Adding 20% Tax Would Curb Abuse Of OTC Drugs For Trimming Pounds, Research Suggests

National Eating Disorders Association-funded study projects tax would reduce purchases 10.3% for households with female children and 5.2% for all families. “Abuse of widely available, over-the-counter drugs and supplements such as diet pills, laxatives and diuretics by adolescents for weight control is well documented, yet manufacturers and retailers can sell them to minors without restriction,” says study author Bryn Austin of Harvard Medical School.

Researchers suggest that adding a 20% excise or sales tax on some OTC drugs and other consumer health products would curb misuse of the products as weight loss aids, particularly by teens, and reduce purchases 17.5% by families with children between the ages of 12 and 17.

A study partially funded by the National Eating Disorders Association and published in the journal Preventative Medicine says a tax would reduce purchases by 10.3% for households with female children and by 5.2% for all families with children.

“Abuse of widely available, over-the-counter drugs and supplements such as diet pills, laxatives and diuretics by adolescents for weight control is well documented, yet manufacturers and retailers can sell them to minors without restriction,” said study author Bryn Austin, a pediatrics professor at Harvard Medical School and Boston Children’s Hospital and director of Harvard's Strategic Training Initiative for the Prevention of Eating Disorders.

Across the US, around 4% of consumers have abused laxatives such as colon cleanses, detox supplements and diuretics as weight loss aids. – National Eating Disorders Association-funded study

The study employed standard simulation methods economists use to estimate the impact of a tax on purchase of products. Austin, who received a NEDA research grant in 2015, says that across the US, laxatives such as colon cleanses, detox supplements and diuretics are “commonly abused” as weight loss aids, estimating 4% of consumers have abused the products.

Austin and her colleagues noted research showing an estimated 21% of women and 10% of men in the US have used weight loss supplements, and women 18 to 34 years old have the highest prevalence of past-year use at 17%. Laxatives, including colon cleanse/detox supplements and diuretics are commonly abused in weight control attempts.

“Among people with bulimia nervosa or other similar eating disorders, lifetime estimates of abuse of laxatives for weight control have ranged from 15% to as much as 62%,” Austin said. She noted a 2010 study of US adults found 1.9% of women and 1.4% of men reported using diuretics as a weight loss method.

Taxation, Austin said, “may be an effective public health strategy to reduce purchasing of potentially dangerous OTC drugs and supplements sold for weight loss, especially for households that include children ages 12-17 years” or who have a daughter in the residence.

Taxation also could raise revenue for government agencies to sponsor public health initiatives and promote healthy strategies for weight maintenance, the researchers said.

In a NEDA release, CEO Claire Mysko said the research "shows that there are clear steps we can take to improve the health and wellbeing of our kids." The association considers diet pills and weight loss supplements dangerous and linked to "the epidemic rates of eating disorders we’re seeing among young people.”

One-Third Of Supplement-Related ER Visits

Austin noted that a recent Centers for Disease Control and Prevention study estimated that nearly 23,000 US emergency room visits annually can be attributed to dietary supplements, with one-third of the adverse events attributable to supplements sold for weight loss.

In the US, the only OTC drug FDA has approved for a weight loss indication is orlistat in a 60-mg dose, available from GlaxoSmithKline PLC as alli. Launched in the US in 2007 with substantial marketing and advertising following its approval as an Rx-to-OTC switch and later in Europe, alli has not been a consumer health sales driver for GSK due to the gastrointestinal side effects of orlistat and the firm has attempted more than once to divest the brand. (Also see "Alli Labels In U.S. Add Seizure Advisory Similar To E.U. Change" - Pink Sheet, 23 Jul, 2014.)

Weight loss is not an approved health claim for dietary supplements available in the US, though many products are marketed with labeling and advertising claims for their use as beneficial for shedding pounds. FDA enforcement against violative supplements indicated for weight loss typically targets products found to contain drug ingredients, while fraudulent ad claims for the products are commonly investigated by the Federal Trade Commission.

The study, which also had support from the Ellen Feldberg Gordon Challenge Fund for Eating Disorders Prevention Research and the Harvard Strategic Training Initiative, did not recommend whether local or state governments should levy a tax on the products or whether it should be imposed by Congress.

The Consumer Healthcare Products Association disagrees with the recommendation and points out it conducts ongoing programs to prevent misuse of OTC drugs and supplements.

"While we sympathize with the National Eating Disorders Association’s goals to work with people affected by eating disorders, we strongly disagree with their policy conclusions. It is very important to address misuse while also ensuring that consumers who need and properly use these products continue to have access to them. Taxation is a very blunt instrument that harms the vast majority of consumers and is a bad strategy to target the minority of people who misuse products," said CHPA in a statement to the Pink Sheet.”

The Council for Responsible Nutrition also disagrees with the researchers' recommendation and says their findings are inaccurate.

"Additional taxation of any legitimate product, whether it is a food, OTC, or a dietary supplement, would not solve the problems described in the proposal," said Mike Greene, CRN's senior vice president, government relations, said in a statement.

"These well-meaning advocates repeatedly argue that eating disorders and body dysmorphia concerns may arise from the use or abuse of legal dietary supplements and other products. This assertion is not based in fact. CRN is not aware of any scientific evidence to prove causation or effect between eating disorders and the responsible use of dietary supplements,” Greene said.     

2012 Data From 60,500 Households

Austin and her colleagues analyzed data from 60,538 US households contacted in a 2012 study to determine annual quantities and expenditures on OTC drugs or dietary supplements making “weight-loss, cleanse/detox, or diuretic” claims. The sales analyzed were aggregated from all purchases recorded by scans of universal product codes for each household in 2012.

The researchers created an additional database documenting health-related claims for products on packaging and advertising and tallied annual quantities and expenditures on all supplement products bearing claims in weight loss, cleansing/detox and diuretic. They estimated reduction percentages in household purchases with a simulated 20% added tax and price elasticity using the Quadratic Almost Ideal Demand System frequently used by economists to study consumer behavior. The researchers found cleanse/detox and weight loss products were “price inelastic,” meaning a tax on those items would have relatively little influence on overall purchasing behavior but nonetheless would be effective in raising revenue.

A tax on diuretic supplements, however, would result in a greater decrease in purchases of those products. Researchers have highlighted concerns over teen access to weight-loss and body-building supplements over the past couple years.

In Massachusetts, concern regarding eating disorders and body image prompted a state lawmaker to introduce legislation to age-restrict sales of dietary supplements promoted for strength-training, body-building and weight-loss to consumers over 18. The bill failed to move this year but is likely to re-emerge in the state's next session and similar bills are expected in other states. (Also see "Massachusetts Bid Stalls To Age-Restrict Sales Of Bodybuilding, Weight Loss Supplements" - HBW Insight, 10 May, 2018.)

Imposing or increasing a tax to curb use of a consumer product due to public health concerns most often is associated with cigarettes and other tobacco products. However, study results remain inconclusive about whether adult smokers generally are motivated to quit when local, state or federal taxes are increased on the products they use. A common recommendation from researchers is that with increases in cigarette taxes associated with small decreases in consumption, a sizable tax increase, as much as 100%, is needed to substantially decrease adult smoking.