Despite warnings, health food stores recommend over-the-counter dietary supplements to minors

The American Academy of Pediatrics recommends against using body-shaping supplements -- supplements are unregulated by the US Food & Drug Administration -- for males and females under age 18. Despite the adults-only labeling, it is legal for minors to buy these products in 49 states.

Results of recent studies led by senior investigator Ruth Milanaik, DO, in which testers identifying themselves as 15-year-old boys and girls called 244 health food stores in 49 states (both independently owned and large-chain retailers) will be the focus of three presentations Sunday at the Pediatric Academic Societies meeting in San Diego.

All three studies were conducted by Alexis E Tchaconas, BA; and college students Laura A Fletcher and Maguire Herriman. They were overseen by Andrew Adesman, MD, and Dr. Milanaik, both of Cohen Children's Medical Center in New Hyde Park, NY.

Dr. Milanaik said previous studies have shown the high prevalence of minors using these products -- both athletes and non-athletes. It is the responsibility of all who are in a position to educate minors regarding supplement usage to be knowledgeable of the risks, she said.

Teenagers dealing with negative body images are increasingly turning to over-the-counter supplements, despite recommendations from the American Academy of Pediatrics to avoid such products, Dr. Milanaik said. . She warned that health food store supplements are not always healthy, and health food store attendants are not always "experts" when selling well-known "fat burning" thermogenic products (such as Hydroxycut,and Shredzm), testosterone boosters, or products containing creatine.

Despite many testosterone boosters bearing warnings such as "for adult use only," the team found that 41 percent of sales attendants told callers identifying themselves as 15-year-olds they could purchase a testosterone booster on their own. The findings are reported in a study entitled Over-the-Counter Testosterone Boosters and Underage Teens: Easy Access and Misinformation Provided by National Retailers.

Although testosterone boosters are specifically not recommended for children under age 18 unless for documented medical reasons, 9.8 percent of sales attendants recommended a testosterone booster, the study showed.

"Adolescents are being enticed by flashy advertisements and promises of quick, body-shaping results," Dr, Milanaik said. "In this body-conscious world, flashy advertising of `safe, quick and easy body shaping results' are very tempting to younger individuals trying to achieve 'the perfect body.' It is important for pediatricians, parents, coaches and mentors to stress that healthy eating habits, sleep and daily exercise should be the recipe for a healthy body."

"Health food stores that advertise that their employees are 'trained experts' need to re-educate their employees and reinforce that these products are not recommended for minors," Dr. Milanaik.

Despite the AAP's statement that the use of weight-loss supplements is unhealthy for minors, sales attendants at health food stores frequently recommend these products to underage female teens looking to lose weight, according to the third study: Weight Loss and Underage Teens: Supplement Recommendations from National Retailers

Dr. Milanaik said that all of the research drives home the fact that parents and teens should not assume that products coming from health food or vitamin stores are safe or recommended for minors.

"Health food stores need to focus not only on knowing what products to recommend," said Laura Fletcher, one of the principal investigators, "but often more importantly, what products not to recommend for customers of certain ages and conditions."

The products in the study, Hydroxycut, Shredz and testosterone boosters, often carry specific warnings that state "for adult-use only," Dr. Milanaik said. These warnings reflect research that has previously documented adverse health effects for growing minors.

"In the instance where warnings are clearly printed on supplement bottles," Ms. Fletcher said, "sales attendants must be aware of the dangers associated with underage use. The goal of ridding adolescents of body image-related insecurity in a healthy, supportive and medically-approved environment needs to be prioritized."

Health food store supplements do not always equal healthy, and health food store attendants are not always "experts," Dr. Milanaik added.