CNN
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Recent studies indicate that protein shakes, pre-workout supplements, and various other dietary aids are not merely components of a gym routine; in adolescents and young adults, they may also be linked to body image disorders characterized by an obsessive focus on muscle growth and leanness.

Dr. Kyle Ganson, an assistant professor at the Factor-Inwentash Faculty of Social Work at the University of Toronto and the lead author of the study, noted via email, “The consumption of six specific dietary supplements aimed at muscle enhancement was linked to increased symptoms of muscle dysmorphia. This encompasses widely used products like whey protein and creatine, particularly among young individuals looking to build muscle.”

The research revealed a particularly strong correlation between muscle dysmorphia and weight-gain supplements. Symptoms, such as spending excessive hours at the gym and preoccupation with dietary choices, escalated with the number of supplements used, as highlighted in a recent article published in PLOS Mental Health.

The research team evaluated data from 2,731 individuals aged 16 to 30 as part of the Canadian Study of Adolescent Health Behaviors, which focuses on disordered eating habits, muscle-building tendencies, body image, and social health. Participants’ reported use of dietary supplements was contrasted with their assessed symptoms of muscle dysmorphia using the Muscle Dysmorphic Disorder Inventory.

As an observational study, it remains unclear whether supplement use contributes to the development of muscle dysmorphia symptoms or if individuals already experiencing these symptoms are more inclined to use more supplements, explained Dr. Gail Saltz, a clinical associate professor of psychiatry at NewYork-Presbyterian Hospital and Weill Cornell Medical College, who was not part of the research.

The findings suggest that many young individuals who may not resort to anabolic steroids—known to have detrimental health effects—might still be utilizing other substances as a way to cope with muscle dysmorphia, highlighting a need for greater public awareness, according to Saltz.

“People often assume that supplements are safe simply because they are labeled as such,” Saltz cautioned. “However, this is not necessarily the case.”

Muscle dysmorphia is classified as a variant of body dysmorphic disorder, characterized by an intense fixation on a perceived flaw in appearance, as described by Saltz. Individuals suffering from muscle dysmorphia often believe they need to be leaner and more muscular.

“Those grappling with muscle dysmorphia frequently encounter significant social difficulties and can endure severe emotional distress,” Ganson stated. “Moreover, these individuals might take extreme measures to achieve their body ideals, which could include the use of anabolic steroids.”

It’s important to note that the issue goes beyond mere self-esteem issues, according to Saltz. Even if individuals reach the body image they are striving for, the underlying distress may not disappear.

“When they look in the mirror, their perception differs significantly from what others see,” she explained.

Warning signs of muscle dysmorphia can include an overly strict exercise regimen, emotional turmoil, and struggles with meeting academic or professional expectations, according to Ganson.

Individuals with muscle dysmorphia may also avoid typical body exposure, such as going shirtless at the beach, or skip social events due to concerns about their appearance, Saltz added.

The inclination to use supplements for altering physical appearance is widespread.

While approximately 2.2% of young adult males report using anabolic steroids, a striking 36.3% report using protein powders and shakes, and 10.1% admit to using various other muscle-enhancing products like creatine and growth hormones, according to a study published in June 2022.

Most supplements are easily accessible and subject to minimal regulation, leading to concerns. “Research on these products has identified that many are misrepresented and sometimes contaminated with harmful substances, including anabolic steroids,” explained Dr. Jason Nagata, an associate professor of pediatrics at the University of California, San Francisco and co-author of the study.

While the U.S. Food and Drug Administration (FDA) does monitor negative health impacts and occasionally inspects production facilities, the agency lacks the authority to approve dietary supplements before they are sold to the public under the Dietary Supplement Health and Education Act.

Nagata also pointed out that there is a scarcity of studies evaluating the safety and effectiveness of dietary supplements.

“Legal muscle-building supplements can act as a gateway to steroid use,” Nagata noted. “Our previous research has shown that young adults who use muscle-enhancing substances are three times more likely to begin using anabolic steroids within seven years.”

Additionally, many pre-workout supplements contain caffeine—some equivalents to multiple cups of coffee.

Some individuals engage in a practice known as “dry scooping,” which involves consuming protein powder without mixing it with water.

“Dry scooping is particularly unsafe as it delivers a concentrated dose of a product that should be diluted in water,” Nagata warned. “This practice can lead to toxic effects due to the high concentration.”

It’s crucial to challenge the narratives and ideals portrayed in social media, especially for teenagers undergoing developmental changes and frequently comparing themselves to others during puberty, according to Nagata.

“Social media often promotes muscle-enhancing supplements and anabolic steroids, showcasing exclusively their positive effects,” he pointed out. “This can aggravate body image issues and lead to muscle dissatisfaction, resulting in the use of anabolic steroids or other muscle-enhancing drugs and supplements, particularly among teenagers.”

This trend is especially prevalent among boys, who tend to share their physiques more publicly than girls and are more inclined to emphasize muscles over facial appearances on social media, Nagata noted.

“Men’s physiques are more visible on social media than ever, especially through influencer accounts. The idealized images shared by influencers are often heavily altered or represent the best among numerous photos,” he added.

Treatment options for muscle dysmorphia vary and may include cognitive behavioral therapy, which focuses on examining and reframing thought patterns, according to Saltz.

In some cases, medications prescribed for anxiety, depression, or obsessive-compulsive disorder may also be necessary, she added.

Families, healthcare providers, and sports coaches play a crucial role in recognizing muscle dysmorphia in younger individuals, according to Saltz.

Given that the perceived flaws often feel very real to those affected, gaining insight into the problem can be challenging. Those surrounding individuals with muscle dysmorphia can assist by understanding the signs to look for.