Extreme Muscle-Building Exercise Behaviors as Responses to Psychosocial Challenges Among Adolescents in the United States

Background and Purpose:
Extreme muscle-building exercise (MBE), encompassing both excessive and deficient behaviors, poses significant health risks among adolescents. While MBE is generally encouraged to promote youth mental and physical health, recent studies highlight the potential harms of engaging in MBE at its extremes. Excessive MBE has been associated with addictive psychopathology and an increased risk of stroke due to arterial stiffness, whereas deficient MBE has been linked to cardiovascular issues and depressive symptoms. Excessive MBE can serve as a coping mechanism in response to traumatic experiences such as physical fights, bullying, and sexual violence victimization. These events often lead to feelings of powerlessness, shame, and body dissatisfaction, prompting some adolescents to pursue MBE as a means of regaining control, protection, or self-esteem. Similarly, deficient MBE may reflect withdrawal or reduced motivation commonly observed in adolescents experiencing depressive symptoms or low self-esteem, particularly following unresolved trauma. Understanding the psychosocial context underlying extreme MBE behaviors is crucial for developing policies and interventions that support youth facing such challenges.

Methods:
Data from the 2023 Youth Risk Behavior Survey (YRBS) were analyzed using multinomial logistic regression. The YRBS employed a three-stage cluster sampling design to collect data from a nationally representative sample of 9th to 12th grade students. A weighting factor was applied to account for nonresponse and the oversampling of Hispanic and Black students. The dependent variable, MBE, was categorized as deficient (0–1 day/week), normative (2–4 days/week), and excessive (>5 days/week), with normative MBE serving as the reference group. Independent variables included traumatic experiences (physical fights at school, sexual violence, and bullying) and body image perceptions (underweight, overweight, and about the right weight). Demographic factors such as sex, race/ethnicity, grade level, and sports team participation were controlled for.

Results:
Descriptive statistics showed that 38.28% of adolescents reported deficient MBE, 31.46% reported normative MBE, and 30.26% reported excessive MBE. Multinomial logistic regression revealed that involvement in physical fights was significantly associated with excessive MBE (RRR = 1.39, p < .01). Body image dissatisfaction also played a critical role: adolescents perceiving themselves as underweight or overweight were more likely to report deficient MBE than normative MBE (RRR = 1.46, p < .01; RRR = 1.40, p < .01, respectively). Interestingly, body image dissatisfaction decreased the likelihood of excessive MBE (RRR = 0.81, p < .05 for underweight; RRR = 0.71, p < .01 for overweight). Participation in three or more sports teams significantly increased the likelihood of excessive MBE compared to no team involvement (RRR = 2.37, p < .001).

Conclusions and Implications:
This study underscores the importance of supporting adolescents facing psychosocial challenges through trauma-informed care, body image education, and responsible oversight in sports environments. The findings also support school policies that foster inclusive, supportive environments encouraging balanced physical activity and promoting healthy peer relationships.