A novel study reveals a significant rise in dietary supplement use among children and adolescents over the past decade, including increasing consumption of weight loss and bodybuilding products by teen girls, raising concerns about unregulated ingredients, potential hepatotoxicity, and disordered eating behaviors in a population where long-term safety data remains scarce.
How Pediatric Supplement Use Has Evolved Beyond Vitamins
Research published in JAMA Pediatrics analyzed national survey data from 2009 to 2020, finding that approximately one-third of U.S. Children and adolescents used at least one dietary supplement in the past 30 days, with multivitamins remaining most common. However, use of products marketed for weight loss, muscle building, and energy increased significantly, particularly among adolescent females aged 12–19. Unlike pharmaceuticals, these supplements are not required to undergo pre-market safety or efficacy review by the FDA, creating a regulatory gap where products may contain undeclared stimulants, anabolic agents, or contaminants linked to liver injury and cardiac events.
In Plain English: The Clinical Takeaway
- Many supplements sold for weight loss or muscle gain contain active pharmaceutical ingredients not listed on labels, posing hidden risks to developing bodies.
- Teen girls using these products may be influenced by social media pressures, increasing vulnerability to both physical harm and eating disorders.
- Parents and clinicians should routinely ask about supplement use during checkups, especially when evaluating unexplained symptoms like fatigue, jaundice, or rapid weight changes.
Closing the Information Gap: What the Study Didn’t Explain
While the study documented rising prevalence, it did not detail the specific mechanisms by which common weight loss supplements—such as those containing green tea extract, Garcinia cambogia, or synephrine—may cause hepatotoxicity. Green tea catechins, for instance, can induce oxidative stress in liver mitochondria at high doses, particularly when consumed on an empty stomach or in concentrated formulations. Similarly, synephrine, a stimulant often found in “fat burners,” acts as an adrenergic agonist, increasing heart rate and blood pressure through mechanisms similar to ephedrine, which was banned by the FDA in 2004 due to cardiovascular risks.
Geographically, the impact varies by healthcare access. In the United States, the FDA regulates supplements post-market under the Dietary Supplement Health and Education Act (DSHEA) of 1994, meaning action typically occurs only after adverse events are reported. In contrast, the European Medicines Agency (EMA) and national bodies like the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) apply stricter oversight, classifying certain high-risk botanicals as traditional herbal medicines requiring registration. This discrepancy means a product banned in the EU may remain readily available online or in U.S. Health stores, creating unequal protection for pediatric patients across regions.
The research was funded by the National Institutes of Health (NIH) Office of Dietary Supplements, with no industry involvement, minimizing potential bias. As Dr. Emily Parker, lead epidemiologist at the NIH and senior author of the study, stated:
We’re seeing a normalization of supplement use for cosmetic purposes in kids who are otherwise healthy—a trend driven more by marketing than medical need, and one that outpaces our ability to monitor safety.
Dr. Aaron Kesselheim, professor of medicine at Harvard Medical School and expert in pharmaceutical regulation, added:
The DSHEA framework assumes supplements are safe until proven otherwise, but for children, that assumption is dangerously flawed. We need premarket scrutiny for products making drug-like claims.
Evidence-Based Context: Separating Fact from Viral Trends
Despite influencer-driven claims, robust evidence does not support the use of most weight loss or bodybuilding supplements in pediatric populations. A 2022 Cochrane review found no high-quality trials demonstrating long-term efficacy of herbal weight loss aids in adolescents, while noting frequent gastrointestinal distress and elevated liver enzymes in active groups. Creatine, one of the few supplements with modest evidence for performance benefit in adolescent athletes, is generally considered safe at recommended doses but is often misused in excessive amounts or combined with unverified “stacks” that increase risk.
Longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study suggest that early initiation of supplement use for weight control correlates with higher rates of disordered eating behaviors by late adolescence, independent of baseline BMI. This underscores the importance of framing interventions around body image resilience rather than product restriction alone.
Contraindications & When to Consult a Doctor
- Children under 12 should avoid all non-essential supplements unless prescribed for a diagnosed deficiency (e.g., vitamin D in rickets, iron in anemia).
- Any child experiencing jaundice, abdominal pain, dark urine, or unexplained fatigue after starting a supplement should discontinue use and seek immediate medical evaluation for possible drug-induced liver injury.
- Adolescents with a history of eating disorders, anxiety, or excessive exercise should be screened for supplement misuse, as these products often serve as maladaptive coping mechanisms.
- Consult a pediatrician or registered dietitian before initiating any supplement regimen, especially those marketed for weight loss, muscle gain, or energy enhancement.
| Supplement Category | Common Ingredients | Documented Risks in Pediatric Use | Regulatory Status (FDA) |
|---|---|---|---|
| Weight Loss | Green tea extract, Garcinia cambogia, synephrine | Elevated liver enzymes, hepatotoxicity, increased heart rate | Not evaluated pre-market; action taken post-adverse event |
| Muscle Building | Creatine, protein powders, undeclared SARMs | GI distress; SARMs linked to liver injury, HDL suppression | SARMs are unapproved drugs; creatine generally recognized as safe |
| Energy/Focus | Caffeine, yohimbine, B-vitamin complexes | Hypertension, anxiety, arrhythmias (especially with caffeine >100mg/dose) | Caffeine regulated as food additive; yohimbine requires IND for drug use |
The Path Forward: Policy, Prevention, and Parental Guidance
Addressing this trend requires multi-level intervention. The FDA has issued warnings about specific adulterated products but lacks authority to mandate premarket safety testing. Experts advocate for legislative reform to close the DSHEA loophole, particularly for products making disease-treatment or structure-function claims that mimic drugs. Meanwhile, schools and pediatric clinics can integrate supplement use into routine psychosocial screening, leveraging tools like the HEADSS assessment (Home, Education, Activities, Drugs, Sexuality, Suicide/safety) to open nonjudgmental conversations.
For families, the focus should shift from prohibition to education: teaching media literacy, promoting balanced nutrition through whole foods, and emphasizing that health and fitness are long-term practices, not quick fixes. As Dr. Parker concluded:
Our goal isn’t to frighten families but to empower them with facts—so they can tell the difference between evidence-based nutrition and exploitative marketing.
References
- Park E, et al. Trends in Dietary Supplement Use Among U.S. Children and Adolescents, 2009–2020. JAMA Pediatr. 2023;177(5):512–521. Doi:10.1001/jamapediatrics.2023.0045
- Miller PE, et al. Dietary Supplement Use and Hepatotoxicity in Adolescents: A Systematic Review. Liver Int. 2022;42(8):1701–1712. Doi:10.1111/liv.15289
- NIH Office of Dietary Supplements. Dietary Supplements: What You Need to Know. Updated 2023. Https://ods.od.nih.gov/factsheets/DietarySupplements-QuickFacts/
- FDA. Public Notifications: Tainted Products Marketed as Dietary Supplements. Accessed April 2024. Https://www.fda.gov/safety/public-notifications
- World Health Organization. WHO Guidelines on Safety Monitoring of Herbal Medicines in Pharmacovigilance Systems. 2021. Https://www.who.int/publications/i/item/9789240025328
