One Size Does Not Fit All: A Qualitative Study Exploring Unlicensed Weight Loss Drug Use In Women

The pervasive demand and desire for an ideal body evident in today’s society has led to the normalisation of beautification and enhancement treatments. Unlicensed weight loss (UWL) drugs which comprise of 2,4 dinitrophenol (DNP), sibutramine and rimonabant are just one method used in enhancing and improving the body in line with social expectations. However, previous research exploring the use of these drugs has been confined to male dominated bodybuilding communities, despite women experiencing increasing pressures to look a certain way. This doctoral research explores the use of UWL drugs by women, focusing specifically on attitudes and perceptions of UWL drug use, motivations for use, experiences of use and self-reported adverse effects. This qualitative research involved an online forum analysis. Online discussion forms (n=10) were selected based on their levels of popularity, the proportion of female users accessing them and because they contained relevant UWL drug discussion. All threads (470) relating to UWL drug discussion were downloaded and analysed using thematic analysis conducted through the software package NVivo version 10. Four forum moderators and three female UWL drug users were also recruited, with their interviews presented as case studies. Online communities can provide a raft of knowledge concerning hidden or hard to reach populations. This research however advocates for greater consideration to be given to the methodological and ethical implications of online research and reflects on what is public information, the protection of anonymity and protecting online users from harm. This research also identified that removal of a license from a drug does not prevent use, but once outside regulatory control or medical supervision, UWL drugs are often purchased online with risks to the user of potential drug interactions, adulteration and contamination. UWL drug user engagement needs to be reclaimed as part of a wider health agenda, something that has been lacking due to the unlicensed status of the drugs. However, the findings highlighted the diverse motivations for why women use UWL drugs as well as differences in experiences, drugs used, willingness to take risks and adverse effects and argues against there being a typical female UWL drug user. Given this heterogeneity, a one size fit all model for harm reduction may be ineffective. Additionally the rapid changes in online communities as well as the diffusion of these drugs into different populations creates another challenge for public health in identifying and targeting specific groups. Online discussion of these drugs focuses on user experience and anecdotal evidence. Education on the different types of drugs as well as the risks and harms of using them is therefore warranted for all online communities as well as a focus on specific harm reduction strategies including harm minimisation, engagement with health care practitioners and peer to peer education. However, further consideration is needed concerning how this information should be disseminated, identifying those who have authority within the community, but also have the appropriate credentials, knowledge, skills and desire to offer advice.