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Could a Diet Pills Tax Help Get These Toxic Products Out of Kids’ Hands?

We don’t have to tell you that our toxic consumer culture is a major driver of our society’s obsession with weight. You know it. We know it. And the $66 billion diet industry knows it. What the diet industry does not want you to know, though, is that most of what they sell is at best useless junk -- and that could not be truer than for diet pills. Almost all the over-the-counter (OTC) diet pills and powders on the U.S. market are sold as dietary supplements, which means they are wildly under-regulated, thanks to Congress’ cozy relationship with deep-pocketed industry lobbyists, and they are not prescreened for safety or efficacy like prescription drugs are.

Ever since Congress tied the hands of the U.S. Food and Drug Administration nearly 25 years ago with the Dietary Supplement Health and Education Act, the dietary supplement industry has been given practically carte blanche to market anything they think they can get away with. A recent study from the U.S. Centers for Disease Control and Prevention estimated 23,000 Americans end up in the emergency room every year because of illnesses and injuries, sometimes life threatening, caused by dietary supplements. Among girls and women, fully a third of these ER visits are caused by weight-loss supplements. The American Academy of Pediatrics stated unequivocally in a 2016 position statement that, no matter what their weight may be, teens should not take diet pills.

So what can we do? Thanks to the innovative legal research of New York University public health law scholar Jennifer Pomeranz, we have options: We can tell policymakers that stores should not sell these products to minors, and we can tell store owners to move them behind the counter, so they are not in the sight line of every child or teen who frequents their business. These are options we are advocating for now in Massachusetts, and hopefully other states and communities will follow suit. Another important policy option is to tax them as harmful consumer products, just like we’ve already done for tobacco, alcohol, and indoor UV tanning. Added taxes on cigarettes have been one of the most effective strategies to date to drive down teen smoking. Could this strategy work for diet pills too?

To answer this question, we realized we needed to bring together expertise from two really different fields. Bryn brought to our team expertise in eating disorders prevention, including in how changes in law and policy can help advance public health goals. Nate, an economist, came bearing a lot of experience in studying effects of taxes on harmful consumer products. With the help of a new grant at just the right time from the NEDA Feeding Hope Fund for Clinical Research, we were able to roll up our sleeves and get to work.

Because a tax on diet pills and powders hasn’t been tried yet in the U.S., we needed to use state-of-the-art simulation methods developed by economists to estimate the likely effects on consumer purchases if a tax were to be imposed on a product. Simulation methods are already standard practice in economics to forecast what might happen to markets if prices are adjusted with policy interventions. We figured if the methods can be used to answer these other types of research questions, why not use them to figure out what might happen if we taxed diet pills?

We pulled together the information we needed from Nielsen/IRi National Consumer Panel and Retail Scanner databases -- which are nationally representative of U.S. households and offer the most accurate and complete picture of what households are buying and in what amounts – and then we got to work to answer the question, “What would happen if a 20% tax were added to the price of OTC products making weight-loss claims?” We found for households that purchased an OTC diet pill or powder in the past year, a 20% higher average price of these weight-loss products could lead to a 5.2% decrease in purchases of those products. That may not sound like a lot, but there are over 126 million households in the U.S. and roughly one in five of them purchase these products, so a 5% decrease across millions of American households is a lot of diet pills not finding their way into the medicine cabinets in people’s homes.

But we know that not all households are the same, depending who is living there. Children can be more vulnerable than adults to believing the deceptive advertising and false promises many of these products make. At every turn, our society puts intense pressure, particularly on teen girls and young women, to get thin or stay thin no matter the costs or consequences. So we took a closer look at households with children ages 12 to 17 years old present and households with a daughter present. Among those with teenagers, we estimate a 20% added tax on diet pills could lead to purchases dropping 17.5%. And among households with a daughter present, the tax could lead purchases to drop 10.3%.

At the very least, these findings are intriguing. Our study offers the strongest evidence yet that an added tax on diet pills could be an effective public health strategy to reduce the purchase of potentially dangerous OTC diet pills and powders sold for weight loss, especially for households that include teens or a daughter. This is just one study, though, and we hope to see many more follow. With enough evidence and enough advocacy, maybe we can convince lawmakers to consider novel policy approaches like our diet pill tax. After all, we all know our toxic consumer culture needs some serious cleaning up.
 

About the Author:  S. Bryn Austin, ScD, is Director of the Strategic Training Initiative to Prevent Eating Disorders (www.hsph.harvard.edu/striped) based at Harvard T.H. Chan School of Public Health and Boston Children’s Hospital in Boston, MA. She is also Professor of Pediatrics at Harvard Medical School. Nathan Tefft, PhD, is Associate Professor of Economics at Bates College. Together they carried out the first economic study of the potential public health benefit a tax on OTC diet pills, which was published in the scientific journal Preventive Medicine in June 2018: Austin SB, Liu SH, Tefft N. Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects. Preventive Medicine 2018 (Epub ahead of print).