Running head: USE OF STIMULANT & WEIGHT LOSS SUPPLEMENTS
Use of Stimulant and Weight Loss Supplements in a University Sample
Sarah Pope
Northern Arizona University
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USE OF STIMULANT & WEIGHT LOSS SUPPLEMENTS
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Abstract
College students (n=235) from a Southwestern regional university were surveyed about their use
of supplements containing bitter orange, ginseng, yohimbine (yohimbe), caffeine as well as OTC
weight loss products. Participants also provided demographic information including gender,
height, weight, ethnicity, smoking status, and age. Responses to the survey were used to
determine characteristics associated with OTC stimulant and weight-loss products. No definitive
relationship between BMI score (or status) was established. A significant relationship between
gender and smoking status was observed. Further research in this area must be conducted to
establish predicable behavioral and characteristic relationships among stimulant and weight loss
supplement users.
Keywords: Supplements, college students, stimulant use, BMI
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Use of Stimulant and Weight Loss Supplements in a University Sample
Dietary supplements are a unique class of over-the-counter (OTC) products marketed and
sold for use as health enhancers. Like pharmaceuticals, supplements are designed with the intent
to be promoted as catalysts for optimal physical or psychological wellness. Non-vitamin, nonmineral supplements are marketed as anxiolytics, immune boosters, aids to weight-loss, memory
enhancers, aphrodisiacs, et cetera. However, unlike pharmaceuticals, supplements are not subject
to the kind of rigorous testing and regulation that a substance classified as a drug must undergo
to be placed on the market. The 1994 Dietary Supplement Health and Education Act (U.S. FDA,
1995) established that dietary supplements would be regulated as a food item opposed to a drug.
As a result of this act, supplement products can be sold without prior evidence of effectiveness
and are not governed by FDA provisions and requirements prior to introduction to the consumer
market. Thus, the safety, purity, and efficacy of supplements varies greatly (Allison, Fontaine,
Heshka, Mentore, & Heymsfield, 2001; Haller & Benowitz, 2000).
Despite the often suspect nature of many supplements, they are widely consumed by a
large number of individuals throughout the United States. It has been estimated that close to 160
million people living within the U.S. take some form of supplement daily (Perez, 2011). Data
from the Center for Disease Control and Prevention nutrition survey has shown an increase in
adult supplement use from 40% during 1988-1994 to 54% from 2003-2006 (Bailey, et. al.,
2010).
Commonly utilized supplements include those marketed for weight-loss and energy
enhancement. The 2001-2002 National Health and Nutrition Examination Survey reported that
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11.5% of respondents had used a non-regulated over-the-counter (OTC) product for weight loss
within the year (Pillitteri, et. al., 2008). Another survey that assessed patterns of supplement use
conducted between 1996 and1998 found that 7% of those who participated in the study had been
or were currently using a supplement product for weight reduction (Blanck, Khan, & Serdula,
2001). The prevalence of OTC supplements used to decrease weight is particularly interesting
given that demographic studies have shown that those most likely to use supplement products
tend to have Body Mass Indexes (BMIs) considered to be within the normal range (Kirk, Cade,
Barrett, & Conner, 1999; Radimer, Bindewald, Hughes, Bethane, Swanson, & Picciano, 2004).
The correlation between low to normal BMI scores and supplement use strongly suggests one of
two scenarios. First, the supplements could indeed be facilitating the reduction of previously
overweight BMI’s. Secondly (and of particular interest in this study) the continued use of these
weight-loss products despite the retention of a healthy BMI suggests a potential for product
misuse or abuse.
Populations who may be particularly vulnerable to inappropriate use of OTC products
marketed for weight loss (or stimulant supplements used for the intent of weight reduction)
include the college student demographic. Previous studies have reported rates of supplement use
higher than the national mean, among college samples (Newberry, Beerman, Duncan, McGuire,
& Hillers, 2001; Stasio, Curry, Sutton-Skinner, & Glassman, 2008). Student supplement
consumption has been reported to be as high as 74.1%, while the average for national samples is
closer to 19% (Stasio, Curry, Sutton-Skinner, & Glassman, 2008). Also, disordered eating
behaviors tend to be more prevalent among young-adults, including those who pursue advanced
education (Klemchuk, Hutchinson, & Frank, 1990). With this in mind, it is reasonable to suspect
USE OF STIMULANT & WEIGHT LOSS SUPPLEMENTS
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that supplements used to aid weight reduction may be incorporated into unhealthy body
modification behaviors.
Due to the lack of regulation imposed upon weight loss and stimulant supplements, users
may be unaware of potential safety risks and/or lack of efficacy of these products. Barron and
VanScoy (1993) reviewed a number of supplements sold between 1962 and 1992 focusing on the
type of clinical testing (if any) these products underwent before being released to the consumer
market. They found that only 42% had undergone any type of testing with results from these
studies often providing very little support for efficacy among many supplements. Other, more
recent, reviews have shown some support for many of the most commonly used supplements
(Barnes, 2003; Bent, 2008). However, many of the trials conducted for these OTC products
suffered from poor methodologies, variable preparation of these products, and often equivocal or
conflicting results. It must be noted that the lack of evidence for these products does not
inherently indicate an inability to affect physiological processes. More so, the lack of
investigation raises important questions about the potential for negative side effects resulting
from use of these untested supplements.
A number of adverse effects have been reported for many OTC products resulting from
contamination, supplement-pharmaceutical interactions, or as a result of the biological action of
the supplement itself (Barnes, 2003; Bent, 2008; Housman & Dorman, 2008). Perhaps the
supplement most notorious for its deleterious complications is the weight-loss product ephedra
(also known as Ma Huang). Reports of cardiovascular complications resulting from ephedra use
along with the clinical observance of toxicity due to many of the alkaloids found in this product
led the FDA to issue a warning against use in 2003, leading to a legal ban of ephedra in 2004
(Dhar et. al., 2005). Despite the history of cardiovascular complications associated with many
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weight-loss supplements the FDA still maintains a laizze-faire approach in regard to regulation
of supplement product safety and standardization (Heinrich, 2002). This means that any number
of complications may arise from weight-loss or stimulant OTC product use without the user
being informed of these possible effects beforehand.
Because of potentially negative consequences that may result from supplement
consumption, it is important to better understand the patterns that most often accompany weight
loss and stimulant use amongst the college demographic. The purpose of this study was to gain
insight into potential lifestyle and health patterns associated with those college students who use
stimulant and weight loss supplementation. In particular, we wanted to discover if there was a
relationship between stimulant/weight loss supplement use and BMI within the student sample.
In attempt to answer this question, this study surveyed an adult sample of undergraduate students
about their supplement use. Duration and frequency of use for many popular weight-loss and
stimulant products such as bitter orange, yohimbine and ginseng were examined and compared to
reported BMI scores.
Method
Participants
Adult college students (mean age 20.2±4.7 years) recruited from Northern Arizona
University psychology courses participated in this study. Of the 235 students who participated,
approximately 70% were female, and  95% identified as Caucasian. Involvement in this study
was completely voluntary and anonymous. Responses were not included if participants did not
agree to participate following an informed consent procedure or were not at least 18 years old.
Compensation was given in the form of extra credit for their enrolled psychology course.
Materials and Procedure
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Participants completed the survey using an online data collection system
(SurveyMonkey). All data was collected within a four-month period during the Spring semester
of 2009. After agreeing to informed consent, participants answered survey questions about their
demographic status, height, weight, and use of stimulant and weight loss supplements.
Participants were surveyed about their use of supplements containing bitter orange,
ginseng, yohimbine (yohimbe), caffeine supplements as well as OTC weight loss supplements.
All participants were debriefed after completing the survey and provided with contact
information for the Principal Investigator of the study should they have any further questions or
concerns.
Results
Survey responses were analyzed using a t-test and Pearson correlation. Analysis were
considered to be significant if the p-value was at or below the set alpha level of .05. Mean BMI
scores were compared between respondents who had used OTC stimulant products (ginseng,
yohimbine, bitter orange, OTC weight-loss products, taurine, or caffeine supplements) within the
past year and those who did not. Analysis revealed that the BMI for those who had used any of
the previously listed stimulants were slightly higher (M=24.65, SD= 4.38) than those who did
not (M=23.66, SD=5.52). However, this difference was not found to be significant t(226)=3.74
p=n.s. The prevalence of stimulant use by participant characteristics were analyzed using
Pearson chi-square test. This analysis revealed a relationship between current smoking status and
stimulant use c2(2, N=235)= 17.95 p=.00 (see figure 1) as well as gender and stimulant use c2(1,
N=235)=6.71 p=.01 (see figure 2).
Discussion
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This study attempted to determine whether there is a predictable relationship between
BMI and stimulant use. In particular, we wished to assess whether BMI status (overweight,
under weight, etc.) could be used as a predictor of stimulant use. However, this sample fails to
reveal significant differences between mean BMI. The majority of participants reported normal
BMI status (see table 1) and this trend was further demonstrated by the mean BMI scores of both
stimulant users (24.65) and non-users (23.66). This observation may be a reflection of the
general popularity of stimulant use among this college sample, the majority of respondents
(55.9%) reported use of at least one stimulant product within the past year.
Ginseng was by far the most utilized stimulant supplement, with 36.2% of respondents
reporting use of this stimulant within the year of survey participation. Ginseng was chosen as a
supplement for this survey due to the fact it is often marketed to the public as an energizing
agent. However, ginseng is advertised for a number of uses including female sexual
enhancement (Polan, Hochberg, Trant, & Wuh ,2004), to reduce stress (Norred, Zamudio, &
Palmer,2000), improve immune function (Liou, Huang, & Tseng, 2005), even to treat cancer
(Jung, et. al., 2011). The wide-spread use of products such as ginseng within this sample
suggests there may be a variety of interpretations regarding mechanism of action for these
supplements. Thus, there may be wide variation between participants in regard to reason for use,
or ascription of efficacy.
Because supplements are not required to have a validated mechanism of action, nonprescription products (like ginseng) can be marketed for any purpose. This lends to a general
confusion about how, if, or when these products should be used. Of the 85 participants who had
used ginseng, there could be 85 different reasons for use. Future research in this area might wish
to focus on assessing both psychological as well as physiological reasons for use of stimulant
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supplements. Assessment of perceived pharmacological properties would allow research to focus
on specific supplement which are known for their use as stimulant and/or weight-loss products.
These specific products could then be used to assess potential relationships between use and BMI
status.
The specific purpose of this study was to determine if there was a relationship between
stimulant use and BMI among college students. More broadly, the general goal of this study was
to determine whether certain lifestyle patterns or participant characteristics were associated with
college student use of stimulant and weight loss products. Within this focus, we were able to
determine two characteristics that were significantly related to use of the designated supplements
within this study.
Analysis revealed a relationship between gender and stimulant/weight-loss supplement
use. Specifically, it appears that a higher proportion of men use stimulant products compared to
those who identified as female (see figure 2). This observation is contrary to previous studies
which have demonstrated that use of supplements is more common among female cohorts
(Bailey, et. al., 2011; Blanck et. al, 2007; Pillitteri, et. al., 2008). However, many of the studies
that have recognized a female preference for supplement use examined a variety of supplements
opposed to stimulants in particular. The male partiality for OTC products observed in this study
is more congruent with research that has delineated characteristics of illicit stimulant users,
which have demonstrated that stimulants tend to be more often used by male college students
(Hall,Irwin, Bowman, Frankenberger, & Jewett, 2005; Low, & Gendaszek, 2002).
Another significant relationship noted within this study was that between smoking status
and stimulant use. A higher proportion of current and former smokers used stimulant products
within this sample (see figure 1). This phenomenon seems reasonable for a number of reasons.
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First, smoking is often used to augment weight loss (Bean, et. al, 2008; Grogan, Hartley, Conner,
Fry, & Gough, 2010). If the participants in this study were using the products observed here for
the purpose of weight reduction, it would be expected that other behaviors associated with
weight management (both healthy and harmful) may be reported in conjunction with stimulant
use. Also, nicotine is a known central nervous system stimulant; its use has long been associated
with the consumption of other stimulants (both illicit and legal) and is often used as a predictor
of non-nicotine stimulant abuse (Weinberger, & Sofuoglu, 2009).
Limitations and Future Directions
It should be noted that there was number of issues with the present sample. In particular,
the effect size for this study was rather small (Cramer’s V was given a value of 0.10). This
causes one to wonder whether some of the observed trends, such as a higher mean BMI score for
stimulant users, would have displayed statistical significance with an increase in power (such as
increased sample size). Also, the majority of participants were gleaned from the psychology
department of NAU, potentially biasing the sample in unforeseen ways. To increase power and
generalizability to the college population, future research should attempt to increase both the
sample size and incorporate participants with a variety of academic focuses.
As mentioned previously, the FDA does not regulate OTC supplements. As such, many
of the products marketed as stimulant or weight loss supplements are also promoted and used for
a variety of reasons unrelated to metabolic or cognitive enhancement. Potential studies would
benefit from first collecting surveys that aim to establish which supplements are most often being
used for the purpose of weight-loss or to improve performance. If these products were identified,
more information regarding participant characteristics (such as BMI status) could be acquired to
assess associations with these specific supplements.
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Although this study used BMI as a potential predictor of supplements being used to
augment body modification practices, there are a number of other characteristics associated with
attempted weight reduction. Noted here was a relationship between smoking status and
stimulant/weight loss supplement use. It was also mentioned that nicotine often accompanies
weight reduction efforts. However, there are a number of other behavioral indicators of a body
image focus, such as time spent exercising, skipping meals, or excessive thoughts about weight.
Any number of these indicators could be incorporated into further research on weight loss
practices and supplement use within the college population.
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Table 1
BMI Status of Respondents*
Underweight
BMI Category
Normal
Overweight
Obese
Stimulant User
7.32
58.54
20.33
13.82
No Use
4.85
62.14
23.31
9.71
*Value Represents % of respondents
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% Use Within Status
Figure 1
Prevalence of Stimulant Use by Smoking Status
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
use
no use
current
former
Smoking Status
never
% Use Within Gender
Figure 2
Prevalence of Stimulant Use by Gender
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
use
no use
male
female
Gender