(USA TODAY) -- When it comes to body image, large, lean and muscular is in, and it's "extremely common" for teenagers to turn to diet, exercise, protein powders or steroids in hopes of bulking up and enhancing muscle development, a study finds.
Although these techniques are most often seen among boys, in some cases they are nearly as widespread among girls, says the study published Monday in Pediatrics.
Asked about methods they have used to increase their muscle size or tone, 2,793 middle school and high school students (average age 14) in Minneapolis/St. Paul said they:
• Changed eating: 68% boys; 62% of girls
• Exercised more: 91% boys; 81% of girls
• Used protein powders or shakes: 35% boys; 21% girls
• Used steroids: 6% boys; 5% girls
• Used other muscle-enhancing substances such as creatine, amino acids, hydroxyl methylbutyrate (HMB), DHEA, or growth hormones: 11% boys; 6% girls
Researchers did not collect data indicating whether eating changes were healthy or unhealthy nor how much or what type of exercise was adopted. Almost 12% of boys and 6% of girls, however, reported using three or more of the general muscle-enhancing behaviors, "indicating a relatively high level of use," says the report.
The findings suggest that "increasing muscle strength or mass or tone is an important piece of body image for both boys and girls," says lead study author Marla Eisenberg, professor of pediatrics at the University of Minnesota School of Medicine. "Kids really are seeing that as a goal."
And it's not just a behavior isolated to athletes or certain teams, says Eisenberg. Students who said they did not play sports also reported these muscle-enhancing efforts.
Teenage interest in re-shaping or building their physiques is nothing new. What is new, is a social and cultural emphasis "not just about having a healthy physique," but about achieving the "perfect" muscular body, she says, which ultimately is "just one more cultural ideal that young people find hard to achieve."
As a result, the many good reasons for teens to be physically active - skill development, having fun and general health and fitness - run the risk of being overshadowed by the goal of looking like someone in a magazine ad or in the sports pages, she says.
And given greater awareness of performance-enhancing and muscle-building substances, teens know there are many other ways to bulk up, "ways that are not recommended and not safe, but may be quite effective," says Eisenberg.
This study is a reminder that parents and physicians need to be aware that these behaviors are going on and that they need to be discussed with their adolescents, says Joel Brenner, medical director of the Sports Medicine Program at Children's Hospital of the King's Daughters in Norfolk, Va., and chair of the American Academy of Pediatrics Council on Sports Medicine and Fitness.
The use of steroids and other performance-enhancing substances is clearly dangerous and needs to be avoided, but inappropriate changes to diet or exercise can also be hazardous, he says.
Even when teens are involved in supervised strength and conditioning programs, parents need to stay aware of their child's goals and make sure their activities remain "part of an overall fitness program," Brenner says.