Muscle building supplement use in Australian adolescent boys: relationships with body image, weight lifting, and sports engagement

Protein supplement consumption prevalence, habits and complications in adolescents

INTRODUCTION

The consumption of nutritional and protein supplements by adolescents may have important consequences for their health.

METHODS

Prospective observational study based on a survey of adolescents enrolled in 6 schools selected at random in the city of Seville. Our primary objective was to determine the actual consumption of dietary supplements in the adolescent population and quantifying their protein content.

RESULTS

We obtained a total of 263 valid responses that showed a prevalence of consumption of nutritional supplements of any kind of 19.01%, of which 56.0% (10.64% of the total) corresponded to adolescents that consumed protein supplements for a mean protein intake of 0.26 g/kg/day (SD, 0.18). The profile of consumers of any type of supplements differed from that of nonconsumers in age, use of long-term medication and weight loss or high-protein diets. The comparison of adolescents who consumed protein supplements versus nonprotein supplements only evinced a significant difference in the control of supplement consumption. Although most of these adolescents were not subject to external control, 25.92% of those who consumed protein supplements were monitored by a professional, compared to 7.38% of consumers of nonprotein supplements. In the group that consumed protein supplements, 85.18% of adolescents achieved the desired effect and 18.51% reported some form of negative effect.

CONCLUSIONS

The prevalence of protein supplement consumption among adolescents in our area is 10.64%, with consumption of amounts corresponding to 25% of the recommended daily allowance of protein. The profile of protein supplement consumers is very similar to that of nonprotein supplement consumers.

Appearance and performance factors associated with muscle building supplement use and favourable attitudes towards anabolic steroids in adolescent boys

Introduction

The demand for appearance and performance enhancing substances, including muscle building supplements and anabolic androgenic steroids, is increasing in Australia. However, little is known about the associations between appearance and performance-based factors and appearance and performance enhancing substances (APES), particularly among adolescent boys. This study sought to examine (a) the prevalence of muscle building supplement use in a sample of adolescent boys and (b) how both performance and appearance factors relate to muscle building supplement use and favourable attitudes towards anabolic androgenic steroids in this sample.

Method

N = 488 adolescent boys aged 13-16 (Mage = 14.59) from nine Australian schools completed measures of supplement use, favourable attitudes towards using steroids, muscle dissatisfaction, body fat dissatisfaction, mesomorphic ideal internalisation, weight training, and sports participation. Hierarchical logistic regressions were used to examine cross-sectional correlates of muscle building supplement use and favourable attitudes towards using anabolic androgenic steroids.

Results

In the past three months, 12.7% of the sample had used muscle building supplements. Both appearance and performance-related factors - mesomorphic ideal internalisation and weight training - were related to muscle building supplement use. Only one appearance-related factor - body dissatisfaction - was related to favourable attitudes towards anabolic androgenic steroids.

Discussion

The findings from this study are important as they may help to guide intervention strategies regarding appearance and performance enhancing substance use by Australian adolescent boys, with the ultimate goal of ensuring this population's safety.

Gendered perspectives on women's anabolic-androgenic steroid (AAS) usage practices

BACKGROUND

The masculinizing effects from anabolic-androgenic steroid (AAS) appear to be different between men and women, leading to calls for more gender-specific information regarding women and AAS use. This study sought to gather perspectives from both men and women on the unique challenges surrounding women's use of AAS, irrespective of their personal use. Secondly, the study interrogated how women's AAS practices differ from those of men specifically.

METHODS

The data presented in this paper come from a subsample of participants who participated in a larger study investigating women and performance and image enhancing drug (PIED) use in Australia. Participants were included in the current analysis if they were: (i) males or females who competed with or coached female strength athletes using AAS and (ii) female and male strength athletes who used AAS. The final sample comprised 21 participants of which there was a proportion of males (n = 7) and females (n = 7) using AAS.

RESULTS

Women's choices in AAS selection were predominantly around oral compounds (e.g. Oxandrolone) as well as other PIEDs (e.g. Clenbuterol). Some women report the use of injectable AAS represents a change in the profile of the typical female user as it reportedly comes alongside drastic physical and psychological changes.

CONCLUSIONS

The unique challenges facing women who use AAS are largely isolation and stigma, with little evidence-based practice or education being available to them online or through peer-groups. Future work may consider piloting harm reduction strategies that may be co-designed with this group.

Goodform: A cluster randomised controlled trial of a school-based program to prevent body dissatisfaction and muscle building supplement use among adolescent boys

Although body dissatisfaction is common among adolescent boys, few intervention programs specifically developed for boys have been shown to be effective for reducing body dissatisfaction. Our study aim was to evaluate Goodform, a 4-session, teacher delivered intervention program specifically developed for boys to reduce body dissatisfaction and muscle building supplement use. The Goodform program was based on cognitive dissonance, social learning theory, and a social norms approach, and drew from two existing body image intervention programs that have shown promise among males: The Body Project- More than Muscles, and the Athletes Training and Learning to Avoid Steroids Program (ATLAS). A sample of 488 boys in grades 9 and 10 (M_age = 14.81, SD_age = 0.51) at nine secondary schools in Australia were randomly assigned to Goodform (n = 244) or control (n = 244) at the school level. Self-reported body image, supplement use, anabolic androgenic steroid (AAS) use, and attitudes around using AAS and muscle building supplements were measured at baseline, post-intervention, and eight-week follow-up. Analyses with multi-level, mixed-effect regression models revealed no changes over time attributable to the intervention. Our results have implications for researchers in the body image and eating disorder prevention fields. Lessons learned in this study can inform future school-based efforts for reducing muscle building supplement use.

The Liver King Lie: Misrepresentation, justification, and public health implications

It is well-established that performance and image enhancing drugs (PIEDs) are effective in increasing muscle mass and strength. PIEDs are unique in that, while harm may result from use, there is little evidence of widespread individual or social harm comparable with other illicit substances. However, given the rapid growth of the online health and fitness industry, the digital consumption of hardcore fitness content represents a space ripe for indirect harms. A poignant example of this trend among the digital health and fitness community is the contestation around 'fake natty' users, who falsely claim to not use PIEDs. The non-disclosure of use has the potential to give individuals who are not enhanced the false impression that they too can achieve a bodily ideal which is similar, potentially resulting in psychological distress and risky behaviours. In this commentary, we discuss this harmful phenomenon using the case study of the fitness influencer Brian Johnson, more commonly known as Liver King. Employing a psycho-criminological lens, we use Social Identity Theories to understand the 'Primal' identity, before unpacking Johnson's disavowal of his PIED consumption through Sykes and Matza's (1957) techniques of neutralization. We conclude with an overview of the harms surrounding fake natural influencers and cognitive dissonance, before attempting to map a path towards emic harm reduction in collaboration with the digital fitness community.

A quantitative analysis of factors which influence supplement use and doping among adolescent athletes in New Zealand

Objectives

Doping is a maladaptive behaviour which poses numerous risks and potentially enhances athletic performance while supplement use poses threats of positive, yet inadvertent, doping control results. Investigation is required to understand factors that influence adolescent supplement use and doping in New Zealand (NZ).

Design

A survey was completed by 660 athletes aged 13 to 18 years, of any gender, who competed at any level of any sport in NZ. Forty-three independent variables measured autonomy, confidence sources, motivational climate, social norms and age.

Methods

Multivariate, ordinal, and binary logistic regression models measured associations between independent variables and five dependant variables: supplement use, doping, doping considerations and intent (soon and in the next year).

Results

Confidence through mastery, internally perceived locus of control (IPLOC) and volition decreased the odds of doping while confidence through self-presentation, subjective and descriptive norms increased the odds of supplement use and doping.

Conclusion

To decrease the odds of doping, adolescent autonomy should be increased in sport through opportunities for volitional decision making and exposure to mastery as a confidence source.

Correlates of weight-related self-monitoring application use during emerging adulthood in a population-based sample

PURPOSE

This study was designed to examine (1) the types of technologies or other applications (apps) emerging adults use to track their eating, physical activity, or weight; (2) who uses these apps and (3) whether eating and weight-related concerns during adolescence predict app use in emerging adulthood.

METHODS

Longitudinal survey data were obtained from EAT 2010-2018 (Eating and Activity over Time study, N = 1428), a population-based sample of ethnically/racially and socioeconomically diverse adolescents (mean age: 14.5 ± 2.0 years), who were followed into emerging adulthood (mean age: 22.0 ± 2.0 years). Data were used to examine sociodemographic correlates of physical activity- and dietary-focused app use. Adjusted, gender-stratified logistic regressions were used to investigate longitudinal relationships between eating and weight-related concerns in adolescence and app use in emerging adulthood.

RESULTS

Compared to men, women were more likely to use physical activity- (23.2 versus 12.5%, p < 0.001) and dietary-focused apps (16.1 versus 5.5%, p < 0.001). Among women, eating and weight-related concerns in adolescence, particularly unhealthy muscle-building behaviors (OR = 1.73, 95% CI 1.03-2.92), were associated with later dietary-focused app use. Among men, use of other muscle-building behaviors and body dissatisfaction in adolescence predicted use of physical activity- (OR_{other muscle-building} = 1.60, 95% CI 1.03-2.49 and OR_{body dissatisfaction} = 1.67, 95% CI 1.06-2.65) and dietary-focused (OR_{other muscle-building} = 2.18, 95% CI 1.07-4.47 and OR_{body dissatisfaction} = 2.35, 95% CI 1.12-4.92) apps 8 years later.

CONCLUSIONS

Eating and weight-related concerns may predict later use of physical activity- and dietary-focused apps; future research is needed to understand whether use of such apps further increases eating and weight-related concerns.

LEVEL OF EVIDENCE

III, well-designed longitudinal cohort study.

The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors

Background

Mediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention's effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use.

Methods

This study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators.

Results

In girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role.

Conclusion

Interventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

Protein, Creatine, and Dieting Supplements Among Adolescents: Use and Associations With Eating Disorder Risk Factors, Exercise-, and Sports Participation, and Immigrant Status

Objective: This study aimed to estimate the number of weekly users of protein, creatine, and dieting supplements and to explore whether weekly use was related to eating disorder (ED) risk factors, exercise, sports participation, and immigrant status.

Methods: In total, 629 and 1,060 high school boys and girls, respectively, self-reported weekly frequency of protein, creatine, and dieting supplement use, and weight and shape concerns, appearance internalization and pressure, self-esteem, mental distress, physical activity level, exercise context, and the type and weekly frequency of sport played. Multiple hierarchical regression analyses were performed to investigate explanatory factors for supplement use.

Results: More boys than girls used protein and creatine supplements. Immigrant boys had more frequent use of all supplements than non-immigrant boys, and immigrant girls used creatine supplements more frequently than non-immigrant girls. In total, 23–40 and 5–6% of the variation in the weekly frequency of supplement use in boys and girls, respectively, was explained by immigrant status, ED risk factors, and exercise and sports participation. More frequent use of protein, creatine and dieting supplements in boys was significantly explained by more weight and shape concerns, fitness center exercise, and weight-sensitive sports participation. Depending on the type of supplement, more frequent use of supplements in girls was significantly explained by lower self-esteem, more engagement in weight-sensitive sports, and less engagement in general sport and exercise activities.

Conclusion: Weekly supplement use was common and more frequent among boys than girls. The weekly use of protein, creatine, and dieting supplements was related to ED risk factors, exercise and sports participation, and immigrant status in boys but not in girls.

Motivators of Indiscriminate and Unsafe Supplement Use among Young Australians

BACKGROUND

There is growing concern about the self-administration of supplements, which can often be indiscriminate, counterproductive to health, and serve as a gateway to more harmful drugs and substances. Research suggests that high uptake of performance- and image-enhancing drugs (PIEDs) is correlated with body image to accentuate masculinity. This study provides insights into limiting unhealthy supplement usage. This research identifies reasons for casual unhealthy supplement use among young adult Australians through the Theory of Planned Behavior (TPB) lens, providing practitioners with insights into developing interventions to deter their use.

METHOD

Semi-structured in-depth interviews were conducted with ten participants aged between 18 and 40, using a convenience sample. Leximancer analysis was used to assess word co-occurrence and map to TPB constructs.

RESULTS

Leximancer identified positive attitudes, social norms, and perceived behavioral control towards supplement usage. Key themes that influenced supplement use were weight loss, body image, nutrition, training, education, challenges, need, and time. Furthermore, using TPB constructs, affective and instrumental attitudes and prevailing norms were observed when investigating what would cause an individual to use supplements in an unhealthy manner.

CONCLUSION

Through understanding the motivations of indiscriminate supplement use across the Australian population, the study has uncovered several social factors that may reduce or limit the practice of unsafe supplement usage.

Creatine Supplementation in Children and Adolescents

Creatine is a popular ergogenic aid among athletic populations with consistent evidence indicating that creatine supplementation also continues to be commonly used among adolescent populations. In addition, the evidence base supporting the therapeutic benefits of creatine supplementation for a plethora of clinical applications in both adults and children continues to grow. Among pediatric populations, a strong rationale exists for creatine to afford therapeutic benefits pertaining to multiple neuromuscular and metabolic disorders, with preliminary evidence for other subsets of clinical populations as well. Despite the strong evidence supporting the efficacy and safety of creatine supplementation among adult populations, less is known as to whether similar physiological benefits extend to children and adolescent populations, and in particular those adolescent populations who are regularly participating in high-intensity exercise training. While limited in scope, studies involving creatine supplementation and exercise performance in adolescent athletes generally report improvements in several ergogenic outcomes with limited evidence of ergolytic properties and consistent reports indicating no adverse events associated with supplementation. The purpose of this article is to summarize the rationale, prevalence of use, performance benefits, clinical applications, and safety of creatine use in children and adolescents.