Perils of diet pills within a body-conscious society

Two-thirds of Americans are overweight or obese, yet they live in a culture that glorifies thinness. From actors to models, athletes to adolescents, millions of Americans are preoccupied with making their bodies slim and fit.

Enter the fad diets, the quick weight-loss fasts, and the multibillion-dollar diet-supplement industry. Some promise body perfection, a diet miracle in a pill that can slim you down in a matter of weeks.

But since the death on Monday of Baltimore Orioles pitcher Steve Bechler, who had reportedly taken the weight loss supplement Xenadrine RFA-1, the quick-weight loss industry is coming under new scrutiny.

Experts say many diet pills are much more dangerous than consumers realize. As a result, advocacy groups are calling for stricter regulation of the industry - and reviving the enduring debate over a nation that obsesses so much over image and inseams.

"We're a fat society that doesn't want to work hard to lose weight, so we turn toward easy solutions and one of those is taking a pill," says Michael Shlipak of the San Francisco Veterans Affairs Medical Center.

Ephedra, the all-natural stimulant contained in Xenadrine and dozens of other supplements is, generating the most controversy. The FDA is investigating whether it played a role in Mr. Bechler's death, and suggestions that it be banned are coming from Congress and the sports pages. It's already barred in the NFL and collegiate and Olympic sport.

But health experts caution that the whole diet supplement industry can be risky because oversight is so spotty: Unless a supplement is proven to be unsafe, it isn't regulated by the Food and Drug Administration (FDA.) As a result, the quality as well as the dosage can differ dramatically from one product to the next, leaving consumers to play a kind of Russian roulette with their health.

"We've moved to a pre-FDA era with these products," says Dr. Brian Strom of the University of Pennsylvania. "People are fooled into thinking because it's natural, it's safe, when in fact, because it's natural, it's unsafe in this case. It's chopped-up plants."

Defenders of the diet supplement industry, and ephedra in particular, contend the products have been proven to be safe when used as directed. Shane Freedman, the general counsel for Cytodine, the New Jersey company that manufactures Xenadrine RFA-1, says that seven clinical studies have verified ephedra's safety and effectiveness.

He also notes that a toxicology report on what was in Belcher's system at the time of his death will not be available for another two weeks. "It's unfair to draw any conclusions now," says Mr. Freedman. "The science shows that it's safe when used as directed."

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