (32)

Some common side effects of abusing stimulants include:

  • Paranoia
  • Anxiety
  • Agitation
  • Insomnia
  • Reduced appetite
  • High body temperature
  • High blood pressure
  • Irregular heartbeat
  • Euphoria
  • Increased alertness

Some general effects that may be present when someone is misusing prescription drugs include:

  • Forging, stealing or selling prescriptions
  • Secretive online behaviour
  • Excessive mood swings
  • Hostility
  • Disinterest in activities that are usually enjoyed
  • Internet history suggesting an unhealthy interest in weight loss

Long-Term Side Effects of Diet Pill Use

There have not been many studies carried out into long-term use of the majority of diet pills that are currently on the market. It is thought that continued use could lead to effects such as:

  • Rectal bleeding
  • Liver damage
  • Kidney damage
  • Sleeplessness
  • Diarrhoea
  • Agitated mood
  • Hypertension
  • Heart failure
  • Death

Social Effects of Diet Pill Abuse

Addiction can negatively impact on many aspects of a person’s life. While the main person who is affected is the user of the drug, the harmful use of substances can have a terrible impact on the people around them as well. More than just the body and mind are affected; their whole life can be thrown into disarray. Other aspects include:

  • Law and order
  • Financial issues
  • Personality
  • Health and well-being
  • Employment
  • Education
  • Family life
  • Personal relationships

Using the Internet to obtain medication is an extremely dangerous practice. Most of the substances sold are not subject to medical trials and should be avoided at all costs. (33)

Diet Pills Withdrawal Symptoms and Effects

The severity of withdrawal symptoms experienced is dependent on factors such as the duration, dosage and type of diet pill an individual has been misusing. Due to the lack of regulation in their production and distribution, there can be a plethora of harmful substances in a single pill. Anyone who has been using a substance for a significant amount of time is likely to experience emotionally and physically challenging side effects, such as:

  • Fatigue
  • Irritability
  • Cravings
  • Weight gain
  • Muscle aches
  • Impaired memory
  • Increased appetite
  • Low mood/depression

These symptoms can last for weeks, sometimes months, with the worst ones coming on during the first 10 days or so. Treatment in a rehabilitation centre is recommended in order to manage the discomfort of withdrawal symptoms, which are often one of the main causes of relapse. Rehab is also advised because the individual gets medically assessed and offered any relevant therapy. Therapy is the other main component that can ensure a person stops using long term.

Diet Pills Addiction Treatment and Therapy Options

The type of treatment offered would be dependent on the exact substance that has been misused. There is a range of supplements, pills and concoctions on the market that claim to accelerate weight loss. Many of these medications are laxatives, which artificially induce the large intestine to empty. Using this method is highly ineffective as food is often absorbed once it has reached the small intestine.

The action of laxatives is believed by many to eliminate fat and calories. This is, however, a fallacy. A stool caused by these medications mainly contains water, electrolytes, indigestible fibre and minerals.

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Another type of medication that is sold as a diet aid emulates the effects of stimulants such as amphetamines. These enable the user to expend more energy, as well as suppressing appetite, and can also cause a feeling of euphoria.

When an addiction to harmful diet pills materialises, there is often an underlying cause such as an eating disorder or other disorder related to self-esteem. It is imperative that anyone experiencing these types of symptoms seeks help, as eating disorders are extremely harmful mental illnesses that require medical attention. A treatment programme at a respected rehabilitation facility can address the underlying causes of the addiction while treating the physical and psychological problems.

Types of therapy available to those suffering from these symptoms include:

  • Cognitive behavioural therapy
  • Medical nutrition therapy
  • Dialectical behaviour therapy
  • Acceptance and commitment therapy
  • Art therapy
  • Dance/movement therapy
  • Equine therapy
  • Exposure and response prevention therapy
  • Family therapy
  • Interpersonal psychotherapy
  • The Maudsley method (34)

Inpatient rehab vs outpatient treatment for diet pills addiction

Outpatient rehab involves the individual spending around five full days a week at a rehabilitation centre. Depending on the duration and intensity of the addiction, as well as any underlying psychological issues, the service user may take supervised meals. Their care often revolves around a mixture of group and individual therapy, with medication offered in extreme cases to ease withdrawal symptoms.

The role of counselling in diet pills addiction treatment

The role of counselling depends on the severity and duration of the addiction, as well as the underlying cause. If the addiction is more process-based and the user has developed an unhealthy habit without any underlying psychological reasons, short-term therapy may be helpful. People who are suffering from an untreated eating disorder will require urgent medical intervention, and counselling will play a key role in their recovery.

Long-Term Strategies and Recovery from Diet Pill Addiction

Long-term strategies must focus on the treatment of any underlying causes that are driving someone to continue to take substances that have not been approved for use by medical professionals. While diet pill addictions can present themselves as independent process addictions, the majority of the time they are associated with eating disorders.

Both types of addiction require an urgent medical intervention. Treating a process addiction often focuses on helping the individual to learn what has led them to carry out this behaviour and offers alternate coping strategies. Treating an eating disorder is a delicate, long-term process that addresses underlying psychological problems that may be causing the individual to have a harmful relationship with food.

Ensuring the body has its nutritional needs met is a basic fundamental of living a healthy life. People who develop harmful behaviours around food are putting their lives at risk and must seek professional help as soon as possible.

(1) https://metro.co.uk/2019/03/28/slimming-clinics-are-putting-patients-at-risk-with-dodgy-weight-loss-pills-9042283/

(2) https://www.theguardian.com/lifeandstyle/2018/nov/03/diet-pills-danger-sweat-heart-attack-weight-loss-rhiannon-lucy-cosslett

(3) https://nypost.com/2000/04/16/u-k-diet-pill-ban-carries-no-weight-in-u-s/

(4) https://www.diabetes.co.uk/weight/weight-loss-pills.html

(5) https://web.archive.org/web/20190331172847/https://www.bbc.com/timelines/z9nfyrd

(6) https://www.nhs.uk/live-well/healthy-weight/12-tips-to-help-you-lose-weight/

(7) https://www.refinery29.com/en-gb/2019/05/228683/diet-pills-weight-loss

(9) https://www.encyclopedia.com/science/applied-and-social-sciences-magazines/diet-pills

(10) https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity

(11) https://www.cosmopolitan.com/uk/body/health/a14536305/diet-pill-addiction-side-effects-helen-hine/

(12) http://tpcjournal.nbcc.org/counselors-understanding-of-process-addiction-a-blind-spot-in-the-counseling-field/

(14) https://www.ncbi.nlm.nih.gov/pubmed/26594724

(15) scholar.google.co.uk/scholar_url?url=http://jpet.aspetjournals.org/content/jpet/early/2008/02/05/jpet.107.133348.full.pdf&hl=en&sa=X&scisig=AAGBfm2F3cbc4bZ7JDCPbwOVt8lTI5UEDw&nossl=1&oi=scholarr

(16) http://citeseerx.ist.psu.edu/viewdoc/download?doi=

(17) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248697/

(18) https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/

(19) https://www.medicinenet.com/script/main/art.asp?articlekey=16918

(20) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215364/

(21) https://usurj.journals.usask.ca/article/download/89/39/

(22) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025448/

(23) https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction

(24) https://www.psychologytoday.com/us/blog/answers-appetite/201405/is-appetite-genetic

(25) https://www.nationaleatingdisorders.org/blog/how-does-social-media-affect-your-body-image

(26) https://www.teenvogue.com/story/diet-pill-horror-stories

(27) https://www.eatingdisorderhope.com/blog/eds-co-occurring-diet-pill-abuse

(28) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196330/

(29) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094705/

(30) https://www.nice.org.uk/guidance/ng58/documents/evidence-review

(31) https://www.drugs.com/article/side-effects-weight-loss-drugs.html

(33) https://www.ncbi.nlm.nih.gov/pubmed/1886469

(34) https://www.eatingdisorderhope.com/treatment-for-eating-disorders/types-of-treatments

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