Muscle-enhancing Behaviors Among Adolescent Girls and Boys

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Emphasis on muscularity has increased in recent decades. Identifying adolescent populations at risk for unhealthy muscle-enhancing behaviors is of considerable importance, yet recent research in the United States is limited in terms of sample diversity and behaviors of interest. WHAT THIS STUDY ADDS:Muscle-enhancing behaviors were common for both boys and girls, and rates were higher than reported previously. Adolescents in high school, of Asian background, in overweight/obese BMI categories, and involved in sports reported significantly greater use than other youth. abstract OBJECTIVE: Media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to youth. Identifying populations at risk for unhealthy muscle-enhancingbehaviors is of considerable public health importance. The current study uses a large and diverse population-based sample of adolescents to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement.METHODS: Survey data from 2793 diverse adolescents (mean age = 14.4) were collected at 20 urban middle and high schools. Use of 5 muscle-enhancing behaviors was assessed (changing eating, exercising, protein powders, steroids and other muscle-enhancing substances), and a summary score reflecting use of 3 or more behaviors was created. Logistic regression was used to test for differences in each behavior across age group, race/ethnicity, socioeconomic status, BMI category, and sports team participation. RESULTS:Muscle-enhancing behaviors were common in this sample for both boys and girls. For example, 34.7% used protein powders or shakes and 5.9% reported steroid use. Most behaviors were significantly more common among boys. In models mutually adjusted for all covariates, grade level, Asian race, BMI category, and sports team participation were significantly associated with the use of muscle-enhancing behaviors. For example, overweight (odds ratio = 1.45) and obese (odds ratio = 1.90) girls had significantly greater odds of using protein powders or shakes than girls of average BMI. CONCLUSIONS:The use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. Pediatricians and other health care providers should ask their adolescent patients about muscle-enhancing behaviors.

Gender Conformity and Use of Laxatives and Muscle-Building Products in Adolescents and Young Adults

“…The overall gender differences and age trends detected in this study were consistent with previous US epidemiologic data on the prevalence of laxative use and muscle-building product use in adolescent and young adult females and males. 7,9,11,15 The results build on previous research on gender and sexual orientation disparities in laxative and musclebuilding product use by highlighting the unique, independent effect of gender conformity in patterning weight control and muscle-building behaviors in heterosexual and sexual minority adolescents and young adults.…”

“…9,10 Project EAT data indicate that 10.5% of adolescent males and 5.5% of females report using other muscle-building products (eg, creatine, hydroxymethylbutyrate, dehydroepiandrosterone, or growth hormone). 11 Beyond gender differences in laxative and muscle-building product use, emerging epidemiologic data indicate disparities by sexual orientation identity (ie, heterosexual vs sexual minority [gay, lesbian, bisexual, mostly heterosexual]). [11][12][13][14] Sexual minority females, particularly those who identify as bisexual or mostly heterosexual, report higher levels of laxative use than their heterosexual peers, 14,15 a finding that runs counter to the popular misperception that sexual minority females are at lower risk for body dissatisfaction and eating disorders.…”

Use of Performance-Enhancing Substances

“…Terms such as "performance-and image-enhancing substances" and "appearance-and performance-enhancing drugs" emphasize their broader appeal. [10][11][12][13] A Minnesota study evaluating various muscle-enhancing behaviors revealed that in an urban high school population, 38.8% of boys and 18.2% of girls reported a history of protein supplement use. 11 The same study revealed rates of use in middle school for boys and girls as 29.7% and 24.7%, respectively.…”

Weight concerns among adolescent boys

“…Nevertheless, there exists a clear gender difference in the type of weight concerns reported. Compared with girls, boys are more likely to desire an increase in weight gain related to an increase in muscle mass (24) and, indeed, muscle-enhancing behaviours are higher now than in the past among boys (25,26) . Family mealtimes are considered fundamental to the health of adolescents.…”