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Adolescent boys with an intense interest in building muscle were more likely than their peers to start binge drinking and using drugs, a large prospective study showed.
Boys ages 12 to 18 with a high concerned about muscularity and who used muscle- or strength-enhancing products were more than twice as likely as their peers to use drugs such as cocaine, crack, ecstasy, or methamphetamines (OR 2.16, 95% CI 1.49-3.11), according to a study published online in
JAMA Pediatrics.
Similar drug-taking behavior was found for boys in that age group who were focused on thinness as well as muscularity (OR 2.13, 95% CI 1.31-3.46), reported Alison E. Field, ScD, of Boston Childrens Hospital, and colleagues.
In addition, males concerned with their muscles who used potentially unhealthy products such as steroids to beef up their physique were more likely to binge drink compared with their peers (OR 2.06, 95% CI 1.58-2.69).
But there was no association with binge drinking or drug use for those with a focus primarily on being thin or those with eating disorders.
By the time the boys entered adulthood, there were significantly more of them who were extremely focused on weight and physique compared with those who developed eating disorders (17.2% versus 2.9%).
The concern with muscularity and use of potentially unhealthy substances to achieve a desired physique "may represent the male equivalent of purging disorder," Field and colleagues said.
They noted that this large group has been understudied in research and may be entirely missed by healthcare providers because they are not captured by the DSM-IV or the DSM-5 diagnostic criteria for eating disorders.
The results of the current study suggest that the focus in this age group should not be on aberrant eating behaviors but on the cognitive sympt0ms, "namely undue influence of weight and physique on self-evaluation."
Little is known about the prevalence of concerns about physique and eating disorders among boys because most of the research has been conducted among girls, researchers noted.
They therefore analyzed data on 5,527 boys who were 12 to 18 years old in 1999 and followed until 2011.
The boys were part of the Growing Up Today Study, which was begun in 1996 and included children of women participating in the Nurses Health Study II.
The mean age was 15, mean BMI 21, and more than 90% were white and of mid to high socioeconomic status.
Overall, the researchers found:
- 9.2% of the boys reported high concern with muscularity
- 2.4% reported high concern about muscularity and the use of supplements, growth hormones, or steroids to enhance their physique
- 2.5% had high concern about thinness
- 6.3% reported high concern about thinness and muscularity
When the researchers adjusted for age, all four of the above weight and physique categories were associated with an increased risk of becoming obese. But when they adjusted for BMI and dieting frequency, males with high concerns about thinness but not muscularity were more likely to become obese (OR 3.21, 95% CI 1.44-7.13).
Also, the focus on thinness but not muscularity was associated with depression (OR 2.72, 95% CI 1.36-5.44). There was a suggestion of a risk of depression for boys and adolescents who engaged in infrequent bulimic behaviors or overeating (OR 1.28, 95% CI 0.99-1.67).
Until the DSM-5 criteria are revised to better capture this group of boys and adolescents, healthcare providers need to be made aware of this potentially vulnerable group, the researchers concluded.
The study is limited because of the fairly homogeneous cohort, the use of self-reported questionnaires, and no data on whether the boys were involved with sports.
source: Medpage Today
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