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64-563: A limited or excessive appetite is not necessarily pathological. Abnormal appetite could be defined as eating habits causing malnutrition and related conditions such as obesity and its related problems. Both genetic and environmental factors may regulate appetite, and abnormalities in either may lead to abnormal appetite. Poor appetite ( anorexia ) can have numerous causes, but may be a result of physical (infectious, autoimmune or malignant disease) or psychological (stress, mental disorders) factors. Likewise, hyperphagia (excessive eating) may be

128-466: A " toxic food environment ", where fat- and sugar-laden foods have taken precedence over healthy nutritious foods. In these developed countries, overnutrition can be prevented by choosing the right kind of food. More fast food is consumed per capita in the United States than in any other country. This mass consumption of fast food results from its affordability and accessibility. Fast food, which

192-652: A challenge by supplement maker Nutraceuticals. It is also debatable as to whether the ephedrine ban had more to do with its use as a precursor in methamphetamine manufacture rather than health concerns with the ingredient as such. Weight loss effects of water have been subject to some scientific research as a potential non-pharmacological approach. Drinking water prior to each meal may help in appetite suppression. Consumption of 500 mL (18 imp fl oz; 17 US fl oz) of water 30 minutes before meals has been correlated with modest weight loss (1–2 kg; 2.2–4.4 lb) in obese men and women over

256-651: A community. In the study by Ghattas et al. (2020), the probability of overnutrition is significantly higher in higher-income families than in disadvantaged families. High food prices is a major factor preventing low income households from getting nutritious food For example, Khan and Kraemer (2009) found that in Bangladesh , low socioeconomic status was associated with chronic malnutrition since it inhibited purchase of nutritious foods (like milk, meat, poultry, and fruits). Food shortages may also contribute to malnutritions in countries which lack technology. However, in

320-418: A global increase in food insecurity and hunger between 2011 and 2020. In 2015, 795 million people (about one in ten people on earth) had undernutrition. It is estimated that between 691 and 783 million people in the world faced hunger in 2022. According to UNICEF, 2.4 billion people were moderately or severely food insecure in 2022, 391 million more than in 2019. These increases are partially related to

384-492: A group of undernourished children in a hospital in Mexico City , Mexico. They defined three categories of malnutrition: first, second, and third degree. The degree of malnutrition is calculated based on a child's body size compared to the median weight for their age. The risk of death increases with increasing degrees of malnutrition. An adaptation of Gomez's original classification is still used today. While it provides

448-403: A lack of breastfeeding may contribute to undernourishment. Anorexia nervosa and bariatric surgery can also cause malnutrition. Undernutrition due to lack of adequate breastfeeding is associated with the deaths of an estimated one million children annually. Illegal advertising of breast-milk substitutes contributed to malnutrition and continued three decades after its 1981 prohibition under

512-422: A lack of education about proper nutrition, only having access to a single food source, or from poor healthcare access and unhealthy environments. It is not just the total amount of calories that matters but specific nutritional deficiencies such as vitamin A deficiency, iron deficiency or zinc deficiency can also increase risk of death. Overnutrition caused by overeating is also a form of malnutrition. In

576-612: A nation's development." Among those affected, very few people experience the most visible and severe effects: disabling goiters , cretinism and dwarfism . These effects occur most commonly in mountain villages. However, 16 percent of the world's people have at least mild goiter (a swollen thyroid gland in the neck)." Social conditions have a significant influence on the health of people. The social determinants of undernutrition mainly include poor education, poverty, disease burden and lack of women's empowerment. Identifying and addressing these determinants can eliminate undernutrition in

640-600: A new classification system for malnutrition. Instead of using just weight for age measurements, Waterlow's system combines weight-for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting that results from chronic malnutrition. One advantage of the Waterlow classification is that weight for height can be calculated even if a child's age is unknown. The World Health Organization frequently uses these classifications of malnutrition, with some modifications. Undernutrition weakens every part of

704-721: A perceived fault, and may be associated with depression and social isolation. Various hereditary forms of obesity have been traced to defects in hypothalamic signaling (such as the leptin receptor and the MC-4 receptor) or are still awaiting characterization – Prader-Willi syndrome  – in addition, decreased response to satiety may promote development of obesity . It has been found that ghrelin-reactive IgG immunoglobulins affect ghrelin's orexigenic response. Other than genetically stimulated appetite abnormalities, there are physiological ones that do not require genes for activation. For example, ghrelin and leptin are released from

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768-775: A period of 8 to 12 weeks. Refeeding syndrome (RFS) is a metabolic disturbance which occurs as a result of reinstitution of nutrition in people and animals who are starved , severely malnourished , or metabolically stressed because of severe illness. When too much food or liquid nutrition supplement is eaten during the initial four to seven days following a malnutrition event, the production of glycogen , fat and protein in cells may cause low serum concentrations of potassium , magnesium and phosphate . The electrolyte imbalance may cause neurologic, pulmonary, cardiac, neuromuscular, and hematologic symptoms—many of which, if severe enough, may result in death. Refeeding syndrome can occur when someone does not eat for several days at

832-410: A resistant hypothalamus and eventually almost no leptin effect. From then all ghrelin production causes insatiable appetite. Eating issues such as " picky eating " affects about 25% of children, but among children with development disorders this number may be significantly higher, which in some cases may be related to the sounds, smells, and tastes ( sensory processing disorder ). The glycemic index

896-877: A result of micronutrient deficiencies. It adversely affects physical and mental functioning, and causes changes in body composition and body cell mass. Undernutrition is a major health problem, causing the highest mortality rate in children, particularly in those under 5 years, and is responsible for long-lasting physiologic effects. It is a barrier to the complete physical and mental development of children. Undernutrition can manifest as stunting, wasting, and underweight. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernutrition can cause starvation , chronic hunger, Severe Acute Malnutrition (SAM), and/or Moderate Acute Malnutrition (MAM). The signs and symptoms of micronutrient deficiencies depend on which micronutrient

960-401: A result of hormonal imbalances, mental disorders (e.g., depression ) and others. Dyspepsia , also known as indigestion, can also affect appetite as one of its symptoms is feeling "overly full" soon after beginning a meal. Taste and smell (" dysgeusia ", bad taste) or the lack thereof may also affect appetite. Abnormal appetite may also be linked to genetics on a chromosomal scale, shown by

1024-525: A short-term basis clinically to treat obesity , some appetite suppressants are also available over-the-counter . Several appetite suppressants are based on a mix of natural ingredients, mostly using green tea as its basis, in combination with other plant extracts, such as fucoxanthin , found naturally in seaweed. Drugs of this class are frequently stimulants of the phenethylamine family, related to amphetamine . The German and Finnish militaries issued amphetamines ( Pervitin ) to soldiers commonly during

1088-412: A sustained diet that is deficient in both protein and energy. This causes their metabolism to adapt to prolong survival. The primary symptoms are severe wasting, leaving little or no edema ; minimal subcutaneous fat ; and abnormal serum albumin levels. It is traditionally seen in cases of famine , significant food restriction, or severe anorexia . Conditions are characterized by extreme wasting of

1152-438: A traditional Japanese Kampo medicine , is under preliminary research for its potential to stimulate ghrelin and appetite. Malnutrition Malnutrition occurs when an organism gets too few or too many nutrients , resulting in health problems. Specifically, it is a deficiency , excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues and form. Malnutrition

1216-437: A very dry mouth; decreased urine output and/or dark urine; increased heart rate with decreasing blood pressure; and altered mental status . Protein-calorie malnutrition can cause cognitive impairments . This most commonly occurs in people who were malnourished during a "critical period ... from the final third of gestation to the first 2 years of life". For example, in children under two years of age, iron deficiency anemia

1280-420: A way to compare malnutrition within and between populations, this classification system has been criticized for being " arbitrary " and for not considering overweight as a form of malnutrition. Also, height alone may not be the best indicator of malnutrition; children who are born prematurely may be considered short for their age even if they have good nutrition. In the 1970s, John Conrad Waterlow established

1344-523: Is sibutramine which increases serotonin and noradrenaline levels in the central nervous system , but had to be withdrawn from the market when it was shown to have an adverse cardiovascular risk profile. Similarly, the appetite suppressant rimonabant (a cannabinoid receptor antagonist) had to be withdrawn when it was linked with worsening depression and increased risk of suicide. Recent reports on recombinant PYY 3-36 suggest that this agent may contribute to weight loss by suppressing appetite. Given

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1408-430: Is a category of diseases that includes undernutrition and overnutrition . Undernutrition is a lack of nutrients, which can result in stunted growth , wasting , and underweight . A surplus of nutrients causes overnutrition, which can result in obesity . In some developing countries , overnutrition in the form of obesity is beginning to appear within the same communities as undernutrition. Most clinical studies use

1472-413: Is a mental disorder characterized as severe dietary restriction and intense fear of weight gain. Furthermore, persons with anorexia nervosa may exercise ritualistically. Individuals who have anorexia have high levels of ghrelin , a hormone that stimulates appetite, so the body is trying to cause hunger, but the urge to eat is being suppressed by the person. Binge eating disorder (commonly referred to as BED)

1536-466: Is described as eating excessively (or uncontrollably) between periodic time intervals. The risk for BED can be present in children and most commonly manifests during adulthood. Studies suggest that the heritability of BED in adults is approximately 50%. Similarly to bulimia, some people may be involved in purging and binging. They might vomit after food intake or take purgatives. Body dysmorphic disorder may involve food restriction in an attempt to deal with

1600-505: Is estimated that nearly one in three persons globally has at least one form of malnutrition: wasting , stunting , vitamin or mineral deficiency, overweight, obesity, or diet-related noncommunicable diseases. Undernutrition is more common in developing countries . Stunting is more prevalent in urban slums than in rural areas. Studies on malnutrition have the population categorised into different groups including infants, under-five children, children, adolescents, pregnant women, adults and

1664-580: Is highest among children under five. In 2021, 148.1 million children under five years old were stunted, 45 million were wasted, and 37 million were overweight or obese. The same year, an estimated 45% of deaths in children were linked to undernutrition. As of 2020 , the prevalence of wasting among children under five in South Asia was reported to be 16% moderately or severely wasted. As of 2022 , UNICEF reported this prevalence as having slightly improved, but still being at 14.8%. In Asia, India has one of

1728-534: Is lacking. However, undernourished people are often thin and short, with very poor energy levels; and swelling in the legs and abdomen is also common. People who are undernourished often get infections and frequently feel cold. Micronutrient undernutrition results from insufficient intake of vitamins and minerals. Worldwide, deficiencies in iodine , Vitamin A , and iron are the most common. Children and pregnant women in low-income countries are at especially high risk for micronutrient deficiencies. Anemia

1792-403: Is likely to affect brain function acutely, and probably also chronically. Similarly, folate deficiency has been linked to neural tube defects . Iodine deficiency is "the most common preventable cause of mental impairment worldwide." "Even moderate [iodine] deficiency, especially in pregnant women and infants , lowers intelligence by 10 to 15 I.Q. points , shaving incalculable potential off

1856-493: Is low in cost and nutrition, is high in calories. Due to increasing urbanization and automation , people are living more sedentary lifestyles. These factors combine to make weight gain difficult to avoid. Overnutrition also occurs in developing countries. It has appeared in parts of developing countries where income is on the rise. It is also a problem in countries where hunger and poverty persist. Economic development, rapid urbanisation and shifting dietary patterns have increased

1920-666: Is most commonly caused by iron deficiency , but can also result from other micronutrient deficiencies and diseases. This condition can have major health consequences. It is possible to have overnutrition simultaneously with micronutrient deficiencies; this condition is termed the double burden of malnutrition . 'Undernutrition' sometimes refers specifically to protein–energy malnutrition (PEM). This condition involves both micronutrient deficiencies and an imbalance of protein intake and energy expenditure. It differs from calorie restriction in that calorie restriction may not result in negative health effects. Hypoalimentation (underfeeding)

1984-406: Is one cause of undernutrition. Two forms of PEM are kwashiorkor and marasmus ; both commonly coexist. Kwashiorkor is primarily caused by inadequate protein intake. Its symptoms include edema , wasting, liver enlargement , hypoalbuminaemia , and steatosis ; the condition may also cause depigmentation of skin and hair. The disorder is further identified by a characteristic swelling of

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2048-474: Is thought to affect satiety ; a study investigating the effect of satiety found that a high-glycemic food, potatoes, reduced appetite more than a low glycemic index food. Mechanisms controlling appetite are a potential target for weight loss drugs. Appetite control mechanisms seem to strongly counteract undereating, whereas they appear weak to control overeating. Early anorectics (appetite suppressants) were fenfluramine and phentermine . A more recent addition

2112-602: The Second World War . Similarly, the UK military was supplied with more than 72 million Benzedrine tablets and the US military with an approximately equal amount for situations, in which fatigue was not deemed to be an acceptable option. Following the war, large amphetamine surpluses were redirected for use on the black and the civilian market. Indeed, amphetamine itself was sold commercially as an appetite suppressant until it

2176-496: The WHO International Code of Marketing Breast Milk Substitutes . Maternal malnutrition can also factor into the poor health or death of a baby. Over 800,000 neonatal deaths have occurred because of deficient growth of the fetus in the mother's womb . Deriving too much of one's diet from a single source, such as eating almost exclusively potato, maize or rice, can cause malnutrition. This may either be from

2240-446: The central nervous system or certain neurotransmitters to create a feeling of fullness or reduce the desire to eat. The understanding of anorexiant effects is crucial in the development of interventions for weight management , eating disorders, and related health concerns. The anorexiant effect can be induced through diverse mechanisms, ranging from hormonal regulation to neural signaling. Ghrelin , leptin , and peptide YY are among

2304-480: The immune system . Protein and energy undernutrition increases susceptibility to infection; so do deficiencies of specific micronutrients (including iron, zinc , and vitamins). In communities or areas that lack access to safe drinking water , these additional health risks present a critical problem. Undernutrition plays a major role in the onset of active tuberculosis . It also raises the risk of HIV transmission from mother to child, and increases replication of

2368-536: The prevalence of moderate and severe wasting could increase by 14% due to COVID-19; coupled with reductions in nutrition and health services coverage, this could result in over 128,000 additional deaths among children under 5 in 2020 alone. Although COVID-19 is less severe in children than in adults, the risk of severe disease increases with undernutrition. Other major causes of hunger include manmade conflicts, climate changes , and economic downturns. Undernutrition can occur either due to protein-energy wasting or as

2432-447: The right to food , Jean Ziegler proposes that agricultural waste , such as corn cobs and banana leaves , should be used as fuel instead of crops. In some developing countries, overnutrition (in the form of obesity) is beginning to appear in the same communities where malnutrition occurs. Overnutrition increases with urbanisation, food commercialisation and technological developments and increases physical inactivity. Variations in

2496-461: The 1950s discovery of Prader–Willi syndrome , a type of obesity caused by chromosome alterations. Additionally, anorexia nervosa and bulimia nervosa are more commonly found in females than males – thus hinting at a possibility of a linkage to the X-chromosome. Dysregulation of appetite lies at the root of anorexia nervosa , bulimia nervosa , and binge eating disorder . Anorexia nervosa

2560-511: The United States, more than half of all adults are now overweight—a condition that, like hunger, increases susceptibility to disease and disability, reduces worker productivity , and lowers life expectancy . Overeating is much more common in the United States, since most people have adequate access to food. Many parts of the world have access to a surplus of non-nutritious food. Increased sedentary lifestyles also contribute to overnutrition. Yale University psychologist Kelly Brownell calls this

2624-514: The United States: megestrol acetate - a progesterone available as an oral tablet, oxandrolone - an oral anabolic steroid , and dronabinol - THC , the principal cannabinoid in marijuana , available in an oral capsule. Ghrelin , a gut hormone recognized as affecting appetite, is under investigation. Ghrelin itself must be delivered parenterally and research has therefore focused on substances that can be taken orally. Rikkunshito,

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2688-553: The belly , and extremities which disguises the patient's undernourished condition. 'Kwashiorkor' means 'displaced child' and is derived from the Ga language of coastal Ghana in West Africa. It means "the sickness the baby gets when the next baby is born," as it often occurs when the older child is deprived of breastfeeding and weaned to a diet composed largely of carbohydrates. Marasmus (meaning 'to waste away') can result from

2752-454: The burden of overnutrition in the cities of low and middle-income countries. In China, consumption of high-fat foods has increased, while consumption of rice and other goods has decreased. Overeating leads to many diseases, such as heart disease and diabetes, that may be fatal. Anorectic An anorectic is a drug which reduces appetite , resulting in lower food consumption, leading to weight loss . These substances work by affecting

2816-528: The developing world, eighty percent of malnourished children live in countries that produce food surpluses, according to estimates from the Food and Agriculture Organization (FAO) . The economist Amartya Sen observes that, in recent decades, famine has always been a problem of food distribution , purchasing power , and/or poverty, since there has always been enough food for everyone in the world. There are also sociopolitical causes of malnutrition. For example,

2880-642: The elderly population. The use of different growth references in different studies leads to variances in the undernutrition prevalence reported in different studies. Some of the growth references used in studies include the National Center for Health Statistics (NCHS) growth charts, WHO reference 2007, Centers for Disease Control and Prevention (CDC) growth charts, National Health and Nutrition Examination Survey (NHANES), WHO reference 1995, Obesity Task Force (IOTF) criteria and Indian Academy of Pediatrics (IAP) growth charts. The prevalence of undernutrition

2944-515: The elderly, undernutrition is more commonly due to physical, psychological, and social factors, not a lack of food. Age-related reduced dietary intake due to chewing and swallowing problems, sensory decline, depression, imbalanced gut microbiome, poverty and loneliness are major contributors to undernutrition in the elderly population. Malnutrition is also attributed due to wrong diet plan adopted by people who aim to reduce their weight without medical practitioners or nutritionist advice. There has been

3008-567: The epidemic proportions of obesity in the Western world and the fact that it is increasing rapidly in some poorer countries, observers expect developments in this area to snowball in the near future. Weight loss or loss of appetite (" cachexia ") is an effect of some diseases, and a side effect of some prescription drugs . Stimulants such as methylphenidate commonly reduce appetite in patients, and have been prescribed off-label for weight loss. Three agents are approved for appetite stimulation in

3072-698: The health status of individuals in the same society are associated with the societal structure and an individual's socioeconomic status which leads to income inequality, racism, educational differences and lack of opportunities. Infectious diseases which increase nutrient requirements, such as gastroenteritis , pneumonia , malaria , and measles , can cause malnutrition. So can some chronic illnesses, especially HIV/AIDS . Malnutrition can also result from abnormal nutrient loss due to diarrhea or chronic small bowel illnesses, like Crohn's disease or untreated coeliac disease . "Secondary malnutrition" can result from increased energy expenditure. In infants,

3136-635: The highest burden of wasting with over 20% wasted children. However, the burden of undernutrition among under-five children in African countries is much higher. A pooled analysis of the prevalence of chronic undernutrition among under-five children in East Africa was identified to be 33.3%. This prevalence of undernutrition among under-five children ranged from 21.9% in Kenya to 53% in Burundi. In Tanzania,

3200-527: The hormones involved in appetite control. Additionally, neurotransmitters such as serotonin and dopamine in the central nervous system contribute significantly to the regulation of food intake. By contrast, an appetite stimulant is referred to as orexigenic . The term is (from the Greek ἀν- an- ' without ' and ὄρεξις órexis ' appetite ' ), and such drugs are also known as anorexigenic , anorexiant , or appetite suppressant . Used on

3264-423: The immediate risk factors has become a major health priority. The recent evidence on the impact of diet-induced obesity in fathers and mothers around the time of conception is identified to negatively program the health outcomes of multiple generations. According to UNICEF, at least 1 in every 10 children under five is overweight in 33 countries. In 1956, Gómez and Galvan studied factors associated with death in

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3328-430: The long term. Identification of the social conditions that causes malnutrition in children under five has received significant research attention as it is a major public health problem. Undernutrition most commonly results from a lack of access to high-quality, nutritious food. The household income is a socio-economic variable that influences the access to nutritious food and the probability of under and overnutrition in

3392-482: The muscles and a gaunt expression. Excessive consumption of energy-dense foods and drinks and limited physical activity causes overnutrition. It causes overweight, defined as a body mass index (BMI) of 25 or more, and can lead to obesity (a BMI of 30 or more). Obesity has become a major health issue worldwide. Overnutrition is linked to chronic non-communicable diseases like diabetes , certain cancers, and cardiovascular diseases . Hence identifying and addressing

3456-471: The ongoing COVID-19 pandemic , which continues to highlight the weaknesses of current food and health systems. It has contributed to food insecurity , increasing hunger worldwide; meanwhile, lower physical activity during lockdowns has contributed to increases in overweight and obesity. In 2020, experts estimated that by the end of the year, the pandemic could have double the number of people at risk of suffering acute hunger. Similarly, experts estimated that

3520-602: The population of a community might be at increased risk for malnutrition if government is poor and the area lacks health-related services. On a smaller scale, certain households or individuals may be at an even higher risk due to differences in income levels , access to land, or levels of education. Community plays a crucial role in addressing the social causes of malnutrition. For example, communities with high social support and knowledge sharing about social protection programs can enable better public service demands. Better public service demands and social protection programs minimise

3584-566: The prevalence of stunting, among children under five varied from 41% in lowland and 64.5% in highland areas. Undernutrition by underweight and wasting was 11.5% and 2.5% in lowland and 22.% and 1.4% in the highland areas of Tanzania respectively. In South Sudan, the prevalence of undernutrition explained by stunting, underweight and wasting in under-five children were 23.8%, 4.8% and 2.3% respectively. In 28 countries, at least 30% of children were still affected by stunting in 2022. Vitamin A deficiency affects one third of children under age 5 around

3648-455: The risk of malnutrition in these communities. It is argued that commodity speculators are increasing the cost of food. As the real-estate bubble in the United States was collapsing, it is said that trillions of dollars moved to invest in food and primary commodities, causing the 2007–2008 food price crisis . The use of biofuels as a replacement for traditional fuels raises the price of food. The United Nations special rapporteur on

3712-399: The stomach and adipose cells , respectively, into the blood stream. Ghrelin stimulates feelings of hunger, whereas leptin stimulates feelings of satisfaction from food. Any changes in normal production levels of these two hormones can lead to obesity. The amount of leptin hormone production is stimulated by body fat percentage. When body fat accumulates there is overproduction of leptin causing

3776-690: The term 'malnutrition' to refer to undernutrition. However, the use of 'malnutrition' instead of 'undernutrition' makes it impossible to distinguish between undernutrition and overnutrition, a less acknowledged form of malnutrition. Accordingly, a 2019 report by The Lancet Commission suggested expanding the definition of malnutrition to include "all its forms, including obesity, undernutrition, and other dietary risks." The World Health Organization and The Lancet Commission have also identified "[t]he double burden of malnutrition", which occurs from "the coexistence of overnutrition (overweight and obesity) alongside undernutrition (stunted growth and wasting)." It

3840-844: The virus . Undernutrition can cause vitamin-deficiency-related diseases like scurvy and rickets . As undernutrition worsens, those affected have less energy and experience impairment in brain functions. This can make it difficult (or impossible) for them to perform the tasks needed to acquire food, earn an income, or gain an education. Undernutrition can also cause acute problems, like hypoglycemia (low blood sugar ). This condition can cause lethargy, limpness, seizures , and loss of consciousness . Children are particularly at risk and can become hypoglycemic after 4 to 6 hours without food. Dehydration can also occur in malnourished people, and can be life-threatening, especially in babies and small children. There are many different signs of dehydration in undernourished people. These can include sunken eyes;

3904-420: The world – 42% – were unable to afford a healthy diet in 2021. Certain groups have higher rates of undernutrition, including elderly people and women (in particular while pregnant or breastfeeding children under five years of age). Undernutrition is an increasing health problem in people aged over 65 years, even in developed countries, especially among nursing home residents and in acute care hospitals. In

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3968-472: The world, leading to 670,000 deaths and 250,000–500,000 cases of blindness . Vitamin A supplementation has been shown to reduce all-cause mortality by 12 to 24%. As of June 2021, 1.9 billion adults were overweight or obese, and 462 million adults were underweight. Globally, two billion people had iodine deficiency in 2017. In 2020, 900 million women and children had anemia, which is often caused by iron deficiency.  More than 3.1 billion people in

4032-406: Was outlawed in most parts of the world in the late 1950s because of safety issues. Many amphetamines produce side effects, including addiction , tachycardia and hypertension , making prolonged unsupervised use dangerous. Epidemics of fatal pulmonary hypertension and heart valve damage associated with pharmaceutical anorectic agents have led to the withdrawal of products from the market. This

4096-503: Was the case with aminorex in the 1960s, and again in the 1990s with fenfluramine ( see: Fen-phen ). Likewise, association of the related appetite suppressant phenylpropanolamine with hemorrhagic stroke led the Food and Drug Administration (FDA) to request its withdrawal from the market in the United States in 2000, and similar concerns regarding ephedrine resulted in an FDA ban on its inclusion in dietary supplements in 2004. A Federal judge later overturned this ban in 2005 during

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