Most teens are trying to build up or tone muscles, a new survey suggests. And some are doing this in potentially dangerous ways, the study finds. The study was based on a survey of about 2,800 middle and high school students from the Minneapolis-St. Paul area. More than 90% of boys and 80% of girls said they exercised more in order to build or tone muscles. About two-thirds of boys and nearly that many girls said they had changed their eating habits for the same reason. One-third of boys and one-fifth of girls had used protein powders or shakes. Some teens even used potentially dangerous supplements or drugs. About 5.9% of boys and 4.6% of girls said they had used steroids. About 10.5% of boys and 5.5% of girls had used creatine, amino acids, hydroxyl methylbutyrate (HMB), DHEA or growth hormones. The journal Pediatrics published the study. USA Today, the Washington Post, HealthDay News and Reuters Health news service wrote about it November 19.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Teenagers these days want to have bigger muscles. And they are willing to do unhealthy things to get them.

That's the message of a study released today in Pediatrics, the official journal of the American Academy of Pediatrics. Researchers looked at questionnaires filled out by almost 3,000 middle school and high school students from the Minneapolis-St. Paul area. The questions were part of the EAT (Eating and Activity in Teens) 2010 survey.

Teens were asked how often they had tried to increase their muscle size by doing any of the following five things:

• Changing their eating
• Exercising more
• Using protein powder or shakes
• Using steroids
• Using another muscle building substance (such as creatine, amino acids, hydroxyl methylbutyrate, DHEA or growth hormone)

The numbers the survey came up with were surprising. Another recent study found that 8% of female teens and 10% of male teens used protein supplements. But in this latest study, roughly 3 times that many teens reported using them. About 6% of boys and 4% of girls admitted to using steroids. Again, that's 3 times as many as found in the other study. As for creatine and other muscle building substances, about 10% of boys and 5% of girls said they were using them, more girls than previously known.

The study had other interesting findings, too. For example, teens who were overweight were more likely to be doing things to increase muscle size (instead of trying to lose weight). Being on a sports team increased the likelihood that teens would be trying to build muscle. But the difference wasn't as large as researchers thought it might be.

All of this is worrisome. Taking supplements and steroids can be dangerous for your health -- especially if it's being done without a doctor's supervision. It's likely that many of the parents didn't even know their children were using these products.

What Changes Can I Make Now?

The researchers didn't ask the teens why they were trying to get bigger muscles, so we don't know for sure. But we do know that in the media, the "ideal" body is becoming more muscular. There are more images of scantily clad men rippling with muscles. This ideal applies to women, too. No longer is it just about being thin. Now girls want to be thin with muscles.

If you are a parent of a teen, it's important to be aware of this issue and talk about it. Discuss how your teen feels about his or her body. Talk about healthy eating and exercise. Make sure there is plenty of healthy food, including fruits and vegetables, in the house. Try not to buy junk food, fast food or sweetened beverages. Do everything you can to get your teen engaged in sports and other activities that involve exercise.

Set a good example, too. Eat well, get exercise and don't complain about your body -- or criticize the bodies of others. Remember that our children watch what we do more than they listen to what we say.

The authors of the paper say that doctors should talk with their teen patients about their "muscle-enhancing behaviors." While this is true, doctors aren't the only ones who should be asking. Parents, teachers, coaches and anyone else working with youth should be aware of this issue and be talking to teens about healthy choices.

What Can I Expect Looking to the Future?

The media are having a growing impact on our lives -- and that impact is not all positive, especially on our children. We've known for a while that media images of thin bodies have contributed to eating disorders in children. Now we also find that the quest to look muscular is causing many of our teens to do things that could be unhealthy.

I hope that this study and others like it will help guide us as we think about ways to keep our teens both physically and emotionally safe in this ever-changing world.