Symptoms of acute 2,4-dinitrophenol DNP poisoning include fever, dehydration, nausea, vomiting, restlessness, flushed skin and a rapid heartbeat. These can quickly progress to coma and death. Even after prolonged and seemingly uneventful use, this toxicity can develop, says the National Poisons Information Service NPIS , and anyone with symptoms needs to be referred straight to hospital for treatment. According to guidelines on TOXBASE, the clinical toxicology database of the NPIS available to NHS healthcare professionals, those handling emergency cases are advised to quickly introduce cooling measures, fluid resuscitation and sedation to increase the likelihood of recovery.
Additional guidance includes ensuring that the patient has a clear airway, and regularly monitoring temperature, pulse and blood pressure. Agitation can be treated with sedation and patients should be observed for at least 12 hours after consuming the drug. Resources are available for any pharmacist looking to find out more about DNP, says Thomas. Weight loss services should be promoted in every pharmacy, just as smoking cessation should be, and it should be an NHS service.
More broadly, suggests Sudhir Sehrawat, a member of the RPS Welsh Pharmacy Board, pharmacies could, and should, offer a safe space where patients can come and discuss how to lose weight. Sudhir Sehrawat, a member of the Royal Pharmaceutical Society Welsh Pharmacy Board, says that pharmacies could, and should, offer a safe space where patients can come and discuss how to lose weight.
That sentiment is echoed by Soni. But pharmacies are accessible too. J Med Toxicol ;7 3 — Access provided by. DNP: the dangerous diet pill pharmacists should know about As concerns over deaths related to the diet pill 2,4-dinitrophenol DNP increase, healthcare professionals — including pharmacists — are being called on to play their part in raising awareness and preventing DNP-related harm.
Calls for tighter control The case brought the dangers of DNP hurtling into public awareness. Why is DNP available in any shape or form? Source: Simon Thomas Simon Thomas, national clinical lead at the National Poisons Information Service, says the difference between the DNP dose required for weight loss and that associated with fatality is relatively small.
Source: Chloe Adams Chloe Adams, policy officer at the British Dietetic Association, says that DNP is now widely available to purchase from the internet through websites which appear to be legitimate. Many companies sell it illegally online and target bodybuilders or people looking to lose weight without dieting. Healthy, safe, and effective weight loss requires consistent changes to your diet and exercise habits over months and years. This simple 3-step plan can help you lose weight fast. Read about the 3-step plan, along with other science-backed weight loss tips, here.
Some foods can reduce appetite, cravings and help you burn more calories. These are the 19 most weight loss friendly foods on the planet.
Concerned about meth withdrawal? In the last 18 months telemedicine has been used for much more than simple check-ins with the primary care physician, it's now being used to help with…. An expert breaks down the many factors that contributed to the current overdose crisis and what it will take to break the trend.
Harm reduction is more than a "common sense" approach. It's a movement designed to protect the health, safety, and agency of people who use drugs. Caffeine is found in many migraine drugs, but too much caffeine can also be a trigger. How is this possible? Health Conditions Discover Plan Connect. Medically reviewed by Alan Carter, Pharm. Furthermore, preliminary results, with regard to 2,4-dinitrophenol DNP—used as fat burner weight-loss product , suggest that willingness is inversely related with the severity of the health consequences As such, willingness to take risks with DNP despite health warnings appears to be influenced more by the desired goal the magnitude of weight people wished to lose and having past experience with similar products than general risk-taking propensity or other psychosocial factors.
Due to the market increase via the internet, cases of 2,4-DNP misuse are being seen globally in countries such as America, England, and China 20 , The FSA has had to communicate repeatedly to publicly raise awareness about the potentially lethal and permanent effects of 2,4-DNP, in an attempt to combat the rising health complications and deaths caused by the drug by reducing those interested in the drug, alongside warning the current users.
This has contributed to an increasing number of mortalities caused by 2,4-DNP 5 , 37 , 39 , 44 — It is also important to note that although isolated cases of treatments for 2,4-DNP overdoses have been reported with varying degrees of effectiveness [see 47 ], there is to date no established cure or treatment for a 2,4-DNP overdose.
Looking forward, the future of 2,4-DNP as a pharmaceutical drug is not inconceivable. Although the use of 2,4-DNP is controversial, there might be a use for 2,4-DNP for treating extremely overweight or morbidly obese individuals in a clinically controlled environment.
The benefits in entertaining such hypothetical case are twofold: 2,4-DNP is an effective compound for weight loss and its use under a controlled clinical setting would require appropriate understanding of the unique toxicity profile of 2,4-DNP and training for clinical staff.
The latter then would carry over to successfully treating accidental overdose and preventing tragic deaths. Media reports and medical case studies fail to portray how 2,4-DNP users feel and think about the drug. With a few exceptions [e. One concern around the re-emerged 2,4-DNP is that despite official warnings and media reports, 2,4-DNP is continuing to show activity within the weight-loss community and it seems to be increasing in popularity. One plausible approach to mitigate risks against the unintended overdose is to produce 2,4-DNP as a weight-loss drug again to ensure quality control and safety of this—otherwise still dangerous—drug.
This controversial proposition could be rationalized on the premise that regulating production and distribution, while still making the drug available, could reduce harm from questionable quality and uncertainty around concentration.
Equally, it can be argued that this approach would still be too dangerous, and instead regulatory efforts should focus on improving control over the illegal supply.
Often, successful health education for prevention and harm reduction requires taking a holistic approach and addressing the problem in a broader context. In the present study, the key research question is not restricted to 2,4-DNP specifically, but rather, 2,4-DNP is used as a controversial example. Thus, using a hypothetical scenario, in this study we set out to explore whether producing the drug with proper quality control and advice on safe use would 1 increase willingness to use and 2 reduce harm from 2,4-DNP and investigated what factors people would consider important in buying 2,4-DNP if it would be a licensed pharmaceutical drug.
Alongside this, we also investigated whether demographic details age, gender, educational level and health condition disordered eating influence the importance of these factors. This will give an indication of who may be at a higher risk of purchasing unsafe weight-loss substances such as 2,4-DNP. Based on the exploratory nature of the research questions, a sequential mixed method design 50 was used within the current study. Specifically, the research undertook two phases: first, we conducted two focus group interviews which served as an elicitation for the survey content, followed by a quantitative survey.
Focus groups concentrated on the factors young people would consider before buying weight-loss supplements and drugs, such as 2,4-DNP. The results from the elicitation phase contributed toward a self-reported survey which was composed of 31 closed questions and investigated what factors would be considered most or least important in the possible scenario of 2,4-DNP as a licensed weight-loss drug.
Participation in the study was voluntary and anonymous. Participants were fully informed about the aim of the study and conditions of participation. Focus group participants also gave written informed consent to the use of their demographic information such as age and gender, purpose for weight loss and past experience with weight-loss products—with anonymity preserved—for scientific purposes and academic dissemination.
Participants received no compensation. Following institutional ethical approval, convenience sampling was used to recruit in person university students between 18 and 30 years of age via personal networks.
The focus groups contained six females and three males with a mean age of In the focus groups, only two participants had previously used weight-loss substances both of which were female and with their main concern being appearance see Table 1.
The age distribution in the first focus group was slightly more spread ranging from 20 to 25 years than in the second group age range of 19—21 years. Both groups were mixed in terms of gender and involvement in sport and exercise but only the first group included participants with the experience of using a weight-loss product. Participants were informed about the purpose of the study, the voluntary nature of participation, and the confidential nature of the focus groups.
Focus groups lasted between 30 and 45 minutes were audiorecorded and transcribed verbatim by the first author. Semi-structured focus groups were used to collect information on topics surrounding weight-loss drugs and substances in terms of possible benefits, negatives, outcomes and specifically the factors considered when buying weight-loss drugs such as 2,4-DNP.
Based on recommendations within the literature 51 , each focus group consisted of four to five participants. Participants were asked to consider the scenario of 2,4-DNP as a possible weight-loss drug and what factors they or others may consider before buying the products. The focus group interview matrix, alongside the questions, is presented in Presentation S2 in Supplementary Material. Focus group transcripts were analysed using a thematic analysis.
Data were then analysed via a process of line-by-line coding to allow themes i. Once identified, themes were labelled and grouped together to create higher-order themes. Finally, the data were revisited to ensure that each theme was appropriately represented. Following the second focus group, a satisfactory level of saturation regarding important attributes of 2,4-DNP was reached.
In line with the qualitative phase, individuals over 18 years of age were recruited for the survey phase using convenience and snowballing sampling techniques. The questionnaire was made available online using a closed survey platform SurveyMonkey and as a hard paper copy.
The content of the two surveys was identical. This allowed participants to be recruited online via social media and in person. In this method, multiple options are provided in several iterations but only the best and the worst option are selected in each case.
This method is a multiple-choice extension of the paired comparison method, which is scale-free and forces participants to make a selective choice among the issues under consideration For example, when having an ethically produced premium quality product at a low price is not possible, customers must make a choice of which attribute is more important to them e. Similarly, an ideal weight-loss product would be highly effective but also pleasant and free of side effects but this may not be possible in real life.
In the current study, the BWS was formed around the 16 factors produced from the two focus groups see Table 2. In the questionnaire, each attribute appears five times.
In this survey, the BWS was embedded in a hypothetical scenario. The scenario provided a brief background of 2,4-DNP and its current use in society alongside its potential dangers.
The hypothetical situation specified that a pharmaceutical company is considering reintroducing 2,4-DNP on the weight-loss drug market and want to explore what customers think about 2,4-DNP using a market survey. Participants are asked to place themselves as a participant in this market research and to consider what factors they felt were most or least important.
Table 2. Themes, theme explanations, and supporting evidence for the factors considered when buying weight-loss drugs such as 2,4-DNP. EAT is an established screening measure not a diagnostic tool to determine a possible eating disorder or a person who may be at risk. Section C of the test comprises six questions: 1 Gone on eating binges where you feel that you may not be able to stop?
Defined as eating much more than most people would under the same circumstances and feeling that eating is out of control. The EAT, both the belief section and the behavioural aspects, is one of the most widely used screening tools for identifying high-risk individuals for referral to clinical evaluation, consistently showing good psychometric properties 56 , It has been noted that beliefs manifest to a larger extent than behavioural symptoms, suggesting that beliefs are the precursors for developing disordered eating 58 , Those who report behavioural symptoms respond to the belief items congruently, but the opposite is not necessarily the case i.
Satisfaction with weight was recorded with three progressive questions. In case the answer was yes to the weight-loss goal, the main reason behind this goal was further explored.
To facilitate statistical analysis, closed question format questions with pre-set answers were used e. Demographic information we collected included age, gender, ethnicity, employment status, and highest completed education level. Tech, Undergraduate level 4, Undergraduate level 5, Degree, Postgraduate, and other. Finally, employment status was split into five categories: unemployed, student, part-time, full-time, or other.
Following the selection count method [e. Previously, Marley and Louviere 64 showed that this simple calculation is a close and suitable approximation of the true scale values obtainable from multinomial logit analyses. The aggregated BWS scores for the 16 attributes for the sample were obtained by calculating the average time that each attribute was mentioned.
Focus group interviews yielded 16 themes which reflected the characteristics and factors considered when buying weight-loss drugs such as 2,4-DNP. Themes, theme explanations, and supporting evidence are presented in Table 2. The themes on drug characteristics were used as attributes for the BWS in the survey.
It is important to note that despite an agreement in relation to the importance of drug characteristics, participants did not always agree on how important each attribute was or the reasons why they felt it was important. For instance, participants agreed that the cost of a drug such as 2,4-DNP was important but some participants felt that a high price point would prevent or discourage them from buying it.
By contrast, other participants felt that the price would not prevent them from buying the drug and that they may actually choose a more expensive option, if they believed it would be more effective.
The following quote captures these contracting views surrounding the importance of cost:. Focus Group 1—M1. In addition to cost, participants also differed in their views regarding the preferred administration i.
The following quote from a year-old female illustrates this point:. Focus Group 2—F2. Building on this point, although the majority of participants preferred taking drugs orally via pills or shakes , some participants felt that injecting drugs were favourable especially if it resulted in a reduced dosage.
As one participant explained:. The mean age of the sample was For this reason, age groups were divided as 18—25 and over Sixty-five percent of the participants were students. The relative importance of the 16 attributes for 2,4-DNP as a hypothetical weight-loss drug is depicted in Figure 2 depicting the average times an attribute was selected as most and least important and Table 3 summarising the outcome of the item count methods.
Stratified analyses of the average times an attribute was selected as most and least by age group, gender, and at risk for disordered eating status are shown in Table 4. Figure 2. Aggregated Best—Worst Scale scores. Dark blue, median score; light blue, mean score; error bars represent standard deviation. Attributes on the x -axis are 1 long-term side effects, 2 effectiveness, 3 short-term side effects, 4 legality, 5 interactions with other substances, 6 reviews and experiences of others, 7 cost, 8 treatment, 9 degree of lifestyle change required, 10 specificity, 11 accessibility, 12 adherence required, 13 dosage, 14 formulation, 15 storage and preparation, and 16 branding.
Table 3. Attribute Best—Worst Scale counts, interval scale difference scores, and pseudo- ratio scale. Table 4. Based on the survey results, the most important attributes for such a drug were long-term side effects, followed by effectiveness and short-term side effects, with branding, formulation, and route of administration formulation being the least important.
Table 4 and Figure 3 offer a more detailed analysis of the BWS choices. Taken together, the results indicated that across both gender age groups, the highest scoring factor was long-term side effects LT side effects and the lowest scoring factor was branding. The female group ages 18—25 also rated short-term side effects as important. Both younger age groups and females over 25 selected effectiveness as an important factor and storage and preparation as unimportant.
The older age groups and females between 18 and 25 years of age ranked form as unimportant. The older age groups showed a higher concern in terms of legality, in comparison to 18—25 males and females. These are marked in Table 4 , along with the corresponding test statistics. Figure 3. In stratified analysis by reasons for weight loss, the data showed a statistically significant difference in ranking dosage and long-term side effects between those who were satisfied with weight and those who were not.
Alongside this, there was a significant difference in long-term side effect ranks between those who want to lose weight and those that do not.
To the investigators, these results looked like a real game-changer in the fight against obesity, so the drug was introduced to the pharmaceutical market.
Unfortunately for these patients, the rapid generation of heat internally generated by DNP also resulted in a few other adverse effects AEs on the body. For those patients who did not die, they either went blind, lost their sense of taste, or experienced an unpleasant rash. Due to the sheer number of deaths of patients who were prescribed DNP, in addition to the other common and horrific AEs DNP provided, the drug was banned in the United States in and declared unfit for human consumption.
However, the memory of the hope that DNP provided to solve weight loss problems was not lost from social consciousness. Today, those looking to keep slim still consume this drug to reach their weight loss goals, however illegal the drug may be.
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