California moves closer to restricting sale of weight loss supplements

California state lawmakers on Tuesday inched closer to passing a bill that would prohibit retail establishments from selling dietary supplements marketed for weight loss or over-the-counter (OTC) diet pills to anyone under the age of 18.

The Judiciary Committee in the California State Assembly voted 8 to 3 to pass AB 1341, a piece of legislation introduced by two Democrat assemblymembers, Christina Garcia and Cecilia Aguiar-Curry.

The bill now moves to the Committee on Appropriations for a hearing and vote, according to Cindy Morante, secretary of the Judiciary Committee. She said she didn't know when the Appropriations Committee planned to hear the bill. 

Eating disorders

In testimony Tuesday in favor of the bill, Jason Nagata, M.D., assistant professor of pediatrics at University of California, San Francisco (UCSF), said research has found many weight loss supplements are tainted with such substances as stimulants, steroids and prescription drugs. “Rigorous” studies, he added, have shown such weight loss products “pose serious health risks to consumers.”

Supporters of the bill also have contended a link exists between the use of weight loss supplements and eating disorders.

“As a pediatrician specializing in adolescent eating disorders, I have cared for countless youth in the Bay Area who have used weight loss supplements and diet pills, developed eating disorders, become critically ill and required hospitalization,” Nagata said. “The number of teenagers hospitalized for eating disorders at UCSF has doubled since the start of the pandemic. We need to get these dangerous products out of the hands of our kids.”

But Kyle Turk of the Natural Products Association (NPA) called the legislation “a solution in search of a problem.”

“However, there is no problem because there is no evidence of a linkage between dietary supplements and eating disorders,” testified Turk, director of government affairs with NPA.

Turk said his organization in 2019 submitted a request to FDA under the Freedom of Information Act (FOIA) to explore whether there were adverse events in cases involving eating disorders and dietary supplements.

“The answer from the FDA is there is no linkage between eating disorders and supplements—period,” he said. “If AB 1341 were to become law, many products such as vitamin D and calcium would not be made available to people under 18,” which would result in “a catastrophic impact on vulnerable communities using these essential products to supplement their health and get the critical nutrients they need.”

Larisa Cespedes, a lobbyist who testified on behalf of the American Herbal Products Association (AHPA), questioned whether some studies cited by the bill’s sponsors actually showed a correlation between supplements and eating disorders, or body dysmorphic disorder (BDD). Based on a review of the references provided, two of three studies did not actually examine weight loss products, she said.

Later during the hearing, Democratic Assemblymember Lorena Gonzalez—one of the 11 members on the Judiciary Committee—cited a lack of research linking supplements with eating disorders.

“But common sense in all of our experiences can tell you that there is a link and that there is a draw for young women,” Gonzalez said.

She said she advised Garcia the bill doesn’t go “far enough,” and lawmakers in the future should consider restricting youths’ access to water pills and laxatives.

"We need to do more to protect our youth from the harmful effects that weight loss supplements and over-the-counter diet pills have on our youth,” Garcia said in an April 14 press release after the Assembly Committee on Health passed AB 1341. “With easy access, our youth are subject to eating disorders and many other health implications. We need to stand up to an industry that puts profit over people.”

Adulterants in weight loss products

One of the groups in favor of AB 1341 is Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), a graduate-level training initiative based at the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital.

“The scientific research on the dangers of using weight-loss supplements is as incontrovertible as it is chilling: These products have been found again and again to contain a toxic brew of undisclosed ingredients linked to heart palpitations, cardiac arrest, stroke, and even liver damage so extensive as to require organ transplant or resulting in death,” STRIPED Director Bryn Austin, who obtained her doctor of science (ScD) degree from Harvard T.H. Chan School of Public Health, said in the April 14 news release issued by Garcia’s office. “Knowing what we know today about these products, how can we continue to let the manufacturers and retailers who profit from them play Russian roulette with the children of California?”

During the Judiciary Committee hearing, representatives of trade groups opposed to the bill pointed out supplements are subject to regulations by FDA and FTC, including GMPs (good manufacturing practices).

And it’s already illegal for a substance like a pharmaceutical ingredient to be sold in a dietary supplement, noted Cespedes of the Sacramento, California-based lobbying firm Miller Cespedes & Associates.

The legislation “will lead to unintended consequences, including pushing consumers to purchase products from dubious sellers and online marketplaces, where the vast majority of some of these adulterated products are sold,” she warned.

Competing campaigns

Critics of the supplement industry compare the sector to cigarettes, said Dan Fabricant, Ph.D., president and CEO of NPA.

“They think that taxation and age restriction are the solution here because again they’re … taking the page out of the anti-cigarette movement’s book,” Fabricant said in an interview last week. “They don’t like the industry and they’re going to use those tactics against us.”

Fabricant expressed concern that if AB 1341 passes in the California State Legislature, it would pave the way for similar action by other left-leaning states, including New York, Massachusetts, Oregon and Washington state.

California legislators, he concluded, are “basically criminalizing people who are selling supplements, which is bananas.”

NPA has been aggressive in a grassroots campaign to oppose AB 1341. More than 3,500 letters opposing the bill were sent to the offices of California lawmakers, and around 4,000 phone calls were made as well, Turk said in the interview with Fabricant.

But STRIPED also is encouraging people to email or call California lawmakers in support of AB 1341. On one of its webpages, it includes a script that its stakeholders can follow.

“Unfortunately, our culture’s intense focus on weight can lead far too many young people to use diet pills or supplements in attempts to lose weight,” the script states. “Not only are these products underregulated, unproven, and laced with dangerous chemicals, they can contribute to a lifetime of eating disorders and other serious health problems.”

Asked about lawmakers’ predominant concerns with weight loss supplements, Turk responded, “The one comment that consistently came back to me was, ‘Well, your products aren’t regulated by the FDA.’”

He added, “We can talk about that until we’re blue in the face, but really the most concerning part of it was we’d have these introductory conversations with folks [in the California State Assembly]. We’d follow up. There was never a dialogue between [legislative] staff and myself, where they were transparent in what they were doing.”

During the Judiciary Committee hearing, Turk said AB 1341 would bar the sale of such ingredients as thermogens and lipotropics to minors. The bill defines weight loss supplements as including such things as thermogens, lipotropics, hormones—including hormone modulators and hormone mimetics—appetite suppressants and ingredients considered adulterated under federal law.

“That would mean school lunches, Egg McMuffins … steak and other common food products suddenly become contraband,” he testified. “And in our view, it’s ridiculous to put these building blocks of nutrition in the same category as alcohol and tobacco.”

Near the end of the Judiciary Committee hearing, Garcia said she didn’t “appreciate the misinformation campaign that’s out there.”

“Many weight products, for example, are sold as food and have Nutrition Facts labels on the back of packages so they would not be covered by AB 1341,” she said. “If they are being sold specifically as diet supplements, they would be covered.”

Garcia added, “But the reality is that these young children pick up these habits as kids and carry them into adulthood—and we have them for a lifetime.”