State bills that would ban minors’ access to diet pills and supplements marketed for weight loss and muscle building without a prescription have picked up steam in recent days in the Northeast.

Legislation in New York, which has been delivered to Gov. Kathy Hochul, would prohibit the sale of over-the-counter diet pills or supplements for weight loss or muscle building to minors without a prescription from a healthcare provider.

By March, both chambers of the New York State Legislature had passed the bill, but it was only recently sent to the governor. If signed by Hochul, the legislation would become the first in the U.S. to limit minors’ access to certain categories of dietary supplements, which are a class of food regulated by FDA predominantly under a 1994 law called the Dietary Supplement Health and Education Act (DSHEA).

Similar legislation is being considered in the Garden State and was the subject of a Dec. 15 hearing in a health committee in the New Jersey Senate.

In September, Calif. Gov. Gavin Newsom vetoed a bill that would have prohibited the sale of weight loss supplements and over-the-counter diet pills to anyone younger than 18 without a prescription.

Advocates of the bills have expressed concerns with the number of young people who suffer from eating disorders and who may turn to diet pills and certain categories of supplements marketed for weight loss and to build muscle, for example.

Related:California Gov. vetoes weight loss supplements bill

“Eating disorders are diagnosed based on a number of criteria, including the presence of what clinicians call unhealthy weight control behaviors (UWCBs),” states the “justification” section of S16D in New York. “One UWCB of particular concern is the use of pills or powders to lose weight or build muscle, which are often sold as dietary supplements. Although they are sold alongside multivitamins and other supplements largely regarded as safe, these products often contain unlisted, illegal pharmaceutical ingredients that pose serious risks.”

Industry stakeholders have acknowledged the risks to public health associated with eating disorders. However, they maintain dietary supplements promote health and aren’t the cause of eating disorders.

In a Dec. 13 letter, Natural Products Association (NPA) President and CEO Dan Fabricant urged Hochul to veto S16D/A431.

The legislation “fails to list specific ingredients or products of concern, nor does the sponsor point to any dietary supplements that are the genesis of this legislation during testimony in the assigned committees,” Fabricant wrote. “Instead, S-16/A431 tasks the Department of Health to consult with the public to determine which dietary supplements shall be prohibited for sale to consumers under 18 without a prescription.”

In his six-page letter, Fabricant pointed out the governor of the largest state representing the supplement industry vetoed a bill to restrict minors’ access to weight loss supplements and OTC diet pills.

In his written veto message to lawmakers, Newsom noted that the California Department of Public Health (CDPH) would have been tasked with determining what products are subject to AB 1341, a bill championed by Assemblywoman Cristina Garcia, who represents a district in southeastern Los Angeles County.

“I commend the work of the author, as this bill raises an important public health issue related to the safety of diet or weight loss pills that can result in injury,” Newsom wrote. “However, dietary supplements for weight loss are not considered drugs and, therefore, this measure would require CDPH to evaluate every individual weight loss and dietary supplement product for safety, which is beyond the scope of the department's capabilities.”

During a Dec. 15 hearing in the New Jersey Legislature before the Senate Health, Human Services and Senior Citizens Committee, several individuals testified for and against S2387, which also would restrict minors’ access to OTC diet pills or supplements for muscle building.

Paige Sklar, who has worked with the National Eating Disorders Association (NEDA), was among those who testified in favor of the bill.

“Research shows that dietary supplements sold for weight loss and muscle building often contain drugs that are prescription only, illegal or untested for human use,” Sklar said in her testimony. “This can lead to serious health risks, including stroke, testicular cancer, severe liver injury and even death.”

Industry stakeholders have countered products marketed as dietary supplements but spiked with drugs are already illegal.

Testifying on behalf of the Council for Responsible Nutrition (CRN), Cassie Folk said S2387 doesn’t “regulate online sales, which is the most common source of unsupported claims and the least scrutinized … for products that do not meet high-quality standards and may contain questionable ingredients.”

“The vast majority of these products are available through social media and online platforms, not your standard reputable retail store,” she added.

Folk described the New Jersey bill as "overly broad" and said it "inadvertently captures numerous products that are safe." 

"We want to be a part of the solution," she added. "We also want to see the harmful products removed from the marketplace, and we believe there's a path forward."

Sklar maintained certain categories of supplements are not only dangerous for minors struggling with eating disorders, “weight loss and muscle building supplements promote unrealistic and unhealthy results in body types.”

“Their advertisements often entice younger people with promises that obtaining a thin or tone body is the ideal body type,” she said. “To a young audience, this is very appealing as they seek acceptance and approval. This kind of advertising and language is divisive as it excludes different body types that do not fit this mold. This can cause children to feel insecure and as if they must change the way their bodies look to gain acceptance.”

Brianna Mullins, an employee of FEAST, a nonprofit that supports families affected by eating disorders, said a person with an eating disorder may ignore health risks due to their preoccupation with losing weight.

“Studies show that the brain is not fully mature at 16 but closer to 25,” Mullins testified. “Planning, problem solving, emotion regulation, risk/reward and impulse are all areas that affect decision-making. Not being able to make an informed choice as to what is best and healthy for you— especially when the FDA does not regulate supplements and allows these companies to not report dangerous side effects, including death—is unconscionable.”

Kyle Turk, director of government affairs with NPA, observed in his testimony that FDA does, in fact, regulate dietary supplements under DSHEA, and its oversight includes review of serious adverse event reports linked to supplements, which manufacturers must report to FDA.

If eating disorders were associated with the use of dietary supplements, Turk testified, FDA’s AER system called MedWatch would pick that up. Based on Freedom of Information Act inquiries to FDA, no such correlation exists, according to NPA officials.

Turk also warned New Jersey’s legislation would restrict access to such popular ingredients as creatine, taurine, vitamins and ashwagandha.

Adam Adelmann, chief commercial officer at OmniActive Health Technologies, a supplier of ingredients to nutrition brands, also testified in opposition to S2387.

“We support vigorous enforcement of the law that would protect consumers, and we’re happy to work with the state and anyone who finds a viable solution,” he testified. “Still, this legislation misses the mark, however, and will undermine the public health more than it will help it.”

Ultimately, senators on the health committee voted 5 to 2 to advance the bill. A companion bill in the New Jersey General Assembly scheduled for a floor vote this week was pulled from the calendar, industry sources said. Staff for the New Jersey Legislature did not immediately respond to a request for comment on the reasons for the withdrawal or next steps for the bill.

The American Herbal Products Association (AHPA) is among the groups that submitted written testimony in opposition to S2387. Robert Marriott, AHPA’s director of regulatory affairs, said his organization opposes the bills in New Jersey and New York “in line with its longstanding general practice of opposing efforts to enact state-by-state restrictions on specific supplement categories.”

“Both bills fail to address the social forces, which are the root cause of eating disorders and would unduly limit access to lawful and safe dietary supplements,” Marriott wrote in an email to Natural Products Insider.