In July 2017, 24-year-old mother Lucero Garza sought a natural diet pill to aid in her journey to lose weight gained after pregnancy. Without consulting a doctor, Garza bought the supplement’ Avitia Cobrax’ via Facebook. While the supplement was marketed as a natural remedy, its effects were anything but remedial. After consuming the product, Garza began experiencing severe headaches and ultimately fell into a coma. Tragically, she passed six days later.

Doctors confirmed that Garza’s health complications were, indeed, directly correlated with the weight-loss supplement she took. Garza’s story isn’t an isolated experience—in fact, dietary supplements for weight loss, muscle building, energy, and cleanse lead to over 23,000 emergency room visits per year in the U.S. alone. These products are often dangerous, widely accessible, and marketed directly to vulnerable youth.

Many of these compounds contain stimulants such as phentermine, which can raise one’s likelihood of developing high blood pressure or valvular heart disease. Products such as DNP (2,4-dinitrophenol) prevent energy from being stored as fat, increasing body temperature and damaging organs such as muscles and kidneys. Common complications associated with these chemicals include seizures, coma, bone marrow failure, or even cancer.

Furthermore, certain ingredients of these products lack proper evidence for safety or efficacy. For instance, specific chemicals marketed for athletic performance such as glutamine, choline, methoxyisoflavone, and quercetin have not been shown to improve athletic performance significantly. Over-the-counter (OTC) products are also found to contain illegal substances or compounds analogous to illegal substances. A common example found in supplements is the herb Acacia rigidula, which often contain β-methylphenylethylamine, a chemical bearing similar effects to the drug amphetamine.

Additionally, FDA laboratory analysis has confirmed that the weight loss supplement Garcinia Cambogia Premium illegally contains sibutramine, a controlled substance that was retracted from the market because of safety risks. Specifically, research demonstrated a 16 percent increase in risk of major adverse cardiovascular events in patients who utilized sibutramine compared to those who did not. Yet, this substance alone has been found in up to 85 percent in adulterated weight loss supplements.

Beyond illicit ingredients, OTCs often market false information. For example, a recently popularized OTC product is the thermogenic “fat burning” supplement. These compounds claim to accelerate fat metabolism or energy expenditure, while in effect, they overwhelm the liver and can lead to tachycardia or a heart attack.

OTCs and their ingredients can induce alarming psychological events. Adolescent and young adult women who use over-the-counter diet pills are up to 6 times more likely than their peers to be diagnosed with an eating disorder within several years. Moreover, nearly 1 in 10 adolescent girls are estimated to have used non-prescribed diet pills, laxatives, or diuretics in their lifetime. This problem could only continue to worsen, given that the Food and Drug Administration (FDA) has limited statutory authority for oversight of the weight-loss supplement industry, which is expected to be worth $21.42 billion by 2030.

Loopholes in marketing laws allow companies to spread false claims and hide harmful ingredients such as tianeptine, which possesses the same qualities as opioids. Many of these products aren’t prescribed or regulated and are, instead, sold over-the-counter at brick-and-mortar stores as well as online with little-to-no oversight. They capitalize on the insecurities of minors, despite serious risks, and are disturbingly easy to purchase in the status quo.

Today’s youth are often bombarded by the notion of the “perfect body.” Advertisements often capitalize on insecurities around body image and athletic performance, pushing messages of instant transformation and peak physical appearance. Retailers frequently use influencer endorsements and strategic language to target adolescents, capitalizing on their desire for social acceptance. Muscle-building supplements, in particular, are marketed as essential tools for achieving hyper-masculine ideals, glamorized through social media and fitness culture.

Social media only serves to exacerbate this toxic feedback loop, glamorizing muscle gains, weight-loss journeys, and filtered bodies. Celebrities and influencers alike use popular platforms like TikTok to promote diet pills and other muscle-building supplements, many of which are unregulated, as shortcuts to aesthetic goals.

Among peers, the pressure is even more palpable. A Missouri teen shared anonymously: “It’s [almost] like everyone craves the ‘after’ picture without showing the pain it takes to get there.” That pain is often internalized, and body dissatisfaction—and potentially dysmorphia—quickly becomes normalized. What originates as a seemingly harmless journey to “get in shape” can immediately spiral into a lifelong dependence on diet pills and muscle-building supplements.

STRIPED (Strategic Training Initiative for the Prevention of Eating Disorders) at the Harvard T.H. Chan School of Public Health is at the forefront of the nationwide effort to fight back. STRIPED combines research, policy advocacy, and youth engagement to challenge the normalization of these harmful products. Their efforts helped lead to the passage of New York State’s groundbreaking law, S16A/A431A, which prohibits the sale of over-the-counter diet pills and muscle-building supplements to minors. This legislation is a historic first in the U.S., setting a national precedent for prioritizing youth health over industry greed.

But STRIPED’s advocacy is bigger than one bill. It’s about shifting how we talk about health, fitness, and bodies. Now more than ever, we need youth voices at the forefront. STRIPED gives young people the tools to advocate for themselves through policy, education, and peer collaboration.

The authors, Natalie Wang, Sahana Srikanth, Gaurish Agrawal, Ketan Tamirisa, are affiliated with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) at the Harvard T.H. Chan School of Public Health, a public health initiative that leads national efforts to prevent eating disorders and address related health risks.