Results from the current study reveal that behaviors aimed at increasing muscle size or tone are extremely common: almost all students report doing at least 1 behavior with this as the goal, and up to one-third reported the use of unhealthy methods, such as taking steroids or other muscle-enhancing substances. Muscle enhancement is common and was particularly high among boys and those involved in sports teams, as seen previously.19–21,23,24,29
However, use was not limited to these groups. This finding suggests that, in addition to a “thin ideal” and focus on leanness,35,36
muscularity is an important component of body satisfaction for both genders.
The current study found reports of muscle-enhancing behaviors (ie, steroids and other substances) to be higher than other recent research with US youth.20,21,37
These differences could be due to the demographic makeup of the different samples. The current study was almost 20% Asian youth (primarily Hmong), who reported higher rates of use of the muscle-enhancing behaviors examined here (compared with other racial groups in this study), but had lower representation in other recent studies.20,21,37
Similarly, our sample was largely of lower economic status, a group that has not been separately reported on in earlier work. Future research including a wider variety of muscle-enhancing behaviors and using a more diverse and nationally representative sample of young people is needed to replicate the current study’s findings.
This study’s findings regarding associations between higher BMI and the use of muscle-enhancing behaviors are subject to possible alternate interpretations. Specifically, high BMI may reflect muscle mass rather than adiposity (particularly in males), which may result from use of the behaviors of interest. However, existing research has shown that overweight and obese young people engage in a variety of weight control and body change strategies at greater rates than their average-weight peers,37–39
which suggests that weight status may indeed contribute to the adoption of the muscle-enhancing behaviors examined here. Further research with more comprehensive measures of body weight and composition is needed to disentangle this association.
Interestingly, this study did not find significant clustering of muscle-enhancing behaviors within schools. Rather than being driven by a particular school sports team coach or other features of a school’s social landscape, this diffusion suggests that muscle-enhancing behaviors are widespread and influenced by factors beyond school, likely encompassing social and cultural variables such as media messages and social norms of behavior more broadly. As with the large body of literature investigating an array of influences on body dissatisfaction relating to thinness, continued research into media portrayals of muscularity,5–7
as well as interpersonal interactions such as weight- and shape-teasing, or sharing muscle-enhancing substances among peers may be promising avenues for understanding the parallel phenomenon of dissatisfaction with regard to muscularity and unhealthy behaviors aimed at muscle enhancement.
Data for the current study come from a single state and, as such, may not be representative of muscle-enhancing behaviors elsewhere in the United States or in other countries. In addition, all measures were self-reported and included the use of illegal substances, which may have led to underreporting. Finally, more detailed measures of muscle-enhancing behaviors and body weight were not assessed. Specifically, we do not have data regarding whether respondents who changed their eating adopted healthy or unhealthy dietary changes, and use of several other muscle-enhancing substances were assessed in a single item. Similarly, the measure of BMI does not distinguish adiposity from weight because of muscle mass; it is therefore possible that associations seen here were due to increased muscle resulting from the behaviors under study. Future research should include other assessments of body weight and composition to further address this question.
However, the large and diverse sample from multiple schools permitted statistically valid analyses of relatively uncommon behaviors and smaller groups not typically considered in epidemiological research (eg, certain racial groups) and allowed for an examination of clustering by school. Finally, this study used 5 measures of muscle-enhancing behavior spanning the range from general health behaviors (eg, exercising) to extremely unhealthy behaviors (eg, steroid use), which provides a more comprehensive picture of muscle-enhancing efforts among a US sample of male and female youth than has been available previously.