By Jennifer Germain

Just over two years ago I began a PhD which aims to explore the use of unlicensed weight loss (UWL) drugs amongst females. Whilst I have always had a personal interest, and had researched areas around eating behaviour, body image and eating disorders, my background and knowledge of weight loss drugs and other drug use was at that point very limited. Perhaps in part due to this, I was not originally aware of the complicated and nuanced motivations for why people used UWL drugs. In hindsight, I realise that I started this research with quite a naïve and simplistic approach, which I feel had been shaped by my own experiences as a female living in an image conscious society. From a very young age, I have like most been inundated with images depicting ever-changing body trends and ideals; ranging from the voluptuous curves of Pamela Anderson, androgynous shape of Kate Moss to the current trends of the Kim Kardashian bum, thigh gap and abs crack. Being a public health researcher in the area of human enhancement of course does not make me impermeable to the feelings of inadequacy created in a society, which has such strong beauty and body ideals. However, where I needed to be wary was in the danger of allowing my own thoughts and feelings influence how and what I thought about those who are using UWL drugs. Now, further into the PhD process, although I’ll admit I am still relatively new to the world of drugs research, I have realised that the assumptions I held about those who are using weight loss drugs, many of which I didn’t even realise I had at the beginning of this process, are ultimately untrue.

Reflecting on my research process there were three assumptions that influenced my views on UWL drug use. First of all, my PhD focuses specifically on the use of UWL drugs in women as my initial assumption was that the vast majority of UWL drugs users would be female;

“Of course women are the ones taking weight loss drugs, all women want to be thin.”

I also wanted to move this area of research away from focusing on male dominated bodybuilding communities and the use of fat burner drugs such as 2,4 dinitrophenol (DNP). In order to capture information relating to the use of UWL drugs in women I conducted an online forum analysis. The analysis was aimed at specifically identifying discussions relating to those drugs. In particular I was looking for threads and posts centred on the UWL drugs DNP, Sibutramine and Rimonabant. Searches were carried out on online search engines for the name of each drug plus the word forum and the top 30 websites from each search was accessed. In order to specifically identify female forum users, (1) I used online analytical tools to identify which forums had the highest proportion of female users, (2) looked for forums with specific sub-forums aimed at women, and (3) identified forums where it was possible to identify the gender of the forum posters. During this process it was apparent that a very large proportion of online discussions relating to UWL drugs came from men or at least took place on forums that were dominated by male users. In addition, I also carried out searches on video sharing websites such as YouTube, looking for females who were posting their experiences of using UWL drugs. What my searches here found that was whilst the larger share of advertisements promoting the purchasing of UWL drugs were aimed at women, the overwhelming majority of videos discussing the use of the drugs were made by men. Of course, there could be many different reasons for this, for example women may be more reluctant than men to share that they are using UWL drugs, but regardless of this, I realised that my assumption that women would be overwhelmingly more likely to use UWL drugs was incorrect.

My second assumption was centred on the idea that women use extreme weight loss measures such as UWL drugs primarily due to social pressures;

“The pressures women face to conform to an ideal body is the main reason why women use UWL drugs.”

The analysis I have carried out of online communities does provide some evidence of this nature with some women being deeply unhappy with their bodies, comparing themselves to others and being so desperate to lose weight that they are willing to try any means with UWL drugs usually the last resort. Quotes from the analysis such as “I feel like clawing my face off when I look at myself in mirror”, “I’ve just ordered more [weight loss pills] cos I’m that desperate” and “She looks awesome. Standing next to her sucks” illustrate this point. However, it was also apparent that there are many other reasons why women are using UWL drugs. For instance, women spoke of using these drugs whilst competing in fitness or bodybuilding competitions, “I am planning to do my first bodybuilding competition and I’m looking for some advice regarding supplements”, to increase energy, “I don’t credit them for burning fat but they do have a kick”, or because they had seen a plateau in their weight loss, “The only reason I am taking them is because I have reached a plateau in my weight loss and need a little bit of a boost”. Finally, many women spoke of using UWL drugs to maintain their weight and simply saw them as just another part of their overall weight loss strategy: “Diet pills should be regarded as supplements. You should still exercise and diet alongside them”. It became abundantly clear that the motivations and reasons for why women are using UWL drugs are far more complicated than simply because of the society we live in.

My final assumption focused on the idea that women taking UWL drugs are not aware of the harms and risks of doing so;

“The drugs are being taken out of desperation, women just haven’t considered how potentially dangerous they might be.”

Again, this is an extremely simplistic view, if we think of other risky behaviours that people engage in then we know that even when people are aware of the dangers of, e.g. smoking, consuming too much alcohol or eating excessive amounts of fatty food, this doesn’t necessarily mean that they stop those behaviours. Quite often, the effect, so how good you feel engaging in that behaviour or taking that drug, completely outweighs the side effect. This was particularly apparent in my research as the majority of women who were taking UWL drugs were not doing so without any consideration of the risks or side effects, but instead are informed users making informed choices. They have done their ‘research’ and they are seeking out information about these drugs such as examining the risks and the side effects: “Have you women ever tried DNP? If so how did it feel?”, “What are the dangers associated with taking these pills?” or they have already sought out this information and are making an informed choice “I just read up on DNP…it does not sound pleasant says the angel on my left shoulder, but losing half a pound a day would be tempting says the devil on my right shoulder”.

Using online forum analysis to identify UWL discussion has enabled me to achieve an overall picture of the main attitudes, feelings and experiences related to UWL drug use. Reflexive practices of challenging my assumptions and considering the impact of my own experiences, perceptions and feelings has altered my research positionality, enabling me to have a much more complex and complete understanding of the motivations and reasoning behind UWL drug use, which I lacked at the beginning of the PhD process. Furthermore, this stage has informed the design of the subsequent stages of my PhD with my attitude shifting from a wholly preventative viewpoint of how can we stop UWL drug use to instead considering how we can learn from online communities in how best to promote and share information about safe UWL drug use. I have moved away from seeing UWL drug use as a completely negative behaviour carried out by desperate individuals to an appreciation of the many different groups and motivations for its use.

If you would like to read more about weight-loss drugs in general I recommend reading:

1. McVeigh, J., Germain, J., & van Hout, M.C. (2016). 2,4-Dinitrophenol, the inferno drug: a netnographic study of user experiences in the quest for leanness. Journal of Substance Use.
2. Petroczi, A., Vela Ocampo, J.A., Shah, I., Jenkinson, C., New, R., James, R.A., Taylor, G., & Naughton, D.P. (2015). Russian roulette with unlicensed fat-burner drug 2,4-dinitrophenol (DNP): evidence from a multidisciplinary study of the internet, bodybuilding supplements and DNP users. Substance Abuse Treatment, Prevention and Policy.
3. Hoxha, B., & Petroczi, A. (2015). Playing with fire? Factors influencing risk willingness with the unlicensed fat burner drug 2,4-Dinitrophenol (DNP) in young adults. Public Health.
4. Yen, M., & and Burns Ewald, M. (2012). Toxicity of weight loss. Journal of Medical Toxicology.