Workout Supplement Overuse a Novel Eating Disorder?

Liam Davenport

August 28, 2015

Almost one third of men who use over-the-counter workout supplements to augment gym training are concerned about their use of the supplements, and almost 1 in 10 have been cautioned by their physician on this, a new study suggests.

Richard Achiro, PhD, California School of Professional Psychology, at Alliant International University, Los Angeles, who presented the research, said that the findings may point to the emergence of a novel eating disorder.

He told delegates that the biggest predictor of workout supplement overuse was body dissatisfaction. However, a model that included low self-esteem and gender role conflict or an underlying insecurity with one's sense of gender accounted for a greater variance in the overuse of supplements than body dissatisfaction alone.

"This is an interesting and important finding because it points to the fact that using these supplements excessively is about more than the body," Dr Achiro commented to Medscape Medical News.

"Rather, it seems that it has more to do with deeper, underlying issues relating to one's sense of self which tend to be concretized and represented by a perfectly muscular/lean physique in this population of men."

He presented the research at the American Psychological Association's 2015 Annual Convention.

To examine excessive workout supplement use, the researchers recruited 195 men aged 18 to 65 years who worked out at least twice per week and had consumed at least one supplement in the previous 30 days.

They administered the Legal Appearance and Performance-Enhancing Drug Scale (LAPEDS), an online survey developed for the study that asked questions on subjects that included supplement use, self-esteem, body image, eating habits, and gender role conflicts.

The results showed that more than 40% of men had increased their use of supplements over time, and that 22% had replaced regular meals with dietary supplements not intended as meal replacements.

Moreover, 29% of respondents said that they were concerned about their supplement use, and 8% reported that their physician had told them to reduce or stop taking supplements because of actual or potential adverse effects.

The findings also revealed that 3% of the men had been hospitalized because of kidney or liver problems related to the use of supplements.

The researchers then administered complete subscales of the Eating Disorder Examination Questionnaire to the participants and found a high correlation with the LAPEDS.

Structural equation modeling revealed that excessive use of supplements and disordered eating, collectively termed risky body change behaviors, were associated with internalization of cultural standards of attractiveness, self-esteem, gender role conflict, and body dissatisfaction.

These relationships were moderated by the phase of training, specifically, the "bulking," "cutting," and "maintaining" phases, which suggests that phase of training is a critical factor to understanding shifts in risky body change behaviors.

Discussing the findings, Dr Achiro noted that eating disorders have traditionally been overlooked in men. "I think it's been missed because we have historically only characterized eating disorders in line with a woman's drive for thinness, and we haven't really considered that, for men, a lot of times, the end in terms of what their physiological ideal looks like is different from women."

"So it makes sense to believe that the way in which eating disorder behavior is getting expressed in men is different from that of a woman."

The problem is compounded by men being generally "harder to reach" in terms of psychological treatment, Dr Achiro said. He hoped that general practitioners become more aware of this issue and ask their patients whether they are overusing these supplements if they experience problems with diarrhea or with their liver.

Dr Achiro stressed that he is not on a "crusade" against the supplement issue. "I think these supplements can be used healthfully by many men, and I'm certainly not opposed to a lifestyle that includes working out for fitness and using supplements, if that's part of what helps to make a man fit," he said.

"I'm really talking about the psychological factors, such as low self-esteem, underlying insecurities with masculinity, and body dissatisfaction, that are being expressed in a way that's looking more and more like an eating disorder in this population of men."

He concluded: "It's important to realize that as men's bodies get objectified more and more in the media and catch up to the way in which women's bodies have been objectified in the media, it only makes sense to believe that more emotional health or psychological health issues in men are going to start expressing themselves in the form of eating disorders, which historically has not been the case."

Cautious Interpretation

Approached for comment, Stuart Murray, PhD, a postdoctoral fellow at the University of California, San Diego, Eating Disorders Center for Treatment and Research Program, described the study as "valuable" and "novel."

Nevertheless, he cautioned: "We have to be very careful in interpreting data like this. It would be beyond the data if the authors suggested that protein supplement consumption was linked with disordered eating or caused disordered eating or was reflective or a symptom of disordered eating."

"I think the next step in this line of research really needs to be looking at what's normative protein supplement consumption."

Dr Murray highlighted that it is clear from recent studies that eating disorders are more common among men than has previously been thought, with 25% of anorexia nervosa and bulimia nervosa and 50% of binge eating disorder cases occurring in men.

He added: "I do agree with the sentiment that it's less likely to be on the clinician's radar to screen for protein consumption in the context of screening for an eating disorder."

"I think that a strength of this [study is] that it's shining a light on a new variety of potential behaviors, [and] it illustrates how other eating disorders can be behaviors oriented towards more muscular bodies and not just towards thinner bodies."

Dr Murray pointed out that, historically, men have been excluded from studies of eating disorders, and "those studies went on to inform the diagnostic criteria and treatment paths."

He said: "We have this female-centric view of eating disorders, when, in reality, the ideal portrayed to males is muscular, and so it stands to reason that when you value a muscular body, the kind of behaviors that you endorse to obtain that body will be different than for a woman who values a thin body."

The authors and Dr Murray have disclosed no relevant financial relationships.

American Psychological Association 2015 Annual Convention. Session 1340. Presented August 6, 2015.


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