The prevalence of, and motivation for, mass building supplement use among teenage males

Inhaltsverzeichnis

Acknowledgments

Abstract

List of Figures / Tables

1 Chapter 1: Introduction
1.1 the research topic
1.2 the research problem
1.3 aim and objectives of the research
1.4 definitions of some terms and concepts

2. Chapter 2: Literature review / theoretical framework
2.1 historical perspective on steroid and supplement development
2.2 supplements
2.2.1 products - form, brands, availability
2.2.2 potential dangers of supplement use for teenagers
2.3 motivational components of supplement use
2.3.1 sport
2.3.2 body dissatisfaction
2.4 Body Dysmorphic Disorder
2.5 Muscle Dysmorphia

3 Chapter 3: Research design and methodology
3.1 sampling procedure (size and characteristics of sample group)
3.2 measuring instrument (questionnaire development)
3.3 procedure followed to gather data
3.4 technique for data analysis
3.5 sources of error

4.1 results of research
4.2 discussion of findings

5 Chapter 5: Conclusions and recommendations
5.1 conclusions and evaluation of hypothesis
5.2 recommendations for further study

6 List of references

7 Appendices
7.1 Appendix A - List of OTC Mass Building Supplement Brands in South Africa.
7.2 Appendix B - Commonly Used Mass Building Supplements and their Adverse Effects.
7.3 Appendix C - Questionnaire Administrator Instructions
7.4 Appendix D - Questionnaire
7.5 Appendix E - Code Sheet for questionnaire
7.6 Appendix F - Raw Data

Acknowledgments

The journey towards this, the end product of many months of hard work, has not been an entirely isolated one. I would like firstly to thank my academic advisor Lauran Benjamin for her nurturing guidance, support and gently encouragement „pushing" me to constantly improve the quality of work delivered. Her advice has been both informative and thought-provoking.

Sincere appreciation goes to Mr W Illsley, the Headmaster of Pretoria Boys" High School for graciously granting access to the sample group, without which this research would not have been possible. To his secretary, Ms К Dodds and the team of tutor teachers, many thanks for taking the time to assist in the coordinating, distribution and administering of the questionnaires; your assistance is greatly appreciated.

Finally, to my friends and family, who have no doubt heard quite enough about this topic already; your quiet support and patience has made the „dream" a reality. My seemingly endless hours of being preoccupied with work have come to an end, and now you have my undivided attention. I am forever grateful for your understanding and encouragement.

ABSTRACT

The main objective of this study was to gather information from South African teenagers as to the prevalence of, and motivation for, the use of mass building supplements. In addition to gathering information pertaining to the frequency of use, the favoured brand of supplement and the type of supplements used by teenagers; the study also focused on attempting to identify an „at risk" age for the commencement of supplement use. The motivation for the use of mass building supplements was integral in the formulation of the hypothesis; that body dissatisfaction was the primary motivation more than increased sporting prowess for the use of supplements.

Gathering of quantitative data took the form of a structured questionnaire comprising three distinct sections. The first section gathered demographic information on age, grade, race and sporting involvement. The second section focused attention on body image questions and contained three components. In the first component the respondents were asked to rate their level of „body satisfaction" using a Likert-type scale for various aspects of their physique. The second component focused on their „thoughts" about their body and the last component focused on the level of „appearance importance" of the respondents. This section of the questionnaire utilized analysis tables generated originally by Thomas F Cash. The third section focused on gathering information in relation to the level, frequency and descriptions of mass building supplement use among the respondents.

The questionnaire was administered to Grade 8-12 learners (aged 12-19years old) of a Boys" School in Pretoria, South Africa. The sample group was randomly selected and yielded 176 completed or partially completed questionnaires. Data was entered into the Moon Stats statistical programme for analysis; affording the opportunity to generate univariate and bivariate statistics along with calculations of Pearson"s product-moment correlations.

Analysis of data yielded the following results:

The most participated sport of respondents was rugby, with 58,86% of respondents participating in multiple sports. In relation to level of body satisfaction only 9,66% of respondents scored into the „problem zone" indicative of high levels of dissatisfaction with their physical appearance. Only 5,11% were challenged by thoughts of inadequacy with reference to their physical appearance, but 29,89% of respondents scored high enough to fall into the „problem zone" on the questions relating to „appearance importance"; implying that significantly more emphasis is placed on the need to „look good".

It was evident that 40,23% of the teenagers in this study had taken mass building supplements and 25,29% were currently using. The most favoured brand of supplement was USN, with protein shakes being the most common choice of ingestion. Only 2,3% of respondents indicated that they had ever taken steroids and 2,31% indicated that they have used human growth hormones. In relation to the motivation for use, 39,44% indicated that their motivation for use was to look leaner and more muscular, and 45,07% were motivated by improved sporting prowess. The Grade 10 age group was identified as a potential „at risk" group due to the high level of body dissatisfaction and appearance importance.

Pearson product-moment calculations indicated a very weak correlation between body image perception and mass building supplement use. There was also no significant correlation between the motivation for use and current use of supplements. The hypothesis for this study was disproved by the statistics.

Further study in the area of mass building supplement use may focus on the „triggers" for the commencement of use among teenage males. A significantly larger sample group may produce different results than those generated by this study. Longitudinal studies may deliver information as to the potential „gateway" nature of mass building supplements towards subsequent steroid use.

LIST OF FIGURES / TABLES

Figure 1: Bar Chart for Grade

Figure 2: Frequency Histogram for Satisfaction

Figure 3: Frequency Histogram for Thoughts

Figure 4: Frequency Histogram for Appearance Importance

Figure 5: Pie Chart for Current Use ofMass Building Supplements

Figure 6: Pie Chart for Reason

Figure 7: Frequency Histogram for Sport Involvement

Table 1: Cross Tabulation of Grade by Reason for use

Table 2: Cross Tabulation of Grade by Satisfaction

Table 3: Cross Tabulation of Grade by Appearance Importance

Table 4: Cross Tabulation ofReason by Appearance Importance

1 Chapter 1: Introduction

1.1 The Research Topic

The topic of this research is grounded in two fundamental ideas; firstly that teenage males have a desire to look more toned and muscular than they are (Andersen et al.: 2000) and secondly that studies suggest that approximately half of all anabolic steroid abusers are teenagers (Fitzhugh: 2003). The suggestion by Pope et al. (2000), that over-the-counter (OTC) supplements act as ^gateways" to the use of anabolic steroids implies that it is likely that the teenage steroid users began with supplements.

Discussions on OTC supplements have, in the past, been overshadowed by focus on steroid use among both adult and teenage males. In Kanayama et al. (2009) it is suggested that the progression from supplement use to steroid use may be grounded in body image disorders. As such it is of relevance to prioritize the view of teenage males of their bodies in the development of this research.

The prevalence of use of mass building supplements is poorly covered in literature, particularly with reference to teenage males. If the suggestion of Pope et al. is accurate, it would make more sense to be focusing our attention on the teenagers" use of mass building supplements at school level to intervene and prevent the progression to steroid use.

The motivation for supplement use, according to Fitzhugh (2003) is primarily to change the physical appearance rather than improve sporting prowess. This is supported by Morgan (2008) who purports hat society has gradually made the ideal male physique into a “testosterone-driven mesomorphic (triangular) look” (p101).

In light of initial research into the topic of steroid use and abuse among teenage males, I began to question the prevalence of use of mass building supplements among teenage males. The ease of availability of OTC supplements in stores made me question the level of support that this industry gains from teenage boys. In addition, the primary motivation for the use of supplements must be grounded in one of two aspects; body image concerns or a desire to increase their sporting prowess.

1.2 The Research Problem

If the overwhelming purpose of supplement use among teenagers is indeed to improve their physique rather than to improve sporting prowess, it is poignant to focus attention on the body image perception of teenagers. The body image is the personal relationship with the body, the perceptions, beliefs, thoughts, feelings and actions that pertain to the physical appearance (Cash: 2008). Perceived inadequacies in the physical appearance can lead to obsessive behaviour in an attempt to correct the perceived flaw in the appearance. If the focus of this flaw is the inadequacy of the physical appearance it could lead to supplement use in an attempt to „bulk-up" or generate the „wash-board" abdominals desired by many teenagers.

Extreme cases (approximately 2% of the general population) can develop into (BDD) Body Dysmorphic Disorder (Cash: 2008). When teenagers become obsessively preoccupied with flaws in their appearance that causes significant emotional distress, they are suffering with Body Dysmorphic Disorder (Martin & Costello: 2008). Barlow & Durand (2005) found that up to 70% of college students complain of dissatisfaction with their bodies.

According to Phillips (2009), Muscle Dysmorphia (MD) is the most common form of Body Dysmorphic Disorder, occurring exclusively in males. In Paterson (2008) it is professed that one of the identifying characteristics of a male suffering with Muscle Dysmorphia is a poor self-image. Males with MD are preoccupied with the perception that they are too skinny or not muscular enough (Veale, Willson & Clarke: 2009). The possible grounding of supplement use among teenage males in body image dissatisfaction, with the potential for progression into BDD or MD adds value to my initial concerns around OTC supplement use in teenagers. If the motivation for supplement use is born from poor body image, the shift towards Body Dysmorphic Disorder and Muscle Dysmorphia could be easier or more rapid than previously anticipated.

Literature which discusses supplement use makes mention of both physique and sporting prowess as motivators for the use of OTC supplements. It is however unclear whether these factors are interrelated as causes for supplement use or whether there is simply a lack of clarity on the underlying motivation in teenagers. In light of this I hope to add clarity to the motivating factors responsible for the use of mass building supplements in teenage males.

1.3 Aim and objectives of the research

The general aim (or purpose) of this research is to gather information from teenage males on their use of mass building supplements, outlining the most favoured types of products, identifying the most popular brand of supplements used and the prevalence (or frequency) of use. In addition an attempt will be made to identify an „at risk" group of teenagers (age group or grade) for mass building supplement use, i.e. which age group is most susceptible. Information will also be gathered as to their motivation for mass building supplement use, i.e. body dissatisfaction or sporting prowess.

Gathering of this information aims to add to the current body ofknowledge on prevalence and motivation for mass building supplement use among teenage males.

Whilst the general aim is to gather information, I would like to be able to identify a correlation between mass building supplement use and either poor body image (body dissatisfaction) or desire for sporting prowess as a motivating factor.

The specific objectives for this research gave the outline for the data gathering process, which was created as a questionnaire to gather quantitative data. The specific objectives are listed here as questions:

- What is the prevalence of mass building supplement use among teenage males? (Teenagers being the unit of analysis)
- Is there a specific age group between 12-19 year olds that seems to be more prone to the use of mass building supplements?
- Which brand of supplements are the most favoured among teenagers?
- Are more than one brand of supplements used together?
- What is the extent of sport involvement in the sample group?
- What is the motivation for mass building supplement use? (Is it motivated by body dissatisfaction or the desire for sporting prowess?)
- What is the level of body dissatisfaction among teenagers? (with specific reference to their overall perception of their body, their thoughts on their body shape and the importance of appearance of their body)

The specific hypothesis for this research is indicated below:

Teenage body dissatisfaction is the primary motivation for the use of over-the-counter supplements in an attempt to increase muscle mass and hence improve the body image.

In order to address the specific aim and objectives of this research and thus evaluate the hypothesis stated above, a research questionnaire was developed. The questionnaire was generated with collection of quantitative data in mind, and comprised three distinct sections.

The initial section of the questionnaire gathered demographic information from the respondent group. This information included a question requiring data on sport involvement. The second section focused on body image perceptions and the final section was related to mass building supplements.

The sample group was teenage males from Grades 8-12 from a local boys" school in Pretoria, South Africa. A structured questionnaire was administered; the data was coded and entered into the Moon Stats programme for ease of statistical analysis. Correlations were determined using the calculation of the Pearson product-moment correlation, producing both „f' and „p" values.

In the following chapter, attention will be given to the historical perspective of steroids; the range of types of supplements will be discussed, outlining the potential dangers of supplement use for teenagers. As the motivation for use of supplements is integral in this research, each of the motivating factors (body dissatisfaction and sporting prowess) will be discussed. The remainder of the chapter will focus attention on Body Dysmorphic Disorder and Muscle Dysmorphia.

1.4 Definitions of some terms and concepts

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2. Chapter 2: Literature review / theoretical framework

2.1 Historical perspective on steroid and supplement development

In any research revolving around teenagers and their use of „mass building" supplements it is important to note that the use of supplements to build mass and the use of steroids are not mutually exclusive. Many authors of works on body image and steroid use believe that they are inextricably linked. It is debatable as to whether the use of over-the-counter supplements are a „gateway" to the use of more damaging steroids but the overwhelming feeling confirms that the risk is increased when teenagers begin to take supplements.

The Centre for Disease Control and Prevention's (CDC) Youth Risk Behaviour Surveillance- United States, reports that the percentage of students using steroids increased to 6,1% by 2002. The common belief that „supplements" are not potentially dangerous has resulted in a limited amount of information about youths (of school-going age) and their „supplement use" habits. As such, the preliminary information for this research will focus on the prevalence of steroid use among males. The National Centre for Education Statistics estimated that in 2005, of “16,5 million some 5,4% of the public and private school children between” the ages of 14-17 years (660 000 children) had used or were using steroids. In Body Dysmorphic Disorder in Men, Phillips indicates that between 6 and “7% ofhigh school boys have used these drugs” (Phillips: 2001).

Adolescent anabolic steroid use is a nationwide phenomenon with “prevalence rates among high school males [ranging] from 5-11%”, with high school athletes continuing to use these agents to improve their athletic performance and appearance despite the associated risks (Proctor: 1998). In addition, it is reported that school children begin using anabolic steroids before the age of 16 years and up to 86% of these students have no intention to cease their use of these illegal drugs. In light of these statistics, in any attempt to reduce the associated health risks of steroid use/abuse, it is imperative that implementation programmes to that effect are introduced into the school curriculum at the very latest in junior high.

“Performance enhancing drugs” have been around for centuries; the ancient Greeks used “strychnine and hallucinogenic mushrooms” in preparation for the original Olympic Games; years later (1886), the first athlete died from using performance-enhancing drugs (Luciano: 2001, 175). It is agreed that the initial use of performance enhancers was related to sporting achievement but today we are seeing more males utilizing supplements for non-sporting gains.

Metabolic and anabolic-androgenic steroids were first studied on experimental animals; the influence of the testis on metabolic processes in tissues other than the accessory sex organs has been recognized for a long time. The “dramatic effects on vigour and energy reported by Brown-Seguard (1889) after the self­administration of testis glycerol extracts focused attention on energy metabolism, and later several investigators administered extracts to experimental animals, with small and questionable results on energy and nitrogen metabolism” (Kock, 1989; Moore, 1939) (http://www.teendrugabuse.us/teensteroids.html)

German scientists discovered testosterone, the primary male hormone in the 1930s, and developed analogs (drugs with slight chemical changes to the testosterone molecule) during experimentation. Taking the testosterone molecule and synthesizing its structure lead to the invention of the anabolic-androgenic steroid - this is the term we use today to describe this very large group of substances. In 1956 Dr John B Ziegler produced a testosterone synthesis christened Dianabol (Luciano: 2001, 176). Dianabol was introduced in to the market in the 1950s as a product for the building of muscle mass and strength. The use of anabolic-androgenic steroids in sport had reached critical point by the 1960s and several major sporting organizations had already banned the use of steroids and had extensive drug testing policies in place. (http://www.steroidabuse.com/steroids- 101.html)

The dilemma is the fact that testosterone is a naturally occurring entity in the body and is mainly produced by cells in the testicles, called the Leydig cells, and released into the blood stream, which carries it to cells all around the body. Although the testicles are the bodies primary source of testosterone, smaller amounts are produced in the adrenal glands; testosterone is but one of many steroid hormones naturally occurring in the body. They all possess one commonality, in that they are produced from “one basic building block, a fatty substance called cholesterol” (Fitzhugh: 2003, 8).

Anabolic-androgenic steroids are usually synthetic substances similar to the male sex hormone testosterone; „anabolic" refers to a steroid"s ability to help build muscle and „androgenic" refers to their role in promoting the development of male sexual characteristics. There are however very legitimate medical uses for these drugs; the initial utilization of steroids focused on inadequate male sexual development, people suffering with asthma, anemia and breast cancer. The article by Pandina & Hendren (1999) unfortunately suggests that approximately 2% of males will use these drugs illegally.

Although, originally synthesized for legitimate medical practice, the effects produced by the drug has „morphed" into a thriving underground market of producers and suppliers getting rich from the male need to be bigger and stronger. Health food stores boomed in the 1980s with the sales of a central nervous system depressant used to stimulate muscle growth; GHB (gamma hydroxybutyrate) or liquid ecstasy was being sold over-the- counter, marketed as a „health product" (Barlow & Durand: 2005).

A „supplement" is a product intended for ingestion in conjunction with a diet. The belief among supplement users is that the product is able to build muscle mass and hence make them better players of their sport; in addition, they often believe that the use of supplements is a „safe" alternative to steroids (www.timeslive.co.za/sundaytimes/article). Unfortunately, the supplement industry is unregulated, and at present, a supplement has to be proven to be harmful before it will be withdrawn from the market. It is claimed that up to 25% of supplements are tainted with banned substances.

2.2 Supplements

Products available from health food stores (over-the-counter) are predominantly marketed as natural products; they are, as such, unregulated by the Food and Drug Administration (FDA), resulting in both high school and middle school students using these supplements having been misled into thinking that they will enhance their physique and sporting prowess, as a natural alternative to steroid use (Garzon et al.: 2006).

2.2.1 Products - form, brands, availability

According to Pope et al. (2000), the biggest sellers in the „supplement market" are protein powders, bars, creatine, supplements containing ephedrine and adrenal hormones such as DHEA, androstenedione, and their relatives. A huge industry now hawks protein products, amino acids, „fat burners", vitamin combinations, minerals and other exotic substances- many of them worthless and some downright dangerous. Even if the legal „nutritional supplements" were perfectly safe, it is believed that they act as „gateways" to the use of anabolic steroids.

The most commonly used nutritional supplements fall into four main groups:

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Most of the protein supplements favoured by boys, are no better than high-protein foods. In South African stores there is approximately 25 different brands of mass building supplements available over-the-counter (see Appendix A). For the purpose of this research only a selection ofbrands were used in the questionnaire.

2.2.2 Potential dangers of supplement use for teenagers

“Most of the protein supplements [favoured] by boys, while no better than high-protein foods, have so far not been known to be damaging to the health of the user when used properly, however, we do know if they are overused, they can cause kidney damage “ (www.bulimia.com). The pertinent fear here is the regulation of the dosage of protein supplements; if a young man is looking to gain „bulk" through the use of supplements in his diet, the tendency is to attempt to speed-up the process by over-dosing the product to see more rapid effects of the supplement. The gains in mass (if evident at all) may be insufficient for the user and as such, the tendency is to progress to substances that can guarantee bigger or more rapid growth.

“Chitosan, CLA, green tea extract and guar gum all are known to cause gastrointestinal problems such as vomiting, diarrhea and indigestion. Ephedra, bitter orange and country mallow (heartleaf) are the most dangerous. Boys may also use any of the many hormonal preparations (DHEA and other adrenal hormones are popular) available by mail order or at health food stores; these are [often] marketed as „legal steroids"”, with supplemental adrenal hormones increasing blood cholesterol levels (www.bulimia.com).

In the article „Gym and Tonic", it is advised that prior to using any supplement, one should be aware of the long-term safety of the product and its interactions with other supplements and drugs. It is also important to be conscious of the fact that you are not necessarily guaranteed quality assurance of the product due to the fact that labeling of products is not always accurate and quality may vary between batches of the same product, in addition, these products may be contaminated with banned substances and may not produce the effects advertised. After some initial dialog with the supplement “experts” at a few popular pharmaceutical chains, it is blatantly evident that they are blissfully unaware of the content of the supplements they are promoting. I have been told on numerous occasions that the products contain absolutely no Ephedra; yet their understanding of „phedra", found in their „phedra-cut" range is limited or non-existent. They comfortably argue about the damaging effects of creatine on the body, denying flatly that there is any proof to this effect. This is sadly the case that we do not have any reliable studies on the long-term effects of creatine on the body, but again, surely „prevention is better than cure". My primary concern here is that they admittedly sell the products to school boys (this being their largest market), without full disclosure as to the potential damage of the products, both physically and as a „gateway" to steroid use.

Garzon et al. (2006) outline the most commonly used supplements and their adverse (side) effects, these can be seen in Appendix B. Ephedrine in combination with caffeine, both available in health stores, is legal but taken together can cause insomnia, tremors and sometimes heart arrhythmias (Pope et al.: 2000). It is indeed troubling that in „Teen Herbicide" it is reported that a third of teens aged 15-17 know someone using supplements, despite the side effects.

Creatine is a popular supplement among males, “extracted from the protein found in meats and is „presumed" safe [as a supplement]; although the effects of long-term use of creatine pills are [still] unknown” (www.bulmia.com). In the article „Teen Herbicide" it is claimed that creatine is being marketed to children as young as eight years old, with “Teen Advantage Creatine Serum [having been] developed especially for young aspiring athletes” of 8-19 years of age (http://motherjones.com). Creatine is also a popular supplement among males suffering with Muscle Dysmorphia (Phillips: 2009). Pope et al (2000) note that creatine is a common supplement among homosexual males. Although creatine occurs naturally in beef and chicken, when taken in large doses it is unclear how “much of the weight gain is a result of muscle protein” and how much is due to water retention (http://jcem.endojournals.org).

In 2004 the FDA banned the sale of Ephedra (or ephedrine), it is a highly dangerous supplement that increases performance and energy along with weight loss. Ephedra is an amphetamine derived from ma huang (a herb of Chinese origin). In „Teen Herbicide" a “16 year old Illinois football player died of heart failure after taking the Ephedra supplement Yellow Jacket”. Amphetamines, methamphetamines “and ephedrine (the main [ingredients] in Ephedra) are close chemical cousins with similar effects on the body especially when mixed with caffeine”, causing powerful stimulation of the nervous system. Most college athletes start using Ephedra during high school and it is common for students “with high levels of Ephedra alkaloids in their blood to test falsely positive for „speed"” (http://motherjones.com). “Ephedrine is only one of many potentially dangerous drugs taken to burn fat; there are other legal over-the-counter drugs, like pseudoephedrine and phenylpropanolamine which can be purchased in an array of decongestants” from the pharmacy (Pope et al.: 2000, 120).

2.3 Motivational components of supplement use

The most common belief among school-age users is that the supplements will improve their athletic skills and enhance their physical appearance (Garzon et al: 2006). In Kanayama et al. (2009) however, it is suggested that the progression from supplement use to steroid use may be grounded in body image disorders. In Pope et al. (2000), research has found that late maturing boys are less satisfied with their appearance and body image is the greatest single predictor of self-esteem for teenagers.

2.3.1 Sport

It has been suggested that in the sporting world, the use of supplements is as common place as mouth guards. My predominant concern is rooted in the following quotation on the topic of nutritional supplements, “we still believe (as do other experts we know) that they act as gateways" to the use of anabolic steroids” (Pope et al: 2000, p 190). The most common belief among school-age users is that the supplements will improve their athletic skills and enhance their physical appearance (Garzon et al: 2006).

In South Africa, the most popularly supported sport is undoubtedly rugby, with schools competing vehemently for top positions in the arena. It has been suggested in passing, that teenagers are pushed to bulk-up for the rugby team, with parents and often coaches supporting the use of supplements. In addition, after preliminary discussion with suppliers of supplements, they are in agreement that their biggest sales come from school aged boys.

2.3.2 Body Dissatisfaction

Andersen et al (2000) suggest that all teenage males have a desire to look more toned and muscular than they are. Recent research by Susan Paxton found that 26 percent of high school boys had used extreme weight-loss methods (Pope et al.: 2000). The New England Journal of Medicine published research conducted among American students in 1993 the students were all under the age of15 years yet one in fifteen of the boys had been abusing anabolic steroids (Morgan: 2008). The overwhelming belief is that society has gradually made the ideal male physique into a “testosterone-driven mesomorphic (triangular) look” (Morgan: 2008, p101).

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