The search for the “perfect body” can cause mental and physical harm
Severe risks to physical and mental health – including addiction, psychotic episodes, stomach ailments and eating disorders – are the dangerous side-effects of society’s obsession with the “perfect body”, leading to rising incidences of abuse of weight-loss drugs.
South African healthcare professionals have raised the alarm on the long-term health impacts of misuse of weight-loss drugs, taken in higher than recommended doses or used without a prescription and proper medical care for planned weight loss.
With almost half (45.3%) of South Africans over the age of 15 being “highly dissatisfied” with their body size,[i] the risk of abuse of weight-loss medications is likely to be high, said Dr Kate Mawson, member of the South African Society of Psychiatrists (SASOP).
She said pervasive images of idealised beauty and social expectations to look a certain way played a role in people taking the use of weight-loss drugs too far, to the level of abuse, and has impacts on their physical and mental health.
“Some people, especially adolescents, young women, certain athletes and models, are under enormous pressure to be thin. This may lead to trying different substances, medications, diets or behaviours to lose weight. If these behaviours become a habit, then an eating disorder may result,” she said.
Dr Mawson said misuse of prescription weight-loss medications, over-the-counter and so-called “herbal” weight-loss products, and off-label use of medications for other conditions, all held the risk of various side-effects ranging from nausea, diarrhoea, other gastro-intestinal illnesses, and increased risk of heart disease, to insomnia, hallucinations, mood swings and heightened anxiety.
It is estimated that as many as 15% of South Africans struggle with drug addiction.[ii] Although the extent of addiction to prescription drugs, vs illegal substances, is not known, up to 7% of rehab admissions in SA are for prescription drug abuse.[iii]
Globally, almost 1 in 10 teenagers report using non-prescribed or medically unapproved weight-loss products, despite them being largely ineffective and potentially harmful.[iv]
A further problem is use of medications for other conditions, such as ADHD for their untested off-label side effects of appetite suppression and weight loss.
“Just because a product promising weight loss is freely available over the counter at a pharmacy or health store does not necessarily mean it is safe, especially when used outside of the recommended dose or method.”
“The same goes for weight-loss medication prescribed by a doctor, or prescription medication obtained illicitly. If used beyond the recommended dosage or without the guidance of a health professional on a planned weight-loss programme, there are risks of long-lasting adverse physical and mental health impacts that far outweigh the benefit of losing a few kilograms,” Dr Mawson said.
She said that misuse of weight-loss drugs could point to an underlying eating disorder that needs professional treatment, or the misuse of the drugs could in turn lead to an eating disorder, in either case “causing severe mental and physical suffering”.
“Many of these medications are ineffective as weight-loss agents and may prevent you from seeking safe and approved care for weight issues.
“People may already have other mental health issues which underlie their desire to lose weight, such as an eating disorder, a mood disorder or a substance problem. Misuse of weight-loss medications may exacerbate the problem or get in the way of them seeking effective mental health care and treatment for the underlying condition, with severe impacts on their overall health,” she said.
Some eating disorders carry very high physical risks for those who develop them and are also associated with substantial psychological suffering and social dysfunction.
“These are serious illnesses and should always be taken seriously – there is good evidence to show that the sooner a person gets help for the problem, the better their chance of having a full recovery,” Dr Mawson said.
She advises that those who are concerned that their use of weight-loss drugs has become problematic, need help with dealing with their body image or feel their weight concerns are heading towards an eating disorder – or those who are worried about a friend relative – should seek help from a general practitioner, local clinic or social worker.
“Your GP or local clinic doctor can evaluate your physical health, advise on healthy and sustainable weight loss, or refer you to a mental health specialist for further evaluation and treatment.”
The South African Depression and Anxiety Group (SADAG) has support groups for various mental health challenges, including substance abuse and eating disorders. Contact their 24-hour toll-free helpline on 0800 567 567 or visit www.sadag.org
[i] Mchiza, Z.J., Parker, Wa., Makoae, M. et al. Body image and weight control in South Africans 15 years or older: SANHANES-1. BMC Public Health 15, 992 (2015). https://doi.org/10.1186/s12889-015-2324-y
[ii] https://www.wits.ac.za/ccdu/stepping-stones-to-wellness/substance-abuse/
[iii] SA Community Epidemiology Network on Drug Use (SACENDU). Research Update, January - June 2023.
https://www.samrc.ac.za/sites/default/files/attachments/2024-03/SACENDUupdatePhase54.pdf
[iv] Hall NY, Hetti Pathirannahalage DM, Mihalopoulos C, Austin SB, Le L. Global Prevalence of Adolescent Use of Nonprescription Weight-Loss Products: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(1):e2350940. doi:10.1001/jamanetworkopen.2023.50940
