Elaine Gormley was desperate when she turned to slimming pills. She had been obese since childhood, but lost a significant amount of weight by going to Slimming World classes in her early 20s. But by 2012, following a breakup and an operation, the 29-year-old from Belleek in County Fermanagh had gained all 10 stone 6lb of it back. She now weighed 21 stone 5lb.

“I lost my focus. I felt I was unloved,” she says. “A friend said to me that his sister had tried these pills called Dexaprine. She got them on the internet. I said I would give them a go. I heard she was getting massive results.”

Having ordered the pills from Amazon, she started having unpleasant side effects almost immediately. “Within minutes I was beginning to get really, really hot sweats,” she says. “I wasn’t even moving, and the sweat was lashing off me. But at the same time I felt really cold, and my heart was beginning to beat so hard. By the time I got to work, my hands were shaking.”

She tolerated the side effects for three days, weighing herself on the third day. She had lost 8lb. “I thought, ‘This is the miracle that I have been waiting for.’ But then on the fourth day, I took the tablet and my chest started to really ache. I thought I was going to have a heart attack. I had no choice but to stick my fingers down my throat to force myself to be sick – to get the tablet out.”

Gormley told her mother, who threw the pills away. She was lucky. Dexaprine is a potent thermogenic fat-burning dietary supplement, which has since been banned in the UK and the Netherlands. It contains the amphetamine derivative DMAA (1,3-dimethylamylamine), which has been linked to psychiatric disorders, heart attacks and strokes. In 2012, it was implicated in the death of 30-year-old London marathon runner Claire Squires, who collapsed a mile from the finish line. In 2014, Dutch scientists announced that they had found a “cocktail of synthetic stimulants” in the supplement.

When it comes to losing weight, most of us know the only real way to do it is a sustained period of healthy eating and exercise, requiring hard work and patience. But every year, thousands of people buy illegal slimming pills on the internet, enticed by miracle claims of rapid weight loss. One in three slimmers have purchased pills online, according to the joint #FakeMeds survey by the Medicines and Healthcare Products Regulatory Agency (MHRA) and Slimming World. “You just don’t know what you are putting in your body,” warns Danny Lee-Frost, head of enforcement at the MHRA. Many slimming pills have an amphetamine-like effect, and will increase your heart rate. “If there’s a weakness in your heart, you’re in trouble. If you don’t know about it, you will once you start taking them.”

Everything I read linked obesity to every cancer you could imagine. It frightened me into thinking I had to do something

The desperation to lose weight can cause otherwise sensible people to be reckless: four out of 10 survey respondents said they used slimming pills knowing there were health risks. Others are taken in by slick websites and promises of “natural” ingredients.

This is what happened to Sue Golder, 51, a hairdresser from Hatfield in Hertfordshire. She had been overweight when she was young, later compounded by three pregnancies and a hectic family life, but it was only after she lost her husband that she felt compelled to do something drastic. “Everything I read and saw on TV said obesity was linked to every cancer you could imagine. It frightened me into thinking, ‘You’ve got to do something, you’ve only got yourself here for the kids now,” she says.

“I’d been to my doctors. I had sat in tears and asked for help. They had been helpful, just said, ‘You need to exercise more and eat less,’ but it wasn’t the quick fix that I wanted. I Googled “diet pills”, and loads of sites came up. And the one that I was drawn to showed a doctor with a stethoscope around his neck. I thought, ‘That might be all right.’ I didn’t know that people could set up all these fake websites. I looked through it and there was this questionnaire. It looked official. It was so easy to order them on my credit card.”

Golder took the pills for three weeks before a terrifying episode made her stop. “I was here on my own – the children were all at school. I just felt awful – it came over me like a wave. I thought I was going to be sick. My legs were shaking, I could see all these silver dots flying around my head and I was thinking, ‘Oh my God, I’m going to die. My kids are going to find me dead on the floor.’”

The pills that Golder took were Reductil, which contained the now-prohibited substance sibutramine. In 2010 a large clinical trial, the Sibutramine Cardiovascular Outcomes study, found that the cardiovascular risks of sibutramine outweighed its benefits. Although banned throughout the EU, it is still available widely online, and there have been numerous reports of disturbing side effects. In 2012 an Irish teenager developed ischaemic colitis, a severe swelling of blood vessels supplying the intestines, after taking pills containing the substance.

Sibutramine poses a serious threat, Lee-Frost says. “Reductil was a big blockbuster, sold all over the world. Very popular, and then reports came in of unforeseen incidents. Strokes and heart attacks. Eventually it was pulled. You will still find [sibutramine] on the internet, being churned out. It comes out of factories in China. It shouldn’t be sold – it’s an unlicensed product.”

He explains that, although some pills will openly contain sibutramine – an infamous version coming out of China has a blister pack in the shape of a woman’s hourglass figure and lists sibutramine as an ingredient – others don’t mention it at all. “You have pills, capsules and tablets that say they are natural, safe, herbal. But when we have them analysed they contain more sibutramine than the original withdrawn Reductil did.” Aduki diet pills, which claim to be completely natural, are one dangerous example. More than 28,000 of them were seized in a Manchester raid in 2016.

Facebook Twitter Pinterest Josh Hewitt: ‘You see girls saying they suffer from body confidence issues, but as a guy you bottle it in.’ Photograph: Rob Durston/The Guardian

Lee-Frost says Instagram influencers are compounding the problem by promoting their own toned bodies and aspirational lifestyles, and the diet pills to go with them. Instead of glossy magazines, now it is “real people” who are telling us that we all have the potential to look like models (though they all have retouching apps on their phones, and can remove swaths of underarm flab with the swipe of a fingertip).

Women have been subjected to the pressure to conform to the “perfect” body type for decades, but it is increasingly affecting men, too. A university friend of mine, who preferred not to be named, took various internet-bought diet pills along with her boyfriend, who was just as preoccupied with having a slim, toned physique as she was. They both worked at a clothes shop and were recommended them by male models who worked there.

In 2017, 24-year-old Liam Willis died in Swansea after taking diet pills containing 2,4-dinitrophenol (DNP), which speeds up the metabolism to a dangerously fast level. Two years before, pills containing DNP had been blamed for the death of Eloise Parry, 21, from Shrewsbury. The dealer who sold those pills was later jailed for seven years. The same chemical also killed schoolboy rugby star Chris Mapletoft, 18, in 2013. “This was never about rugby. It was never about sport. I think it was all about the six-pack,” his mother, Lesley, told the BBC after his inquest. “A parent should never have to bury their child, not over something like this.”

Pills are not packed in spotless labs. ‘On one raid, we found six blokes living in one room, with one toilet. It stank’

Thankfully, Josh Hewitt, 20, from Richhill in County Armagh, stopped taking the pills he bought on eBay before they could do serious harm, but they did have a detrimental effect on his mental health, making him feel paranoid and anxious (some diet pills have been linked to psychotic episodes). They also made him put on weight. The aspiring vlogger points to the role that social networks played in his decision to use them. “There are pressures that come from online,” he says. “People look for likes, and want to look the best for photos.”

Hewitt had always had a weight problem and suffered low self-esteem, but never confided in anyone. “You see girls on TV saying they suffer from body confidence issues, but as a guy you bottle it in. You don’t want someone to think less of you, what you’re going through. It’s a big issue for men.”

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What can be done to curb the market? Thousands of unlicensed pills are coming into the UK, distributed by people several steps removed from the manufacturers in Asia. Some are Britons paid to “work from home” and sign for the packages of drugs; other distributors are here illegally. Though Lee-Frost compares the crackdown to playing a game of “whack-a-mole”, the MHRA has seized nearly £4m-worth of weight loss pills since April 2013. It works on the basis of referrals from GPs, test purchases, package tracing and tip-offs from Border Force and the Royal Mail. As far as pills containing DNP are concerned, the Food Standards Agency, which is responsible for policing pills that do not claim to be medicines, made only three seizures between December 2014 and August 2017, according to a freedom of information request. The FSA did not respond to the Guardian’s request for comment. The pills remain easy to buy online.

When the MHRA raids premises alongside the police, the scenes it encounters can be deeply unpleasant: these pills are not being packed in spotless white labs. “There is cigarette ash everywhere, a bottle of Johnnie Walker there, half a kebab there; on the table the blister packs are all loose… They don’t care,” says Lee-Frost. “We turned up one morning, on an immigration raid in west London. [The immigration raid team had called the MHRA once they saw the pills.] There were six blokes living in one room with a double bed. It stank. There was one toilet and it was disgusting. I didn’t want to touch it with gloves on.”

If more people knew about the conditions in which these pills were being stored, they might be less likely to buy them. One thing is clear: focusing only on the side effects, even when they can kill you, isn’t enough of a deterrent.

Facebook Twitter Pinterest Sue Golder: ‘I could see silver dots flying around my head.’ Photograph: Richard Saker/The Guardian

“I knew there were risks, but it was more important to me to be skinny at that time,” my university friend tells me. “There were loads of things I have done that weren’t particularly healthy, but when you’re younger, any health problems seem so far away. It’s only now that I actually think, ‘Oh God, I have to start being healthy.’ Ten years ago, this immediate thing was a lot more important to me.”

She describes herself as having been “obsessive” about being thin. “If you’re a young person who has an unhealthy relationship with food anyway, and you’re not following normal standards of eating, there is no way you are going to get put off by pills. It was a risk I was willing to take.” In other words, being thin was more important to her than anything else.

Another woman, who worked in PR for the pharmaceuticals industry and asked not to be named, shared her experience of working to promote a leading legal diet pill. “One big memory is sitting in a focus group watching 10 women discuss their experiences of a rival leading pill. All of them happily offered up the worst places they’d shat themselves – at the supermarket, at a dinner party, at work. Such was their belief it would help them lose weight, they carried on, using sanitary towels for the diarrhoea, and generally living on their nerves. They were all completely relaxed talking about it to each other, as a necessary burden of being an overweight woman.”

She believes what she witnessed says a lot about the stigma of obesity. “The only conclusion I can draw is that being overweight is seen as worse than shitting yourself. In the groups, they would talk about feeling invisible, ugly, disgusting, old, ‘not me’ and insist on how slim they were when they were younger. This was a momentary aberration and they were postponing their happiness until they corrected it.”

Almost all the diet pill users I spoke to mentioned their very low self-esteem, whether they were overweight or not (my university friend wasn’t). Many felt isolated and were dealing with feelings of shame that prevented them from confiding in others. We need, the psychotherapist Susie Orbach says, to “diversify the damn aesthetic”. Society’s perception of physical beauty – male and female – is still so one-note. “Body positive” campaigners are working to change this, but there is still a long way to go.

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“How to stop these pills being attractive?” asks Orbach. “There’s the rub. It isn’t one thing, it’s systemic, which means we need to help parents and educators relax about food and bodies so their preoccupations don’t become their children’s addictions. We need to challenge the narrowness of the government’s ludicrous obesity policy. We need to prosecute [slimming pill] companies for false advertising. We need to show bodies moving and active at all sizes, as the Sport England This Girl Can advert did. We need to start to question the narrow aesthetic and the notion that body is all.”

Golder and Gormley eventually lost their weight healthily, thanks to Slimming World. Hewitt is eating a more balanced diet and taking his dog for more walks. The promise of a miracle transformation didn’t work for them. They were lucky to stop before anything worse could happen to them, but their cases illustrate just how little consumers know about the tablets they are buying. The MHRA encourages people to use its free search function to check that suppliers are licensed. Had Golder used that, she would never have bought those pills. “It’s taken me years to realise it but there is no quick fix,” she says. “Nothing is worth losing your life.”

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