Behaviors Among Adolescent Girls and Boys

Eisenberg ME, Wall M, Neumark-Sztainer D. Pediatrics.
2012 Dec;130(6):1019-26. doi: 10.1542/peds.2012-0095. Epub 2012 Nov 19.

the emphasis that is placed on sport and performance in today’s society, there
is no doubt that adolescents are engaging in muscle building behaviors. With
the potential to earn a collegiate scholarship, it’s also not out of the
question that some of these adolescents might be looking to gain muscle and
strength by pursuing less healthy means. 
In addition, socio-cultural factors may be impacting adolescents’ body
image, forcing many young females to engage in muscle enhancing activities to
promote leanness and muscle tone. 
However, it remains unknown which demographics are engaging in either
the healthy or unhealthy tactics, and to what degree.  Therefore, the purpose of this study was to
examine the prevalence of five muscle building behaviors in male and female
adolescents across various races, weight status, socio-economic status
(measured by parents education level) and sport team involvement.  For this study 2793 adolescents (mean age
14.4 y/o) from 20 different urban middle (grades 6-8) and high (grades 9-12)
schools were surveyed using the 2010 Eating and Activity in Teens survey, and
their height and weight were measured by the research staff.  The Eating and Activity in Teens 2010 survey
is a 235-item self-report assessing factors possibly related to weight status
and weight related behaviors in adolescents. 
For this study questions from previous surveys were adapted to address
muscle building behaviors.  The
participants were asked how often they performed the following muscle enhancing
behaviors over the past year (never, rarely, sometimes, or often).  The questions included (a) “Changed my
eating”, (b) “Exercised more”, (c) “Used protein powder or shakes”, (d) “Used
anabolic steroids”, (e) ”Used another muscle building substance” (creatine,
amino acids, DHEA, growth hormone).  Based
on those questions, behavioral changes (a) and (b) were deemed to be the
healthy options while (c), (d), and (e) were deemed the unhealthy options.  These behaviors were common in both boys and
girls but especially prevalent in boys. 
More than 2/3 of boys reported changing their eating habits (12%
performed often) to help promote muscle growth while more than 90% reported
exercising more (41% performed often). 
Within the unhealthy activities protein usage was reported by 35% of
respondents, 6% reported using anabolic steroids and 11% reported using other
substances.  Responses showed that nearly
65% of girls surveyed reported changing their eating habits and over 80% have
exercised more.  Girls also utilized
protein supplementation (21%), anabolic steroid usage (5%) and “other
substances” (6%). Boys (12%) and girls (6%) both admitted to using 3 or more of
the muscle-enhancing behaviors. 
Furthermore, 61% of boys and 41% of girls from a low socio-economic
status admitted to using 3 or more of the techniques while 37% and 30% of these
male and female respondents admitted to using anabolic steroids.  Also of note, participants with average body mass index
were more prone to use anabolic steroids (24% and 37% male to female) and
utilizing 3 or more of the muscle enhancing techniques (64% to 46% male to

study does a nice job of illustrating that there is anabolic steroid use in an
adolescent female population.  With so
much pressure to compete for scholarships and to meet the socio-cultural beauty
standards, it stands to reason that anabolic steroid use in females would be
prevalent.  Furthermore the results show
that the bulk of respondents came from lower socio-economic statuses.  This was done intentionally by the authors
because it is an area that has often been looked over.  The utilization of these muscle-enhancing
techniques, by both boys and girls, may possibly be seen as a means to earning
a college scholarship, as way to offset college tuition or as the only possible
way to attend college.  With this
information available, the authors believe that targeted interventions by
pediatricians and school physicals may be a way to properly educate adolescents
and their families about proper muscle enhancement.  What are your thoughts on this study?  Are you surprised by the results? Is it
alarming to you that children as young as 11 or 12 years old are consuming protein
supplements, injecting anabolic steroids or utilizing creatine in order to add
muscle mass? What are you seeing in your athletes and what form of steps have
you taken to help educate the students, their families and administrators?

by:  Mark Rice
by:  Stephen Thomas


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Eisenberg ME, Wall M, & Neumark-Sztainer D (2012). Muscle-enhancing Behaviors Among Adolescent Girls and Boys. Pediatrics, 130 (6), 1019-26 PMID: 23166333