The Truth Behind Weight Loss Pills

© Lauren Nicole - Getty Images From health shop supplements to black market slimming pills, we lift the lid on weight loss pills.

Body transformation programmes sound impressive on paper, but the reality – sweaty gym kit, unidentifiable Tupperware stains and DOMS for days – is anything but. Getting into shape is a painstaking process at times. And when you reach a plateau, or if you simply aren't getting the results as quickly as expected, it's tempting to invest in a little external help.

This is where weight loss pills come in, promising to supercharge your efforts and do the heavy lifting for you (metaphorically speaking). Burning fat and shedding pounds while you're sat at your desk sounds too good to be true, but you're already doing the work. And you can buy them at the same store that sells your protein powder. If they weren't safe or effective, retailers wouldn't bother selling them. They wouldn't be allowed. Right?

We look across the weight loss supplements you find in health shops, the anti-obesity drugs prescribed by your GP, and the black market products pushed by unregulated websites to unearth answers to some key questions: are any weight loss pills safe to use? How do they actually work? And, crucially, what's in them?

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The Truth Behind Weight Loss Pills

Drug companies have been producing weight loss pills since the late 1800s. Known simply as 'fat reducers', they were made predominantly from a metabolism-boosting thyroid extract. Then came the invention of 2,4-Dinitrophenol or DNP in the 1930s; an industrial pesticide that still claims lives today – effectively boiling its victims from the inside-out – despite being banned for human consumption. By the 1950s, amphetamines (yes, speed) were the diet pill du jour. A toxic but entirely legal combination of speed, meth, and dextroamphetamine called Obetrol became hugely popular among dieters. There was just one problem: the comedown.

The solution came in the form of rainbow diet pills. Brightly coloured tablets that combined amphetamines, diuretics, laxatives and thyroid hormones with a concoction of benzodiazepines, barbiturates, steroid hormones and antidepressants to suppress the insomnia and anxiety caused by the former. A large investigation by the US Food and Drug Administration saw many of them withdrawn in the 1960s after they were found to be associated with severe adverse side effects such as cardiac arrests, addiction and even death, explains Rick Miller, principal dietitian at King Edward VII's Hospital.

"Up until this time, access to these medications were quite limited to those given out by doctors to patients," he says. "However, a boom from the 1970s until present has seen a rise in over-the-counter dietary supplements, including weight loss and fat-burner supplements, with many containing similar compounds or chemical derivatives to those withdrawn due to their ill-effects... It appears that the mistakes of the past may not have been learnt."

Today, weight loss pills can be split into three categories: 'medical devices' i.e. the weight loss supplements you find in health chains and gyms that tend to have words like 'fat-binder', and 'carb-blocker' plastered all over them. Then there are food supplements, which usually aim to suppress your appetite with caffeine or caffeine derivatives such as green coffee extract, guarana and cocoa bean extract. Finally, there are pharmaceutical drugs, for example, anti-obesity medication issued by a doctor on prescription, or lower-dose pills that can be bought over the counter after a consultation with a pharmacist.

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Where anti-obesity medication is prescribed to people with a BMI of 28 or over – or a BMI of over 27 with a weight-related health condition that would benefit from weight loss – says James O'Loan, consultant pharmacist at Doctor4U, medical devices and food supplements can be bought from high street health shops without advice from a medical professional. "The term 'diet pills' can be used to describe both medical treatments and supplements but is a slight misnomer in the fact that 'diet pills' don't affect your actual diet, but usually affect your appetite or the way food is digested in your body," he explains.

The pharmaceutical drug Mysimba, for example, "works on a part of the brain that controls food intake and energy expenditure, ultimately reducing your appetite and controlling food cravings," O'Loan says, while Saxenda – a daily injection licensed for weight loss in the UK – "works by mimicking a hormone that's usually released after we've eaten, therefore helping to reduce appetite as the body thinks that it's already digested food."

Others prevent you from absorbing fat from the foods you eat. Orlistat "works by blocking around a third of fat from food from being digested by your body," O'Loan says, "it doesn't suppress your appetite but it reduces the amount of fat that would normally get digested". When taken under the right circumstances, all of these drugs are safe and legal, though, it has to be said, not without side effects – especially if misused.

"Many people think that by taking more than the stated dose, they can lose weight faster, but most of the time, this isn't the case," continues O'Loan. "Overdosing on diet pills increases the risk of adverse effects but won't increase your weight loss. It's also easy to fall into a trap of skipping meals or eating an unsustainable diet when using weight loss medicine, but they always work best when used in conjunction with a healthy, balanced diet and exercise."

© Getty Slim man measuring his waist. Healthy lifestyle, body slimming, weight loss concept. Cares about body. The Murky World of Medical Devices

The world of weight loss pills becomes murkier still when they're categorised as medical devices. The umbrella term refers to any product that diagnoses, prevents, or treats an ailment without using "pharmacological, immunological or metabolic means" alone to achieve it – eye drops and throat lozenges, for example. Weight loss pills that swell your stomach with fibre to make you 'full' come under this umbrella, as do carb-blockers, which stop carbohydrates being broken down into sugars, and fat-binders, which dissolve into a gel in your stomach and stick to food fats to prevent your gut absorbing them.

Medical devices are currently assessed and categorised according to European Union (EU) legislation. The government's Medicines and Healthcare products Regulatory Agency (MHRA) will take on the task in the event of a no-deal Brexit. They aren't subject to the same rules as pharmaceutical drugs, which are trialled on hundreds and hundreds of (willing) patients before they can make their way onto shelves. Nor do they have to adhere to detailed food supplement requirements, which are liable for scrutiny under the Food Safety Act.

Online Safety

When it comes to questionable weight loss pills, high-street medical devices are the tip of the iceberg. The real danger lies in the illicit online trade, a hotbed of untested, restricted, illegal and fake pills. The MHRA has seized more than £5 million worth of dodgy weight loss pills over the past six years – types of which have been linked to 16 deaths, it told the BBC – with products found "stored in dirty, rat-infested warehouses and garden sheds". Many contained sibutramine, which was banned by Europe and the US in 2010 after a clinical trial linked the drug to an increased risk of heart attack and stroke.

And yet, despite the obvious dangers that come with ordering weight loss pills from a mysterious online vendor, one third of people trying to lose weight have done so, according to a 2017 survey by the MHRA and Slimming World. Worryingly, 63 per cent endured unpleasant side effects spanning diarrhoea, bleeding that wouldn't stop, blurred vision and heart problems. Four out of five didn't report their symptoms to anyone.

© FotografiaBasica - Getty Images The Truth Behind Weight-loss Pills Dicing with Death

Frightening they may be, but such side effects are, unfortunately, the least of their worries. "There have been increasing reports of death in people who consume unregulated diet supplements bought online in recent years, and this doesn't appear to be slowing down," observes Arti Dhokia, specialist mental health dietician at The Priory's Woodbourne Hospital in Birmingham, who notes a rise in weight loss pills marketed for their 'metabolism-boosting' properties. "Our metabolism works at a rate that is safe," she continues, "an increase may result in weight loss, but it can lead to numerous health complications, including cardiac issues and potentially death."

In pursuit of a svelte body, dieters are dicing with death – and among those unfortunate enough to prematurely meet their maker, their final few hours are agonising. One of the most prolific weight loss pills, DNP, hospitalised 20 people and killed six in 2018, according to the UK National Poisons Information Service (NPIS). When ingested, the toxic capsules turn the energy from fats and carbohydrates into heat. It doesn't take much to take your body temperature to dangerous levels, and there is no antidote or ice bath that can reverse it. One man who overdosed on DNP, which is classified as an explosive under the UK's 2014 Explosives Act, is said to have "literally cooked to death" as his temperature soared to 43.3.

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The dangers aren't limited to banned substances. In the wrong hands, the star of your morning brew can become lethal. In 2015, Chris Wilcock from Lancashire died from caffeine toxicity after taking 'T-5' weight-loss pills that were found to contain the equivalent of 300 cups of coffee. Capsaicin, found in cayenne pepper, synephrine from bitter orange peel, and the amino acids L-carnitine and L-tyrosine are all popular 'natural' ingredients found in weight loss pills that are potentially extremely dangerous in high doses. When you buy from an online vendor, there's no way to know whether their claims match the content of the capsules you receive in the post.

In fact, expecting the correct dosage is pretty generous. Who's to say the pills even contain the right ingredients? When the MHRA seized more than 28,000 Aduki Diet pills from a Manchester warehouse in 2016, lab tests revealed they contained the banned substance sibutramine – despite being advertised as made with 'natural ingredients' online. "Those involved in the illegal supply of medicines aren't interested in your health, they are only interested in your money," warned MHRA head of enforcement, Alastair Jeffrey, after the raid. "Please think carefully before purchasing medical products from internet sites as you have no idea where they have come from or what they might contain."

© BSIP/UIG - Getty Images The Truth Behind Weight-loss Pills

Even if unregulated weight loss pills do contain the correct ingredients in the quantities they claim online – and, by some miracle, they initially appear to work as advertised – they're still unlikely to be the belt-cinching saviour you want them to be. For some, they may even inadvertently bring about the very opposite intended effect, The Priory's Dhokia points out, if you treat them as a green light to ditch the gym and gorge on junk food.

Moreover, weight loss pills don't address the root problem. They just drain your bank account, your health, and your sanity. "Our relationship with food is a complex one," Dhokia continues. "How we feel about the food we choose and how we feel after eating is heavily linked to our own body image, self-esteem and self-worth. Taking diet pills can damage our relationship with food, as calories become the enemy, instead of what we use to fuel ourselves."

As a nation, we've lost the ability to eat intuitively, Dhokia continues. "We no longer listen to what our body needs but nourish ourselves based on what we're told we need," she says. "If we categorise food into good foods and bad foods, how does this affect how we feel after eating them? Guilt that comes from being unable to eat 'as we should' at all times and to meet our body image ideals, can lead to a more chaotic relationship with food, affecting physiological, psychological and social health."

What's the Answer?

If weight loss pills aren't the answer, what is? The reality isn't quick or easy. It doesn't involve turbo-charging your metabolism, interfering with the way your gut processes fats and carbohydrates, or tricking your stomach into thinking you've eaten a full meal. In truth, the only 'one weird weight-loss product doctors hate' are the counterfeit capsules filled with industrial powders by some cowboy dealer in a grimy bedsit who wants to make a quick buck capitalising on your insecurities.

The answer, as ever, is a healthy, balanced diet and regular exercise. It's a reasonable daily calorie deficit. It's taking the stairs rather than the lift and making dinner at home instead of ordering a takeaway. It's putting your health first and your weight second. Your life quite literally depends on it.

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