A call for public policy and research to reduce use of appearance and performance enhancing drugs and substances among adolescents

Prevalence and correlates of appearance- and performance-enhancing drugs and substances use among a national sample of college students aged 18-30

Objective: To identify the lifetime prevalence and correlates of appearance- and performance-enhancing drugs and substances (APEDS) use among a national sample of US college and university students. Participants: Student participants from the 2020-2021 Healthy Minds Study (N = 7,401; ages 18-30 years). Methods: Lifetime prevalence of five forms of APEDS was estimated. Modified Poisson regression analyses were conducted to determine the sociodemographic correlates of protein and creatine supplement use. Results: Lifetime protein (23.8%) and creatine (7.7%) supplement use were most common among the sample. Older age within young adulthood, male sex, perceiving oneself to be normal weight or somewhat overweight, any athletics participation, and 2-3 or ≥ 5 h/week of exercise were associated with greater likelihood of lifetime protein and creatine supplement use. Conclusions: Awareness and prevention efforts on the potential harms of APEDS use are needed on campuses, particularly among males and those who participate in athletics and high-frequency exercise.

"Eat more protein, build more muscle": A grounded theory study of muscle-building behaviors among Canadian adolescents and young adults

Unique risk factors for the development of muscle dissatisfaction and engagement in muscle-building behaviors have been described by theoretical frameworks and supported by empirical research. What remains unknown are the unique processes, including catalysts and facilitators, which underpin engagement in muscle-building behaviors. Therefore, this study used a grounded theory methodology to elucidate the process of engagement in muscle-building behaviors. Thirty-three individual semi-structured interviews with Canadian adolescents and young adults ages 16-30 years were conducted. Transcripts were analyzed using initial and focused coding to identify themes that explained the grounded theory. The core theme underpinning the grounded theory was balancing aesthetic, health, and functional goals in relation to participants' engagement in muscle-building behaviors. Participants described experiences that encompassed several unique phases of muscle-building engagement, including the initiation phase, beginner phase, preservation phase, and intensification phase. Participants also described unique methods of gathering information on muscle-building behaviors, and their own analysis and decision-making processes driving their behaviors. Findings from this study extend prior theory and research by conceptualizing a novel process theory of engagement in muscle-building behaviors among adolescent and young adults, resulting in important implications for research and practice.

Sport specialisation and performance-enhancing substance use by young athletes

Objectives

To investigate the association of reported legal performance enhancing substance (PES) use and consideration of banned PES use among sport-specialised and non-sport-specialised young athletes.

Methods and design

Cross-sectional study of 1049 young athletes enrolled in an injury prevention programme from 2013 to 2020. We used logistic regression modelling to determine the independent association between sports specialisation. We reported (1) legal PES use and (2) consideration of banned PES use after adjusting for the effects of gender, age, having a relative as a coach, unrestricted internet access, use of a weight training regimen, and weeknight hours of sleep.

Results

The final cohort consisted of 946 athletes with a mean age of 14. 56% were female, and 80% were sport-specialised athletes. 14% reported legal PES use, and 3% reported consideration of banned PES use. No difference was found between sport-specialised athletes who reported legal PES use (OR=1.4; 95% CI 0.81 to 2.43; p=0.23) or consideration of banned PES use (OR=3.2; 95% CI 0.78 to 14.92; p=0.1) compared with non-sport-specialised athletes. Reported legal PES use was more common among athletes who were male, older, used weight training, and slept less. Reported consideration of banned PES use was more common among male and older athletes.

Conclusions

PES use is not independently associated with sport specialisation in young athletes. Athlete sex, age, training, and sleep patterns are important factors for young athletes to consider in PES use.

Associations between social media use, fitness- and weight-related online content, and use of legal appearance- and performance-enhancing drugs and substances

Prior research has documented the connection between social media use and engaging with fitspiration with body dissatisfaction, disordered eating behaviors, and various health risk behaviors (e.g., substance use). However, gaps remain in the knowledge base on whether social media use and engaging with fitness- and weight-related online content are associated with the use of legal appearance- and performance-enhancing drugs and substances (APEDS; e.g., whey protein), which was the aim of this study. Data from participants ages 16-30 years in Canadian Study of Adolescent Health Behaviors (N = 2731) were analyzed. Multiple modified Poisson regression analyses were conducted to determine the associations between hours per day of social media use and any engagement with fitness- and weight-related online content in the past 30 days and use of 10 different legal APEDS in the past 30 days. Greater time on social media was significantly associated with use of energy drinks and pre-workout drinks or powders in the past 30 days. Engaging with fitness- and weight-related online content was significantly associated with the use of caffeine, creatine monohydrate, pre-workout drinks or powders, probiotics, protein bars, and whey protein powders or shakes in the past 30 days. These findings expand prior research on the correlates of social media use and engagement with fitness- and weight-related online content among young people and have important implications for healthcare and public health professionals, as well as technology companies.

Use of Legal Appearance- and Performance-Enhancing Drugs and Substances: Findings from the Canadian Study of Adolescent Health Behaviors

BACKGROUND

Use of appearance- and performance-enhancing drugs and substances (APEDS) is common among adolescent and young adults. Many APEDS are legally sold "over-the-counter," however research has documented contamination of legal APEDS and many adverse effects of use. Despite this, little research has been conducted on legal APEDS use in Canada, particularly regarding the prevalence and sociodemographic predictors of use, which was the aim of this study.

METHODS

Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Prevalence and frequency of use of 10 common APEDS in the past 12 months were estimated overall and across genders. Multiple modified Poisson regression analyses were conducted to determine the sociodemographic predictors of APEDS use.

RESULTS

Overall, use of caffeine was most common among the sample (71.3%), along with protein bars (63.4%), and whey protein powders or protein shakes (63.1%). Boys and men reported greater prevalence of use of eight of the 10 APEDS, with the exception of diuretics or water pills and probiotics, compared to girls and women and transgender/gender non-confirming participants. Over three quarters (82.5%) of boys and men reported use of whey protein powders or protein shakes and 50.3% reported use of creatine monohydrate. Use of APEDS varied based on several key sociodemographic identifiers.

CONCLUSIONS

This study is the first to document legal APEDS use among a sample of Canadian adolescents and young adults, providing important implications for health care and policymaking professionals. Further research is needed to gain greater insight into APEDS use among Canadian young people.

Prevalence and correlates of dry scooping: Results from the Canadian Study of Adolescent Health Behaviors

Dry scooping is a novel dietary practice characterized by consuming pre-workout powders without mixing with a liquid as directed. Despite purported benefits of this practice, such as increased energy due to the high concentration of caffeine, there are potential harms of engagement. To date, no known empirical research has investigated dry scooping in epidemiological research. Therefore, the aim of this study was to characterize the prevalence and correlates of dry scooping among a sample of Canadian adolescents and young adults. Data from the Canadian Study of Adolescent Health Behaviors (N = 2731) were analyzed. Prevalence of any dry scooping in the past 12 months among the overall sample, and by gender, was estimated. Modified Poisson regression analysis was used to determine the adjusted associations between sociodemographic and descriptive characteristics and dry scooping. Overall, 16.9 % of the sample reported dry scooping in the past 12 months, which was significantly more common among men (21.8 %) compared to women (14.2 %) and transgender/gender non-confirming participants (8.0 %). Participants who reported weight training, greater time spent on social media, and clinically significant symptoms of muscle dysmorphia were more likely to report dry scooping, while sexual minorities, relative to heterosexual participants, and those with higher education were less likely to report dry scooping. This study is the first known epidemiological study of dry scooping, underscoring the common nature of this contemporary dietary behavior. Findings emphasize the need for future research and prevention and intervention efforts to protect the health and well-being of young people.

Methamphetamine use and disordered eating: a case study of an understudied phenomenon

PURPOSE

Little is known about co-occurring eating disorder (ED) psychopathology and methamphetamine use. Even less is known about the precise nature of how ED symptom profiles and methamphetamine use interact and influence treatment-related practices. The purpose of this study is to report a case study of a patient with co-occuring ED psychopathology and methamphetamine use.

METHOD

We present the case of a White woman in her mid-30s with a long history of body image-related worries and methamphetamine use. She presented for psychiatric assessment initially for methamphetamine addiction and paranoid psychotic symptom treatment, but also reported significant weight and shape concerns.

RESULTS

Over the duration of approximately 1 year of treatment, this patient experienced a reduction in her methamphetamine use, but an increased concern around how abstinence may portend weight gain. She reported that a return to methamphetamine use was underpinned by a drive to manage her weight.

CONCLUSION

With increasing evidence documenting the elevated co-occurrence of methamphetamine use and ED symptomatology, this case report highlights the potential mechanisms by which these respective psychopathologies may be exacerbate the other, rendering both increased risk of relapse, and body dissatisfaction.

LEVEL OF EVIDENCE

Level IV, case study.

Characterizing cheat meals among a national sample of Canadian adolescents and young adults

BACKGROUND

"Cheat meals", described as brief eating episodes that depart from established dietary practices to consume prohibited foods, represent a novel and increasingly common eating behavior with particular salience in adolescence and young adulthood. However, knowledge gaps remain regarding the frequency and characterization of foods and calories consumed during cheat meals, and their associations with eating disorder behaviors and psychopathology. Thus, the aims of this study were to delineate engagement in cheat meals among a large, national sample of Canadian adolescents and young adults.

METHODS

Participants (N = 2,717) were from the Canadian Study of Adolescent Health Behaviors. Frequencies of engagement in cheat meals, and associated foods and calories consumed, in the past 12 months and 30 days were determined. The associations between engagement in cheat meals and eating disorder behaviors and psychopathology were determined using modified Poisson regression analyses.

RESULTS

Engagement in cheat meals in the past 12 months was highest among men (60.9%) compared to women (53.7%) and transgender/gender non-conforming (TGNC; 52.5%) participants. Cheat meals consisting between 1,000 and 1,499 cal were those most frequently reported among all participants. Mean number of cheat meals in the past 12 months was equivalent to > 1 per week, which was similar to engagement in the past 30 days. Finally, engagement in cheat meals in the past 12 months and 30 days was associated with patterns of eating disorder behaviors and psychopathology among all participants, including binge-eating-related behaviors.

CONCLUSIONS

This study further characterized and extended knowledge of cheat meal engagement across genders, aligning with prior research by demonstrating that engagement is associated with greater eating disorder psychopathology. Findings from this study add to the growing characterization of the novel behavioral phenomenon of cheat meals. Specifically, over half of adolescents and young adults across all 13 provinces and territories in Canada reported engaging in > 1 cal dense cheat meal per week, over the past 12 months. Despite the normalization and promotion of cheat meal engagement among the general public and unique fitness communities, engagement in this behavior is linked to greater eating disorder behaviors and psychopathology, including binge-eating episodes. Our findings emphasize the need for further research, public awareness, and clinical interventions aimed at addressing this potentially harmful eating behavior.

Use of appearance- and performance-enhancing drugs and substances is associated with eating disorder symptomatology among U.S. college students

PURPOSE

Body ideals for both men and women are continuing to emphasize muscularity and leanness, which has resulted in the high prevalence of appearance- and performance-enhancing drugs and substances (APEDS) use, particularly among young men. Overall, little research has investigated the individual associations between specific APEDS use and eating disorder symptomatology, including among the high-risk population of young adult college students, which was the aim of this study.

METHODS

Data from the 2020-2021 Healthy Minds Study (N = 7394) were analyzed. Five indicators of lifetime APEDS use were assessed, and a cumulative sum score was constructed. Eating disorder symptomatology was assessed via the SCOFF questionnaire. A total of 14 modified Poisson regression analyses were estimated to determine the association between APEDS use and a positive eating disorder screen among women and men.

RESULTS

Lifetime use of protein supplements and diuretics or water pills were associated with a positive eating disorder screen among both women and men, while use of non-steroid synthetic muscle enhancers was associated with a positive eating disorder screen among men and creatine supplement use was associated with a positive eating disorder screen among women. The risk of a positive eating disorder screen was highest among men who reported use of five APEDS in their lifetime.

CONCLUSIONS

Lifetime use of APEDS is associated with eating disorder symptomatology among a national sample of U.S. college and university students. Prevention and intervention efforts are needed to address the link between these potentially harmful behaviors.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Performance-Enhancing Substance Use and Sexual Risk Behaviors among U.S. Men: Results from a Prospective Cohort Study

Performance-enhancing substance (PES) use is common among young men and prior research has documented cross-sectional associations between anabolic-androgenic steroid (AAS) use and sexual risk behaviors. However, this relationship remains understudied among a longitudinal cohort of young adult men, and research on prospective associations between legal PES (e.g., creatine) use and sexual risk behaviors is lacking. The current study addressed these oversights using data from the National Longitudinal Study of Adolescent to Adult Health (N = 5,451). AAS use and legal PES use were assessed at Wave III (ages 18-26) and 10 indicators of sexual risk behavior were assessed at seven-year follow up (Wave IV; ages 24-32). Linear and logistic regression analyses were conducted adjusting for demographic and behavioral confounders. Participants who reported AAS use and legal PES use had significantly higher number of one-time sexual partners and higher odds of multiple sex partners around the same time in the past 12 months. Participants who reported AAS use had higher odds of any STI in the past 12 months. These results extend prior research on the risk behaviors and adverse effects of PES use. Health care professionals should assess for PES use among young adult men and provide guidance on healthful sexual behaviors.

Lack of supplement regulation: A potential for ethical and physiological repercussions

Background: The sale and utilization of dietary and fitness supplements in America, with industry revenue totaling 140.3 billion in 2020 alone, has proven significant. Unfortunately, these supplements are not held to high standards of manufacturing or marketing, leading to ethical, financial, and physiological repercussions for consumers. Aim: The aim of this study is to discuss specific examples of a prevalent issue within the supplementation industry; we suggest the implementation of regulatory processes in the sale and marketing of such products. Methods: Studies from 2007 to 2021 which illustrate positive or negative effects of specific supplements based on gross revenue or a high level of publicity were analyzed. Results: Within this paper, we outline potential regulations which could assist in mitigating the negative impact that a lack of oversight has precipitated. These regulations include an initial approval request which reviews supplement ingredients, effects, risks, and therapeutic index. Conclusion: If the proposed regulations are introduced, the data collected via supplement applications may be utilized in classifying the supplement by its risk before it is marketed to the general population with supervision by pharmacists when indicated, ultimately reducing the adverse effects of inappropriate supplementation.

Problematic muscularity-oriented behaviors: Overview, key gaps, and ideas for future research

Problematic muscularity-oriented behaviors, such as excessive weightlifting and muscle-building supplement and substance use (e.g., creatine, steroids), are common among young people, particularly boys and men. Theoretical models of eating disorders, and their constructs, are helpful in conceptualizing a number of risk factors that may increase the likelihood of developing problematic muscularity-oriented behaviors; however, these models lack a clear delineation of the factors that may specifically lead to the initiation and pursuit of these behaviors. This paper provides a brief overview of the theoretical models that have usefully framed research on problematic muscularity-oriented behaviors and the risk factors that been identified through this work. In addition, it identifies gaps related to understanding the factors leading to the initiation and continued or discontinued engagement in these behaviors, and it provides ideas for future research to help fill these gaps. Understanding the ways in which risk factors combine sequentially and interactively, to produce pathways to problematic muscularity-oriented behaviors is crucial for researchers to strengthen theoretical understandings of these behaviors, to inform intervention efforts, and guide policy and practice to decrease their rates among youth.

Muscle-building behaviors from adolescence to emerging adulthood: a prospective cohort study

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Muscle-building behaviors in adolescence to emerging adulthood were studied.

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Starting muscle-building behaviors is common from adolescence to emerging adulthood.

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Prevalence of any protein powder/shakes use was 55.1% in males and 33.0% in females.

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Prevalence of any steroids use was 6.7% in males and 5.4% in females.

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Protein powder consumption was associated with future use of steroids.

This study aimed to identify patterns of change in muscle-building behaviors from adolescence to emerging adulthood and determine what adolescent factors predict new-onset muscle-building behavior in emerging adulthood. Prospective cohort data from a diverse sample of 1,535 participants followed from adolescence (baseline, M_age = 14.4 ± 2.0 years) to emerging adulthood (follow-up, M_age = 22.1 ± 2.0 years) from the population-based EAT 2010–2018 (Eating and Activity over Time) study were analyzed. Changes in muscle-building behavior were identified (starting, stopping, persistent use, or never use). Log-binomial regression models examined adolescent predictors of starting (i.e., new-onset) muscle-building behaviors in emerging adulthood. Prevalence of any use in adolescence (EAT 2010) and/or emerging adulthood (EAT 2018) was 55.1% (males) and 33.0% (females) for protein powder/shakes, 6.7% (males) and 5.4% (females) for steroids, and 19.4% (males) and 6.5% (females) for other muscle-building substances (e.g., creatine, amino acids). In particular, 22.6% (males) and 13.7% (females) started protein powder/shakes, 2.2% (males) and 1.0% (females) started steroid use, and 9.0% (males) and 2.0% (females) started other muscle-building substances during emerging adulthood. Adolescent protein powder/shake consumption was associated with starting steroids/other muscle-building substances use in emerging adulthood in males (adjusted risk ratio [ARR] 2.09, 95% confidence interval [CI] 1.29–3.39) and females (ARR 4.81, 95% CI 2.01–11.48). Adolescent use of protein powders/shakes may lead to a two- to five-fold higher risk of new use of steroids and other muscle-building products in emerging adulthood. Clinicians, parents, and coaches should assess for use of muscle-building behaviors in adolescents and emerging adults and discourage use of harmful products.

Associations between ergogenic supplement use and eating behaviors among university students

Ergogenic supplements to improve athletic performance are commonly used among college athletes, but little is known about their association with eating disorder symptoms. The objective of this study was to examine associations between ergogenic supplement use and disordered eating attitudes and behaviors among university students, and to compare differences by sex. Undergraduate students from 10 top-ranked National College Athletics Association (NCAA) Division I colleges completed an online survey on supplement use, athletic activities, and eating attitudes and behaviors. Among 1633 university students, males (38.9%) reported higher rates of current supplement use than females (15.2%) (p < .001). In linear regression models adjusting for athletic status and body mass index, current supplement use was associated with higher Eating Disorders Examination-Questionnaire (EDE-Q) Global, Shape Concern, and Restraint scores in both males and females. Supplement use was associated with driven/compelled exercise (OR 2.00, 95% CI 1.33-2.99) in males and diuretic (OR 6.39, 95% CI 2.02-20.22) and diet pill use (OR 3.07, 95% CI 1.79-5.27) in females. Results suggest ergogenic supplement use is common in undergraduates and associated with disordered eating attitudes and behaviors. Clinicians should screen for disordered eating behaviors particularly in young adults who use ergogenic supplements.

Prevalence and correlates of weight gain attempts across five countries

OBJECTIVE

To determine the prevalence and correlates of weight gain attempts in a pooled sample of adults aged 18 and older from Canada, Australia, the United Kingdom, the United States, and Mexico.

METHOD

Data collected during 2 years (2018 and 2019) of the International Food Policy Study (N = 42,108) were analyzed. Unadjusted 12-month prevalence of weight gain attempts was estimated based on body mass index (BMI; kg/m² ), weight perception, country, survey year, and sex. Logistic regression analyses were estimated to determine the sociodemographic correlates (age, race/ethnicity, education, BMI, weight perception, weight perception accuracy, and self-rated mental health) of weight gain attempts among the pooled sample stratified by sex.

RESULTS

Men (10.4%) were significantly more likely than women (5.4%) to report weight gain attempts (p < .001). Nearly one in five (17.1%) men with a BMI in the "normal" range (≥18.5 to <25.0) reported weight gain attempts. Among both men and women, minority group identity was associated with higher odds, while older age and higher BMI category were associated with lower odds, of reporting weight gain attempts. Country differences over the two survey years showed the prevalence of weight gain attempts in 2019 (vs. 2018) was higher among women in Australia (p < .05) and men in the United States (p < .01).

DISCUSSION

Weight gain attempts are more common among men, compared to women, across five countries, potentially reflecting the global salience of the pursuit of a muscular body.

Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study

BACKGROUND

Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up.

MATERIALS AND METHODS

Nationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001-2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates.

RESULTS

Among the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk.

CONCLUSIONS

We do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.

Association Between Legal Performance-Enhancing Substances and Use of Anabolic-Androgenic Steroids in Young Adults

This cohort study uses data from the National Longitudinal Study of Adolescent to Adult Health database to describe the association between anabolic-androgenic steroid use and legal performance-enhancing substances in young adults.

Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults

BACKGROUND

Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors.

METHODS

We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders.

RESULTS

Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44).

CONCLUSIONS

Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.

Eating disorders in adolescent boys and young men: an update

PURPOSE OF REVIEW

To review the recent literature on eating disorders and disordered eating behaviors among adolescent boys and young men, including epidemiology, assessment, medical complications, treatment outcomes, and special populations.

RECENT FINDINGS

Body image concerns in men may involve muscularity, and muscle-enhancing goals and behaviors are common among adolescent boys and young men. Recent measures, such as the Muscularity Oriented Eating Test (MOET) have been developed and validated to assess for muscularity-oriented disordered eating. Medical complications of eating disorders can affect all organ systems in male populations. Eating disorders treatment guidance may lack specificity to boys and men, leading to worse treatment outcomes in these population. Male populations that may have elevated risk of eating disorders and disordered eating behaviors include athletes and racial/ethnic, sexual, and gender minorities.

SUMMARY

Eating disorders and disordered eating behaviors in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating. Treatment of eating disorders in boys and men may be adapted to address their unique concerns.