New guidance for assessing muscle-building supplement use in teens and young adults

By Vijay Kumar MalesuReviewed by Danielle Ellis, B.Sc.Jul 15 2024

A commentary published in the Journal of Adolescent Health concludes that the use of muscle-building dietary supplements (muscle-building supplements) among adolescents and young adults, particularly boys and young men, is widespread and driven by pressures to adhere to the muscular and lean body ideal.

The authors, Kyle T. Ganson, Ph.D., M.S.W., of the Factor-Inwentash Faculty of Social Work at the University of Toronto, and Jason M. Nagata, M.D., M.Sc., of the Department of Pediatrics at the University of California, San Francisco, provide guidance for healthcare professionals on assessing and mitigating risks associated with the use of these supplements.

The commentary, titled "Adolescent and Young Adult Use of Muscle-Building Dietary Supplements: Guidance for Assessment and Harm Reduction Approaches to Mitigate Risks," underscores the need for healthcare professionals to proactively address muscle-building supplement use among their adolescent and young adult clients.

The authors highlight that, despite the common perception of these supplements as largely benign, there are potential adverse consequences, including disability and death. "Despite the common use of muscle-building supplements, there remains little guidance for health and mental healthcare professionals on how to assess best and support adolescents and young adults using muscle-building supplements, and how to determine whether its use is problematic," they state.

The authors base their conclusions on several studies and data points, noting that lifetime and 12-month prevalence estimates of protein supplement use range from 55% to 83% for boys and young men, while creatine use ranges from 19% to 50%. The use of muscle-building supplements is often influenced by societal pressures and the desire to achieve a certain body image. "Indeed, the high use of muscle-building supplements among boys and young men is driven by pressures to adhere to the muscular and lean body ideal," the authors explain.

Healthcare professionals are encouraged to take a harm-reduction approach when assessing and intervening with clients using muscle-building supplements. Harm reduction emphasizes principles and practices intended to reduce negative effects associated with risky behaviors. This approach acknowledges that abstinence may not be a realistic goal for many adolescents and young adults, given the prevalence of supplement use in their social and athletic environments. "Harm reduction emphasizes multiple principles and practices that are intended to reduce negative effects associated with risky behaviors, including substance use," the authors write.

The commentary provides detailed guidance for healthcare professionals. They suggest assessing which muscle-building supplements are being used, their frequency, dose, and method of use. Additionally, understanding the client's motivations and goals for supplement use is crucial. Evaluating the client's level of knowledge about the supplements they are using and where they obtain information is also important. The authors recommend considering the involvement of parents or family members in supporting the client. "Without this critical information, there is little foundation for engagement and harm reduction interventions," they state.

Additionally, healthcare professionals should assess whether the client's dietary intake meets their nutritional needs and whether the use of supplements is necessary. The authors also recommend assessing other behaviors intended to change appearance, weight, shape, strength, and performance, as these can indicate potential eating disorders or body image issues. They emphasize, "Understanding the current dietary intake of the client provides information as to whether they are consuming appropriate calories and macronutrients to grow and develop."

The commentary emphasizes the importance of a thorough biopsychosocial assessment to determine whether supplement use is having an adverse effect on the client's physical, psychological, and social health. Healthcare professionals should be vigilant in assessing potential and current or past use of anabolic-androgenic steroids (AAS), as the use of muscle-building supplements can be predictive of future AAS use. "Given the connection between muscle-building dietary supplement use and AAS use, healthcare professionals should assess the client for potential and current or past use of AAS," the authors advise.

In conclusion, the authors advocate for a harm-reduction approach to muscle-building supplement use among adolescents and young adults. They recommend that healthcare professionals proactively assess supplement use, educate clients and their families, and provide ongoing monitoring and support to mitigate risks. The commentary calls for a formal evidence-based review to inform the development of clinical practice guidelines on muscle-building supplement use for this population. "A harm reduction approach is advocated, prioritizing the mitigation of risks when absolute abstinence is not considered a viable option by the client," the paper concludes.