Performance-enhancing drugs have been used by elite cyclists such as Lance Armstrong and many professional and amateur athletes in sports such as football and basketball. Sadly, for many athletes, the use of performance-enhancing substances, the use of these substances begins in high school—and even middle school—by both boys and girls. This finding was published in the journal Pediatrics last November by researchers affiliated with the University of Minnesota (Minneapolis, Minnesota) and Columbia University, New York, New York).
The researchers note that media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to teens. Therefore, they noted that the identification of populations at risk for unhealthy muscle-enhancing behaviors is of significant public health importance. They designed a study to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement.
The study group comprised 2,793 diverse adolescents (average age: 14.4 years) who attended 20 urban middle and high schools. The researchers assessed five muscle-enhancing behaviors: changing eating, exercising, protein powders, steroids, and other muscle-enhancing substances. They developed a summary score that reflected the use of three or more behaviors. The data was analyzed in regard to differences in each behavior across age group, race/ethnicity, socioeconomic status, body mass index (BMI) category, and sports team participation.
The investigators found that muscle-enhancing behaviors were common among the students for both boys and girls; however, most behaviors were significantly more common among boys than girls. Not taking gender into account, they found that 34.7% of the students used protein powders or shakes and 5.9% reported steroid use. When they adjusted the data for all variables (i.e., grade level, race/ethnicity, BMI category, and sports team participation), muscle-enhancing behaviors were commonplace. 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. (The higher the odds ratio above 1, the higher the usage.)
The majority of teens surveyed were poor or middle-class. Almost all of them had engaged in at least one muscle-building activity in the past year, most often working out more to get stronger. However, up to one-third of them used what the researchers deemed to be unhealthy means to gain muscle mass, including taking steroids and other muscle-building substances or overdoing it on protein shakes, dieting, and weight-lifting. Student-athletes were more likely than their peers to use most methods of muscle-building; however, steroid use was equally common among athletes and non-athletes. In addition to steroid use, more than one-third of boys and one-fifth of girls in the study said they had used protein powder or shakes to gain muscle mass; 5-0% percent used non-steroid muscle-enhancing substances, such as creatine.
The researchers concluded that the use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. They recommended that pediatricians and other healthcare providers should ask their adolescent patients about muscle-enhancing behaviors.
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