28 Don't harm your body just to change its appearance

36 studies taken together. The people with anorexia nervosa had been followed for 166642 person-years in all (the years each person was followed, added up). Their standardized mortality ratio was 5.86, that is, the chance of death is about 5.9 times that of people the same age. There were 5.1 deaths per 1000 person-years, which means 5.1 deaths if 1000 people are followed for 1 year. About 1/5 of the people who died died by suicide. The standardized mortality ratio for bulimia was 1.93, and for other eating disorders it was 1.92, about 1.9 times people the same age in each case. Another study, in 44 secondary schools in Victoria, Australia, followed students aged 14 to 15 for 3 years, and the same students were checked across 6 rounds. New eating disorders in girls were 21.8 per 1000 person-years, that is, 21.8 new cases if 1000 girls are followed for 1 year. Girls who dieted severely had 18 times the risk of girls who did not diet. Girls who dieted moderately had 5 times the risk. After a further adjustment for past dieting and psychiatric symptoms, taking out the effect of having dieted before and of already having psychiatric symptoms, BMI (body mass index, weight divided by height squared), amount of exercise, and sex no longer predicted a new eating disorder. The authors' conclusion was that "among adolescents, controlling weight with exercise rather than restricting food seems to carry a lower risk of an eating disorder."

Article 2 of the “Administrative Measures for Medical Aesthetic Services” defines medical aesthetics as “the use of surgery, drugs, medical devices, and other invasive or traumatic medical techniques to repair and reshape a person’s appearance and body contours.” In simpler terms, any procedure that breaks the skin or introduces needles or devices into the body qualifies as medical treatment. Articles 8 and 24 stipulate that a facility must first obtain a “Medical Institution Practice License” and have medical aesthetics approved as a service subject by the registration authority before conducting such procedures; if “medical aesthetics” is not listed on the license, the practice is prohibited. Article 11 requires attending physicians to hold valid licenses and be registered; those performing cosmetic surgery must have at least six years of relevant clinical experience, cosmetic dentistry five years, and cosmetic traditional Chinese medicine or dermatology three years each. Article 20 requires that, before the procedure, patients be told in writing the indications, contraindications (when it is suitable and when it must not be done), medical risks, and precautions, and that their signed consent be obtained. Article 336 of the Criminal Law criminalizes illegal medical practice — performing injections, surgery, or treatment without proper licensing. Where the circumstances are serious, the penalty is up to 3 years of fixed-term imprisonment, criminal detention, or public surveillance, with or without a fine, or a fine alone. Where the patient's health is seriously harmed, it is 3 to 10 years of imprisonment plus a fine. Where the patient dies, it is 10 years or more of imprisonment plus a fine.

Cases reported in journals around the world, added up. From January 2015 to September 2018 there were 48 new cases of partial or complete loss of vision after a filler injection. The site with the most events was the nose, at 56.3%. Next were the area between the eyebrows at 27.1%, the forehead at 18.8%, and the nasolabial fold (the groove people call laugh lines) at 14.6%. In 81.3% of the cases the filler was hyaluronic acid. 43.8% had skin changes. 18.8% had a complication in the central nervous system (something went wrong in the brain). 10 cases (20.8%) got their vision fully back, 8 cases (16.7%) got part of it back, and the rest did not recover. The authors' conclusion was that the ways different places handled it differed widely, and no treatment has been shown to work consistently.

The SCOUT trial enrolled 9804 people. All were 55 or older, overweight or obese, and had cardiovascular disease or type 2 diabetes. They drew lots and were split into a group that took the drug and a group that did not. Treatment lasted 3.4 years on average. The main endpoint was a set of bad events chosen in advance: non-fatal heart attack, non-fatal stroke, coming back after cardiac arrest, and cardiovascular death. The rate of these events was 11.4% vs 10.0%. HR 1.16 (95% CI 1.03-1.31, P=0.02). The chance of an event was about 16% higher for the people who took the drug. The true value roughly sits between 3% higher and 31% higher. Non-fatal heart attack was 4.1% vs 3.2%, HR 1.28 (1.04-1.57), about 30% higher. Non-fatal stroke was 2.6% vs 1.9%, HR 1.36 (1.04-1.77), about 36% higher. Cardiovascular death and all-cause death did not increase. All-cause means every cause added together. After the draw, the sibutramine group lost 1.7 kg more on average. The former State Food and Drug Administration, on the basis of a safety assessment, held that "the risks of weight-loss treatment outweigh the benefits," and in October 2010 it notified a stop to the production, sale, and use of sibutramine preparations and the raw drug. Both sibutramine and phenolphthalein (a laxative chemical) are prohibited as additives in food, and health food counts as food.

The Danish researchers went back through records and matched each steroid user with controls of the same age. The original cohort comprised 545 men whose gym doping tests were positive for androgenic steroids between 2006-01-03 and 2018-03-01; they were paired with 5450 controls. An additional validation used 644 refusers and 6440 controls. Results showed a three-fold increase in mortality among users (HR = 3.0; 95 % CI 1.3–7.0). The true multiple sits roughly between 1.3 and 7. The median yearly number of hospital admissions or visits was 0.81 versus 0.36 (P < 0.0001). Median means that half of the users had more visits and half fewer; such a low P-value indicates this difference is highly unlikely to be random. Acne, gynecomastia, and erectile dysfunction each affected over 10 % of users – at least one in ten – a rate clearly above that of controls (P < 0.0001). The validation cohort yielded the same findings. Article 7 of China’s Anti-Doping Regulations states that all substances on the prohibited list are strictly controlled; no organization or individual may produce, sell, import, or export them illegally. The same regulation designates anabolic agents and peptide hormones as prescription drugs, meaning they may be obtained only with a doctor’s prescription; “anabolic agents” is the official term used in legislation.

The Measures for the Supervision and Administration of Drug Distribution and Use Quality say that a drug retailer must follow the system that sorts drugs into prescription drugs and non-prescription drugs. That system puts drugs in 2 kinds. One kind can be bought only with a doctor's prescription. The other can be bought by the person. The pharmacy must sell prescription drugs against a prescription, as the rules require, and keep the prescription for at least 5 years. When the pharmacist or another pharmacy technician is not on duty, a sign must say so, and prescription drugs must not be sold without their review. Prescription drugs must not be sold from open shelves, for a customer to take down. Article 9 of the Measures for the Supervision and Administration of Online Drug Sales says that, when prescription drugs are sold to an individual online, the seller must make sure the prescription comes from a real and reliable source, and must use real-name rules. Article 10 requires a risk warning shown prominently under each drug's display page. Before the prescription has been reviewed, the package insert must not be shown, and no buying service may be offered. Before the prescription is reviewed, the page should not even give a button to buy. Article 8 says that drugs under special state control must not be sold online. These include vaccines, blood products, narcotic drugs, psychotropic drugs, toxic drugs for medical use, radioactive drugs, and drug-class precursor chemicals. The National Health Commission's Guidelines for the Diagnosis and Treatment of Obesity (2024 edition) state that 5 drugs have been approved by the National Medical Products Administration for weight loss in adult primary obesity. The 5 are orlistat, liraglutide, beinaglutide, semaglutide, and tirzepatide. The same guidelines count a BMI (body mass index) from 24 up to but not including 28 as overweight, and 28 and above as obese. A drug is considered only when the person is overweight and also has a related disease, such as high blood sugar, hypertension (high blood pressure), abnormal blood lipids, or fatty liver, or is already obese. The premise is that changing how you live has not brought the weight down. The drug is added on top of that. The guidelines require a full assessment of the illness and the contraindications before the drug, and regular follow-up under a specialist physician while it is used. Semaglutide starts at 0.25 mg a week, with a maintenance dose of 2.4 mg or 1.7 mg. Tirzepatide starts at 2.5 mg a week, up to 15 mg. If the weight lost is under 5%, the guidelines suggest stopping the drug. What happens after stopping is in 3 trials. The STEP 1 extension followed 327 people. After 68 weeks on semaglutide they had lost 17.3% on average. 1 year after stopping, the weight had come back by 11.6 percentage points, and the net loss left was 5.6%. The authors' conclusion was that they had regained 2/3 of the weight previously lost, and that most cardiovascular and metabolic markers had also moved back near the start. STEP 4 took 803 people who had already injected for 20 weeks and lost 10.6% on average, and split them by drawing lots. Those who kept injecting lost another 7.9% over the next 48 weeks. Those switched to a placebo regained 6.9%. In SURMOUNT-4, 670 people first injected tirzepatide for 36 weeks and lost 20.9% on average. Those who kept injecting then lost another 5.5%. Those switched to a placebo regained 14.0%. In July 2026 the Yinchuan market supervision administration issued a risk alert. It said that the internet-famous "weight-loss injections" and "slimming pens" on the market are mostly repackaged drugs of unknown source, smuggled drugs, or counterfeit drugs. Buying them online or through a purchasing agent and injecting them yourself can easily set off a severe allergy, acute pancreatitis, organ damage, and a wound infection. An injection of this cosmetic-medicine kind can be done only at an institution that has a medical-aesthetics qualification. An injection at the person's home, or a private injection at a beauty salon, is not compliant. See item 2 of this section (2 things to check before injections, thread lifts, or surgery).

The researchers followed a group in the electronic records of Kaiser Permanente, a health-care group. There were 2842 transgender women and 2118 transgender men. Average follow-up was 4.0 years and 3.6 years. Each person was matched, on birth year, race, the clinic, and the time of joining, with about 10 times as many cisgender controls, 48686 cisgender men and 48775 cisgender women in all. Transgender women had more venous thromboembolism (a blood clot blocking a vessel) than the controls. Compared with cisgender men, at 2 years it was 4.1 cases per 1000 people (95% CI 1.6-6.7), and at 8 years it was 16.7 cases (6.4-27.5). Counted out, that is 4.1 extra cases among 1000 people over 2 years, and 16.7 extra over 8 years. Compared with cisgender women, the 2 figures were 3.4 (1.1-5.6) and 13.7 (4.1-22.7). Ischemic stroke (the kind of stroke in which a vessel is blocked) and myocardial infarction were, overall, close across the groups. Among transgender women who started hormone treatment only during the follow-up, the differences in venous thrombosis and ischemic stroke were clearer. The evidence on transgender men is not enough for a conclusion. The authors' conclusion was that "these results may suggest a need for long-term vigilance about the vascular side effects of estrogen in transgender hormone treatment."

33 studies were found by the rules and then combined. Among people seen in plastic surgery, the rate of body dysmorphic disorder (magnifying a flaw other people can barely see until it affects daily life) was 15.04%, and the studies ranged from 2.21% to 56.67%. In headcount, about 15 of every 100 people who go for plastic surgery meet it, and study by study the count runs from 2 to 57. Their mean age was 34.54±12.41 years. The second figure is how far the ages spread up and down. 74.38% were women. Among people seen in dermatology the rate was 12.65%, and the studies ranged from 4.52% to 35.16%. Mean age was 27.79±9.03 years, and 76.09% were women. The authors suggest that plastic surgeons and dermatologists assess on their own initiative, pick out the high-risk people, and have several departments manage them together. Another study asked 200 patients with body dysmorphic disorder. 71.0% had sought non-psychiatric treatment such as dermatology or plastic surgery, and 64.0% had received it. The authors' conclusion was that this kind of treatment "rarely improves" body dysmorphic disorder, and looks ineffective for it.

The 2022 Guiding Principles for the Registration Review of Bracketless Aligners, from the Center for Medical Device Evaluation of the National Medical Products Administration, say that this kind of aligner has a "management category of Class II (2)." They require the instructions to state that "during treatment it must be worn under the guidance of a physician qualified in orthodontics," and also to state "the requirements for eating, brushing, and regular return visits." On the product name, they say it is "not recommended to contain empty, hypothetical conceptual names such as 'invisible'." The US Food and Drug Administration (FDA) says: "The FDA has not authorized clear aligners that are sold directly to consumers without a prescription and supervision by a dentist or orthodontist," meaning it has not approved a single clear aligner sold directly to a person without a dentist's prescription and supervision. The FDA also says: "In-person examination by a dentist or orthodontist can help lower the risks of uneven bite, unintended tooth movement, pain, and tooth loss," that is, an examination in person by a dentist or an orthodontist can lower the risk of an uneven bite, teeth moving where they should not, pain, and losing a tooth. After you start wearing them, only regular return visits in person can confirm that the teeth are moving safely as planned. Both of these are regulatory documents. Neither gives the proportion of people who come to harm.

Article 16 of the Regulations on the Supervision and Administration of Cosmetics lists spot-fading and whitening cosmetics as special cosmetics. Article 17 says that special cosmetics may be produced or imported only after registration with the drug supervision department of the State Council. Article 36 requires the label to carry the special-cosmetics registration certificate number. Article 20 requires the registration information to be made public, so the number can be looked up on the National Medical Products Administration website. Article 62 of the Measures for the Administration of Cosmetic Registration and Filing says that a domestic number is «国妆特字» plus the year and a serial number, and an imported number is «国妆特进字». National Medical Products Administration Announcement No. 14 of 2026 published 2 batches of spot-fading cream, in which mercury was found at 4938 mg/kg (milligrams per kilogram) and 9281 mg/kg. The limit listed in the annex to the announcement is not more than 1 mg/kg. These 2 batches were thousands of times over that limit. They were bought at 2 small cosmetics shops, in Sichuan and in Anhui. The package printed a «国妆特字» number. The factory named on it objected. After review, the Guangdong medical products administration found that this enterprise had not produced that batch. A review brought together 30 cases reported in journals, all of them nephrotic syndrome after using a mercury-containing whitening cream, which means a large amount of protein leaking into the urine. All 30 were Asian women, mostly aged 18 to 52. From starting use to falling ill was 1 to 60 months, and half were within 5 months. Most kidney biopsies were minimal change disease (67%) or membranous nephropathy (23%). These are 2 diseases of the glomeruli, the kidney's filters. Very few got better on their own within a month and a half after stopping. In the cases with a record, those who used a mercury-removing drug took 1 to 9 months for the urine protein to turn negative, with a median of 2 months. All 3 who did not use a mercury-removing drug took 12 months or more. A hospital in Beijing admitted 288 people with mercury poisoning from 2014 to 2019. 84 of them (29.27%) were related to cosmetics. The main source of poisoning among women was cosmetics. Of the 18 patients with nephrotic syndrome who were followed, 15 had urine protein and albumin back to normal after an average of 22.67 months. The mercury in these 18 people did not all come from cosmetics.