Summary: A lifetime history of appearance- and performance-enhancing drug and substance (APEDS) use is linked to symptoms of eating disorders, particularly among users of protein and creatine supplements and those using diuretics.
Source: University of Toronto
As cultural ideals increasingly emphasize muscularity and leanness, use of appearance- and performance-enhancing drugs and substances (APEDS) — from protein powders to synthetic muscle enhancers and diuretics — has risen among college-aged men and women. Researchers examined how lifetime APEDS use relates to eating disorder symptomatology in a large sample of U.S. college students.
A new analysis of data from the 2020–2021 Healthy Minds Study, which included 7,394 U.S. college and university students, found that a history of APEDS use is associated with screening positive for eating disorder symptoms. The strongest associations were observed for lifetime use of protein supplements, creatine, and diuretics (water pills).
Lead author Kyle T. Ganson, PhD, MSW, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work, notes that many individuals use more than one APEDS to reach a desired body ideal. “Many people use multiple APEDS to help them achieve their desired body, but this can be problematic, given our findings that use of multiple substances significantly increased the risk of eating disorder symptoms,” he said.
APEDS are commonly used to increase muscle mass, tone, and definition to meet contemporary body ideals. The study emphasizes that even products marketed as healthy or safe can be associated with harmful outcomes when used to pursue unrealistic body standards.
Co-author Jason M. Nagata, MD, MSc, assistant professor in the Department of Pediatrics at the University of California, San Francisco, highlighted the clinical implications: “Our study emphasizes the need for healthcare professionals to remain aware of changing body ideals among youth and young adults, as well as the association between APEDS use and eating disorder symptoms. Appropriate prevention, assessment, and treatment must be made readily available to individuals accessing healthcare services.”
The findings gain added significance in the context of increased eating disorder prevalence observed during the COVID-19 pandemic. The researchers stress that public health strategies should inform young people about the potential risks linked to APEDS, particularly when these substances are used to reach unrealistic body goals. Ganson also pointed to the role of policy measures aimed at reducing APEDS availability and consumption among youth and young adults.
About this eating disorder research news
Author: Kristian Foster
Source: University of Toronto
Contact: Kristian Foster – University of Toronto
Image: The image is in the public domain
Original Research: Closed access. “Use of appearance and performance enhancing drugs and substances is associated with eating disorder symptomatology among U.S. college students” by Kyle T. Ganson et al., published in Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity.
Abstract
Use of appearance and performance enhancing drugs and substances is associated with eating disorder symptomatology among U.S. college students
Purpose
Sociocultural pressures for both men and women increasingly prioritize muscularity and low body fat, contributing to widespread use of appearance- and performance-enhancing drugs and substances (APEDS), particularly among young men. Despite this trend, few studies have examined how specific APEDS relate to eating disorder symptoms in the high-risk population of young adult college students. This study set out to evaluate those associations using a large, national sample.
Methods
Analyses used data from the 2020–2021 Healthy Minds Study (N = 7,394). Researchers assessed five indicators of lifetime APEDS use and created a cumulative score representing the number of different APEDS ever used. Eating disorder symptomatology was measured with the SCOFF questionnaire, a brief screening tool. The team conducted 14 modified Poisson regression analyses to estimate the relationship between specific APEDS and a positive eating disorder screen, analyzing results separately for women and men.
Results
Lifetime use of protein supplements and diuretics (water pills) was associated with a positive eating disorder screen for both women and men. Among men, use of non-steroid synthetic muscle enhancers was also linked to a positive screen. Among women, lifetime creatine supplement use was associated with a positive eating disorder screen. The risk peaked among men who reported lifetime use of five different APEDS.
Conclusions
This study finds that lifetime APEDS use is associated with eating disorder symptomatology in a national sample of U.S. college students. The authors call for targeted prevention and intervention efforts to address the overlap between APEDS consumption and disordered eating behaviors, and for improved clinical awareness and public health messaging about the potential harms of these substances.