During the pandemic, consumers showed concerns surrounding weight gain and disease spread, both of which are suspected to have contributed to an increase in consumption of dietary supplements in the United States, wrote researchers from Boston Children's Hospital and Harvard.
“Prior to the onset of the Covid-19 pandemic, individuals with higher weights had an increased risk of weight-loss supplement use, and perceived weight discrimination was a motivator for higher-weight individuals to avoid medical care and perhaps seek out alternative forms of perceived health-promoting behaviors, such as the use of dietary supplements,” the researchers added.
“There is a possibility that the Covid-19 pandemic may have exacerbated pre-existing experiences of weight-related discrimination among higher-weight adults, placing them at an elevated risk of potentially harmful supplement use.”
Correlation versus causation
The aims of this study were to estimate weight status-related inequities in prevalence of use and change in use of potentially harmful supplements (i.e., weight-loss, cleanse/detox, immunity, and energy supplements) over time in the first year of the Covid-19 pandemic among cisgender women. It also sought to evaluate how the relationship between body size (i.e., weight status) and dietary supplement use differs across weight-related discrimination experiences.
The researchers used longitudinal data from 51,814 cisgender women in the US Covid-19 Pandemic Substudy of the Nurses’ Health Study II and 3 and Growing Up Today Study cohorts, collected from April/May 2020 to April 2021.
Body mass index (BMI) was used to determine weight status categories, and researchers assessed weight discrimination from the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy and 22.6% for immune.
“Participants with higher weight statuses were statistically significantly more likely to report prevalent use of these supplement types,” the researchers wrote. “Having a higher BMI pre-pandemic was statistically significantly positively associated with new onset use of weight-loss.”
New onset use of supplements at baseline (i.e., current use among those with no pre-pandemic use) was 0.5–0.6% for each of weight-loss, cleanse/detox, and energy supplements and 6.5% for immune supplements. Nearly one-tenth of participants reported experiencing weight discrimination (7.8%), the researchers wrote.
“We found that higher weight status and experiencing weight discrimination, independently, were associated with prevalent and new onset use of weight-loss and energy supplements during the Covid-19 pandemic,” the researchers wrote.
“Additionally, weight discrimination moderated associations between weight status and prevalent weight-loss and energy supplement use for women in the 25–29.9 kg/m2 and 30–34.9 kg/m2 weight status ranges, indicating that weight discrimination operates differently across weight status groups and is disproportionately harmful for those living in larger bodies.”
They added: “This is the first known study to examine use of potentially harmful dietary supplements and associations with weight discrimination during the Covid-19 pandemic and highlights the elevated health risks that people with higher weights may face as a result of greater societal weight stigma and ensuing discrimination, as well as exposure to deceptive and potentially dangerous dietary supplements.”
Steve Mister, president and CEO at the Council for Responsible Nutrition, said he finds this study to be “interesting academic research” but that it doesn’t have a lot of practical value for the real world.
“I'm concerned that this kind of research will be used to suggest that dietary supplements are the cause of other problems, and they certainly are not simply because they are in an association relationship with [weight discrimination],” Mister said. "Also, why was immunity thrown into this [study]? It’s something that does not have any direct relationship to weight unless it was used to skew the results. There's no causal connection between any of this data.”
The researchers acknowledged there were some limitations to their study.
“The study sample is not representative of the U.S. population, as participants of the Covid-19 Substudy were drawn from NHSII, NHS3, and GUTS cohorts, which consists of respondents who were nurses or the children of nurses at the time of enrollment. Subsequently, the analytic sample of this study was majority non-Hispanic White and from a middle or higher socioeconomic background than the general population, limiting the generalizability,” they wrote.
However, they doubled down on their message that there is not enough oversight by the federal government to regulate supplements that might be of harm to women and those trying to lose weight.
“There is an urgent need for public health and government intervention against the dietary supplements industry and its inequitable impacts on marginalized populations, such as increased regulation of gendered supplement marketing, as well as policy efforts to reduce weight-based discrimination,” the researchers added.
Source: Social Science & Medicine
Volume 335, October 2023, 116232, doi: 10.1016/j.socscimed.2023.116232
“Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States”
Authors: A. Raffoul et al.