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Teens place a premium on muscular builds and are increasingly taking chances with their health to get them.

When it comes to body image, more is better, at least when it comes to muscle, according to a recent study of teens and body image. Published in the journal Pediatrics, the analysis involved 2,793 middle- and high school students living in the Minneapolis–St. Paul area who reportedly bulking up by using products like steroids and protein powders. The scientists found that the adolescents see toned and muscular bodies as the ideal, and are willing to change eating and exercise habits, as well as use supplements and steroids that have been linked to adverse health effects, to enhance muscle development.

Boys were more likely to take up these habits, with two-thirds of those surveyed reporting changing their eating habit to favor muscle mass. Thirty-five percent of boys used protein powders and 6% used steroids.

Although building bigger muscles was less common among girls, 21% reported using protein powders, 4.6% used steroids and 5.5% used other substances. In total, 12% of boys and 6% of girls engaged in three or more different behaviors to gain muscle. “This ﬁnding suggests that, in addition to a ‘thin ideal’ and focus on leanness, muscularity is an important component of body satisfaction for both genders,” the authors write.

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“We were very alarmed by the high numbers of youth using muscle enhancers such as protein supplements. These behaviors suggest high concerns about youth with regard to muscularity,” says study author Dianne Neumark-Sztainer, a professor of epidemiology and community health at the University of Minnesota.

But the results are complicated by the fact that building muscle may also promote some beneficial behaviors, particularly among teens who were obese. In fact, greater use of muscle-building behaviors was found among kids with higher BMIs or struggling with obesity. The authors write:

Although it is appropriate to promote physical activity in youth, which may have desirable benefits in terms of health and body composition, care should be taken to emphasize moderation in behaviors and to focus on skill development, fitness, and general health rather than development of a muscular appearance.

“There are many confusing messages in our society regarding what is healthy. While it is appropriate and desirable to aim to be physically fit and be involved in physical activity, this should be done through healthful eating and activity behaviors,” says Neumark-Sztainer. “The youth may view taking muscle enhancers as a healthful behavior given that substances such as protein powders are widely promoted. We need to move away from the idea of an ‘ideal body shape’ toward an acceptance of diverse body shapes and sizes.”

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According to Barbara Greenberg, a clinical psychologist, anything taken to an extreme is a problem. “We have a spectrum. Here, what you have is a healthy eating behavior gone all the way to the other side so you’re not only developing problems with eating, but you are developing a substance-abuse problems with steroids too,” she says. “Parents need to have discussions constantly about how to make sustainable gains in a healthy way through eating and exercise, and they need to show a healthy example.”

While the findings may be alarming, pediatricians and body-image experts say they are not very surprising. “I have not only seen it in my private practice, I’ve seen it in the gym too,” says Greenberg. “There are all these media images of muscularity. It used to be Twiggy and now we are seeing more muscularity, which is a newer trend. In the magazines you read about the celebrities who work out with their trainers and it’s not to get emaciated, it’s to get built.”

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Younger kids are often more willing to take risks with their health. “When kids hear the message they need to be perfect, they will do whatever it takes even if it means something unhealthy,” says Robyn Silverman, body-image expert and author of Good Girls Don’t Get Fat. “They may realize there are some risks to what they’re doing, but the pay off is better than the drawbacks. Teens have a way of saying to themselves, That won’t happen to me.”

Both Silverman and Greenberg blame social media with inundating kids with images of beefy men and toned women. “With every disorder — including anorexia and cutting — they’re all happening at younger ages. It has a lot to do with exposure to social media. They’re not supposed to be on Facebook until they’re 13, but many are before that, and there is a lot of imagery on it,” says Greenberg.

Children not only can look up protein powders to take online, but they can stumble upon online support groups that can fuel unhealthy behaviors. “We have seen this in pro-ana sites. Teens can look up how to use steroids, and even if risks are provided, they may filter out the negative,” says Silverman.

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The challenge for parents, however, is to remain aware of what their children are exposed to on television and on the Internet. Greenberg recommends parents involve themselves in their kids’ interests so they can have meaningful discussions about what they’re seeing. “Parents should sit down with their kids and start watching with them regularly, and see if what they see is appropriate,” she says. “Shows can glorify these behaviors in a way that makes them look exciting to kids.” And lead to potentially unhealthy habits.