Muscle-building supplements may put teens at risk for a body image disorder, study finds

Protein shakes, pre-workout mixes and other supplements aren’t always just a part of a gym routine. In adolescents and young adults, they could be connected to a body image disorder that exhibits a pathological focus on muscle development and leanness, according to new research.

“The use of 6 different dietary supplements intended for muscle building was associated with greater symptoms of muscle dysmorphia,” said lead study author Dr. Kyle Ganson, assistant professor in the Factor-Inwentash Faculty of Social Work at the University of Toronto, via email. “This included whey protein powder and creatine, both of which are commonly used among young people trying to gain muscle.”

The association was especially strong with supplements for gaining weight or mass, and the symptoms, such as excessive gym time and obsessing over food intake, increased as the number of supplements used grew, according to a new study published Wednesday in journal PLOS Mental Health.

The study team analyzed data from 2,731 participants ages 16 to 30 of the Canadian Study of Adolescent Health Behaviors, which aims to gather information on disordered eating, muscle-building behavior, body image and social health. The researchers analyzed the participants’ reports of supplement use against their symptoms of muscle dysmorphia, which were assessed using the Muscle Dysmorphic Disorder Inventory, according to the study.

The study is observational, meaning it’s hard to say whether the use of supplements increased the symptoms of muscle dysmorphia or if people with more muscle dysmorphia symptoms were more likely to take more supplements, said Dr. Gail Saltz, clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital and Weill Cornell Medical College. Saltz was not involved in the research.

This study shows that younger people who may not use anabolic steroids, which have been found to be harmful, might still be using other substances to treat their muscle dysmorphia, and the public needs to be more aware, Saltz said.

“Many people think supplements are safe because it’s just a supplement,” she said. “But in fact, that is not always the case.”

What is muscle dysmorphic disorder?

Muscle dysmorphia is a subset of body dysmorphic disorder, in which an individual is preoccupied with an imagined defect in their appearance, Saltz said. Those with muscle dysmorphia believe their body should be leaner and more muscular.

“People who experience muscle dysmorphia often have significant challenges in their social lives, and can experience severe emotional distress,” Ganson said. “Not to mention, these individuals may go to extreme lengths to achieve their body ideal, such as using anabolic steroids.”

And it isn’t just a matter of lowered confidence, Saltz said. Even if people with this disorder reach the ideal image they are striving for, it doesn’t fix the distress.

“When they look in the mirror, they don’t see what you see when you look at them,” she said.

Other warning signs include having a rigid exercise routine, experiencing emotional distress, and facing difficulty completing expectations such as school and work, Ganson said.

You might also see people with muscle dysmorphic disorder avoiding socially normal body exposure — such as removing their shirts at the beach — or missing social gatherings because of feelings around their appearance, Saltz added.

What’s so bad about supplements?

Using supplements to change a body’s appearance is common.

While 2.2% of young adult males report using steroids, 36.3% report using protein powders and shakes, while 10.1% said they use other muscle-building substances such as creatine and growth hormones, according to a June 2022 study.

Most supplements are readily available with little to no regulation, and “studies analyzing these products have found that many are mislabeled and are tainted with harmful substances like anabolic steroids,” said study coauthor Dr. Jason Nagata, associate professor of pediatrics at the University of California, San Francisco.

The US Food and Drug Administration does monitor adverse health impacts and occasionally inspects manufacturing facilities. However, under the Dietary Supplement Health and Education Act, the agency does not have jurisdiction to approve dietary supplements before they enter the public marketplace.

There are also few studies on supplements’ safety and efficacy, Nagata added.

“Muscle-building supplements, which may be legal, can serve as gateway drugs to steroid use,” Nagata said. “We previously found that young adults using muscle-building substances were three times more likely to start anabolic steroid use seven years later.”

Pre-workout supplements often contain caffeine — some with the same amount found in several cups of coffee, he added.

Some people “dry scoop” before a workout or consume protein powder dry without mixing in water, Nagata added.

“Dry scooping is particularly dangerous practice because it provides a high and potent dose of a product that is meant to be diluted in water,” he said. “Dry scooping provides a pure and highly concentrated burst of a product that can have toxic effects.”

How to treat muscle dysmorphia

One important step is to challenge the information and ideals coming out of social media, especially for teens who are undergoing rapid changes and making frequent comparisons with others during puberty, Nagata said.

“Social media posts about muscle-building supplements and anabolic steroids overwhelmingly demonstrate positive muscle-building effects,” he said. “Social media can exacerbate body comparisons and lead to muscle dissatisfaction and the use of anabolic steroids or other muscle-building drugs and supplements in teens.”

This use of social media is especially true for boys, who are more likely to allow for a public following than girls and are more likely to show off muscles online than faces, Nagata said.

“Men’s bodies are on display more than ever on social media, especially through influencer accounts. The idealized bodies that influencers post may be heavily filtered or the best of hundreds of photos,” he added.

When it comes to treating muscle dysmorphia, there are many methods that can be helpful, including different forms of cognitive behavioral therapy that help examine thought patterns and reframe perceptions, Saltz said.

Sometimes medications –– such as those used to treat anxiety, depression and obsessive-compulsive disorder –– are needed as well, she added.

Families, health care professionals and sports coaches are key in helping to identify muscle dysmorphia in adolescents and young adults, Saltz said.

Because the imagined defect feels so real to the person experiencing the condition, it can be hard to have insight into the problem, she added. The people around an individual with muscle dysmorphia can help by knowing what to look for.

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