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Tatyana
Elite Mentor
J. Kevin Thompson, Ph.D.
Professor, Department of Clinical Psychology
University of South Florida, Tampa
Introduction
Body image is a term that has come to represent the "internal" image or representation that we have of our physical appearance (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). It is to be contrasted with the "outer" image or an objective view of attractiveness (i.e., a rating made by a supposedly unbiased observer). Although commonly thought of as overlapping substantially, in fact one’s inner view (body image) is only minimally correlated with actual ratings of attractiveness. The overlap is an astonishingly low 5%.
Additionally, it appears that body image, rather than objective appearance, is more closely related to psychological factors and clinical conditions (e.g., eating disorders, depression, low self-esteem). For these reasons, research into a multitude of aspects of body image has mushroomed in recent years. One such active area of inquiry is the examination of exercise and body image.
Within this general area, researchers have focused largely on the role of athletic status (sedentary, active), type of sport (running, bodybuilding), and contributing risk factors (media pressures).
In this article, I outline some recent work that has focused on bodybuilding and evolving cultural standards of muscularity. I also briefly note the occurrence in recent years of a particular type of body image disorder, muscle dysmorphia, and offer some guidelines for dealing with problematic issues that might accompany an excessive focus on muscularity.
Background
Only in the past 10-15 years have researchers actually given due attention to bodybuilding and body image. A primary reason is the greater prevalence of dissatisfaction with appearance that was initially documented in women, and the close connection between women’s body image problems and eating disorders (which occur roughly 10 times more often in women).
However, beginning with a few studies in the mid-80s, a shift in attention to men’s appearance concerns began, and this was accompanied by a focus on bodybuilding. This was due largely to the finding that men’s dissatisfaction, when evident, was as often due to feeling too thin, small, or lacking in musculature as it was to a concern with excessive size or weight. In short order, researchers found that many individuals were quite unhappy with their lack of muscularity.
Prevalence
Perhaps the best evidence of the increase in muscularity dissatisfaction comes from three general population surveys, covering 25 years (Cash, 1997). Two features relevant to this discussion were assessed (from a broader array of body sites): the upper torso (defined in these studies as the "chest" area) and "muscle tone."
In 1972, 18% of men disliked their upper torso. By 1985 the percentage had risen to 28% and by 1996 it had reached 38% (surpassing, for the first time, women’s dissatisfaction with the breast body site). Percentages for "muscle tone" for men and women were: 1972 (M-25%; W-30%), 1985 (M-32%; W-45%), 1996 (M-45%; W-57%). Another survey by Jacobi and Cash (1994) provides some information on the muscularity satisfaction levels of a general (non-bodybuilding) sample. In a sample of college men and women, they found that 91% of the men and 78% of the women wanted to be more muscular.
Clearly, there is a desire for a more muscular body present for both men and women.
It is also interesting to specifically evaluate bodybuilders, to determine if individuals who are objectively more muscular than average nonetheless experience body image problems (as noted above in the introduction, objective size may not translate readily into inner happiness).
In our own investigation of this type, we found that both male and female bodybuilders/weightlifters (unfortunately, we did not differentiate in this study – a problem common to many investigations in this area) were more satisfied than runners and sedentary controls (Pasman & Thompson, 1988).
In fact, there was no gender difference in the body image of male and female bodybuilders/weightlifters.
Much of the research in this area was recently reviewed by Goldfield, Harper, and Blouin (1998). They noted that bodybuilding appears to be gaining in popularity and estimate that 5 million participate in the USA alone. Their review combines an examination of body image concerns with data on risk for eating problems.
Their analysis revealed that male bodybuilders had more severe body image disturbance and eating problems than a matched athletic control group (4 of 5 studies that met criteria for inclusion).
Four other studies that did not include an athletic control group also indicated such eating and body image problems. The authors noted that there were fewer studies on which to base accurate conclusions for women, but did note that the available research suggests a similar link between bodybuilding, body image, and eating problems for females.
Goldfield et al. (1998) mentioned that the demands of competitive bodybuilding necessarily mandate such behaviors as weight loss prior to a contest and an excessive focus on body shape and body modification. In effect, it is part of the job.
They caution, however, that some individuals who are unhappy with their size or have low self-esteem may "gravitate toward bodybuilding to achieve personal or societal standards of attractiveness" (150). Certainly, the decision to engage in bodybuilding to improve one’s appearance or to meet a personal goal of physical development should not be judged, either positively or negatively, by the professional or lay person. It is a personal and private matter.
Indeed, there is no doubt that physical activity in its many and diverse forms may greatly contribute to enhanced self-esteem. In addition, aerobic and anaerobic exercise strategies are included as a primary component of almost all weight loss programs that are deemed optimal by nutritionists, exercise physiologists, psychologists, dieticians, and other professionals.
The problem, and this is noted by Goldfied et al. (1998), is that preexisting eating or body image disturbances may be exacerbated by such involvement, possibly leading to clinically-severe disorders such as anorexia nervosa, bulimia nervosa, and body dysmorphic disorder.
Ascertaining whether a bodybuilder is engaging in unhealthy behaviors along the path to a more muscular physique will be discussed shortly. First, however, I will review briefly some emerging research on risk factors that may help us understand the desire to add musculature.
Risk Factors and Associated Features
It may be useful to understand whether there are specific interpersonal and/or societal factors that drive someone to be dissatisfied with muscularity and perhaps engage in extreme efforts to approximate a personal or sociocultural ideal. Our own research and that of others has begun to focus on two primary factors.
Teasing
Being teased or receiving negative comments about appearance is one risk factor that has received a great deal of empirical support (Heinberg, 1996; Thompson et al. 1999). A recent study by Pietrobelli and colleagues at the Obesity Research Center at St. Luke’s/Roosevelt Hospital (Columbia University) details the detrimental role of receiving teasing during physical activities (Pietrobelli, Leone, Heymsfield, & Faith, 1998). Subjects were 305 boys and 269 girls, grades 5-8, from a NY public middle school.
The findings indicated that receiving teasing was associated with reduced participation in physical activities, reduced pleasure from exercise, and a lowered sense of control (defined as control related to the physical activity). There were no gender differences in the findings. The authors concluded that efforts to promote physical education in the school setting should contain a component related to awareness of teasing as a problematic interpersonal issue and strategies designed to help children cope with the teasing.
Media Images
A sociocultural component has long been blamed for the excessive concern with appearance found in women. Typically, the media are blamed for perpetuating an impossibly thin ideal as a model for women to emulate, and such images in magazines and on TV have been castigated as causing the widespread use of excessive dieting and bulimic behaviors to achieve the "unachievable."
Interestingly, until very recently, almost no work has been conducted on an evaluation of the cultural images of appearance for men. Certainly, bodybuilding as a sport has been around for quite some time, and these images have been accessible. However, such exposure, via television and magazines, is less than that provided to other high-profile sports, such as football, baseball, and basketball.
In addition, in recent years, a great deal of media attention has been devoted to the bodies of WWF wrestlers – there are currently three cable shows devoted to this "sport." Although there are no studies that have evaluated the evolving muscularity trends for men in the big three sports (baseball, football, basketball), it is generally conceded that, especially over the past 10 years, participants have increased in muscle mass. Indeed, the two highest profile current baseball icons (Mark McGuire, Sammy Sosa) have a high degree of muscle bulk and definition.
Recently, one study entered the void of research in this area, and generated a great deal of media attention and controversy. Pope, Olivardia, Gruber, and Borowiecki (1999) assessed the changing ideals of male body image by examining popular male action toys.
They evaluated the changes in some toys over a 30 year period, and included in their analysis the following figures: GI Joe, Luke Skywalker and Hans Solo (from Star Wars), The Gold Ranger, Ahmed Johnson, Iron Man, Batman, and Wolverine). They measured the waist, chest, and bicep circumferences of the figures and scaled the measures using allometry to approximate the dimensions of a male of 70 in. (1.78m) in height.
Much of their analysis focused on GI Joe, because of the availability of models from 1973 to 1998. The findings indicated a big increase in sizes for the measured body parts from GI Joe Land Adventurer (1973) to GI Joe Extreme (1998). The chest increased in size from 44.4 in. to 54.8 in. and the biceps increased from 12.2 in. to 26.8 in. The authors noted that, extrapolated to a 70 in. (height) male, "GI Joe would sport larger biceps than any bodybuilder in history" (p. 68).
Although the waist increased in size also (31.7 in. to 36.5 in., the authors noted that the latter figure has "the sharply rippled abdominals of an advanced bodybuilder" (p. 67) whereas the early models have far less definition. The Stars Wars duo also acquired "particularly impressive gains in the shoulder and chest areas" (p. 69), however, the presence of clothing precluded the measurement of actual size changes over the years. There was only one "notable exception" to the trend of increased muscularity of models over time, "Mattel Company’s Ken, the boyfriend of Barbie" (p. 70).
These findings should, necessarily, be interpreted with some caution. Only a few action figures were examined. Second, as noted earlier, there is a lack of comparable data from other media models. Third, as always, it is impossible to determine cause and effect – there is no evidence that exposure to male action figures leads boys to develop a negative body image, or pursue a lifetime of bodybuilding.
The authors do suggest that, anecdotally, their impression is that comic strip characters, male models in magazines and male movie actors have also become more lean and muscular in recent years. Follow-up studies should address these and other methodological weaknesses. Perhaps the timing was right for such an overreaction to a very small-scale study with so many limitations.
For the past 20 years, researchers have focused on female dolls, primarily Barbie, as providing unrealistically thin body sizes for girls and women to emulate. Hopefully, the follow-up research will receive as much media attention.
Clinical Problems: Eating Disorders and Body Dysmorphia
As with any avocation that requires exacting standards for meeting an ideal physique (ballet, gymnastics, wrestling, horse jockeys, etc.), there is always the possibility that some individuals who engage in bodybuilding may engage in excessive behaviors or develop problematic traits.
Restrictive intake of calories, especially before competition, may be a symptom that needs monitoring. Purging of food, via self-induced vomiting or laxative abuse, is often part of the bulimic cycle, and is a serious issue necessitating immediate counseling or intervention. A third, relatively new, clinical condition that has recently received a great deal of attention, is body dysmorphic disorder (Thompson et al., 1999). This is a disorder reserved for individuals who have the following characteristics: excessive preoccupation with an aspect of appearance, intense obsessive-compulsive activities centered around the site of concern (i.e., checking, weighing, grooming, etc.), and behavioral avoidant features (i.e., refusal to engage in social activities because of disparagement of the appearance feature.
Research suggests that any aspect of appearance may become the focus of this level of dissatisfaction, leading to severe interference with social and occupational functioning. However, Pope, Phillips and colleagues have found a special type of BDD, which they term "muscle dysmorphia" (Phillips, O’Sullivan, & Harrison, 1997; Pope, Gruber, Choi, Olivardia, & Phillips, 1997).
The central feature of this clinical syndrome is an individual who is preoccupied with muscularity, often believing that he or she is small, weak, or inadequate in this area – a belief that is commonly incorrect, in comparison to an objective rating. The individual may engage in compulsive bodybuilding, weightlifting, and consumption of bulking-up foods and other substances, yet maintain the elevated level of muscularity insecurity.
Research into the prevalence, assessment, and treatment of muscle dysmorphia is just beginning, and it would be premature to conclude that it occurs commonly. However, it may be important to be aware of warning signs. The primary symptom, as hinted at above, is a preoccupation with one’s muscular or size inadequacies, which simply does not fit with the views of others (the objective observer).
The individual continues to maintain that he or she is not well-developed in the area of concern, and is truly distressed by this belief. Behaviorally, the person may engage in excessive and lengthy workouts, designed to "fix" the problem, express great irritation at others who disagree with his appraisal of his shortcomings, and avoid social activities and/or interpersonal commitments.
In extreme cases, the obsession may produce such compulsive workout behavior that the individual may be fired from his occupation and/or lose close personal relationships.
Summary and Recommendations
Clearly, work in this area is just emerging and much of the research has the "pathologizing" flavor of so much of mental health research (i.e., researchers focus on the psychological problems vs. the positive health associations). Nonetheless, it may be important to recognize potential problems related to an unhealthy focus on muscular development and the consequent undesirable behaviors such a desire may produce. Especially for adolescents, guidelines for early detection and sensible training need to be considered. Counselors, mentors, teachers and co-trainers might consider the following strategies:
* Ensure that a non-toxic "teasing" environment exists for gym classes and intervene with both the teased and the perpetrator to resolve this negative type of interpersonal relationship.
* Use educational and "media literacy" strategies to inform children about the representativeness of body sizes perpetuated by toy action figures and sports icons.
* In any training program, for adults and adolescents, set realistic body shape and weight goals.
* Provide information regarding normal and healthy eating practices, as well as clear-cut definitions of the dangers of restrictive dieting and bulimic behaviors.
* In cases of low self-esteem, suggest alternative or complementary routes to building self-competence.
* Consider referral for a mental health evaluation if signs of muscle dysmorphia exists.
Professor, Department of Clinical Psychology
University of South Florida, Tampa
Introduction
Body image is a term that has come to represent the "internal" image or representation that we have of our physical appearance (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). It is to be contrasted with the "outer" image or an objective view of attractiveness (i.e., a rating made by a supposedly unbiased observer). Although commonly thought of as overlapping substantially, in fact one’s inner view (body image) is only minimally correlated with actual ratings of attractiveness. The overlap is an astonishingly low 5%.
Additionally, it appears that body image, rather than objective appearance, is more closely related to psychological factors and clinical conditions (e.g., eating disorders, depression, low self-esteem). For these reasons, research into a multitude of aspects of body image has mushroomed in recent years. One such active area of inquiry is the examination of exercise and body image.
Within this general area, researchers have focused largely on the role of athletic status (sedentary, active), type of sport (running, bodybuilding), and contributing risk factors (media pressures).
In this article, I outline some recent work that has focused on bodybuilding and evolving cultural standards of muscularity. I also briefly note the occurrence in recent years of a particular type of body image disorder, muscle dysmorphia, and offer some guidelines for dealing with problematic issues that might accompany an excessive focus on muscularity.
Background
Only in the past 10-15 years have researchers actually given due attention to bodybuilding and body image. A primary reason is the greater prevalence of dissatisfaction with appearance that was initially documented in women, and the close connection between women’s body image problems and eating disorders (which occur roughly 10 times more often in women).
However, beginning with a few studies in the mid-80s, a shift in attention to men’s appearance concerns began, and this was accompanied by a focus on bodybuilding. This was due largely to the finding that men’s dissatisfaction, when evident, was as often due to feeling too thin, small, or lacking in musculature as it was to a concern with excessive size or weight. In short order, researchers found that many individuals were quite unhappy with their lack of muscularity.
Prevalence
Perhaps the best evidence of the increase in muscularity dissatisfaction comes from three general population surveys, covering 25 years (Cash, 1997). Two features relevant to this discussion were assessed (from a broader array of body sites): the upper torso (defined in these studies as the "chest" area) and "muscle tone."
In 1972, 18% of men disliked their upper torso. By 1985 the percentage had risen to 28% and by 1996 it had reached 38% (surpassing, for the first time, women’s dissatisfaction with the breast body site). Percentages for "muscle tone" for men and women were: 1972 (M-25%; W-30%), 1985 (M-32%; W-45%), 1996 (M-45%; W-57%). Another survey by Jacobi and Cash (1994) provides some information on the muscularity satisfaction levels of a general (non-bodybuilding) sample. In a sample of college men and women, they found that 91% of the men and 78% of the women wanted to be more muscular.
Clearly, there is a desire for a more muscular body present for both men and women.
It is also interesting to specifically evaluate bodybuilders, to determine if individuals who are objectively more muscular than average nonetheless experience body image problems (as noted above in the introduction, objective size may not translate readily into inner happiness).
In our own investigation of this type, we found that both male and female bodybuilders/weightlifters (unfortunately, we did not differentiate in this study – a problem common to many investigations in this area) were more satisfied than runners and sedentary controls (Pasman & Thompson, 1988).
In fact, there was no gender difference in the body image of male and female bodybuilders/weightlifters.
Much of the research in this area was recently reviewed by Goldfield, Harper, and Blouin (1998). They noted that bodybuilding appears to be gaining in popularity and estimate that 5 million participate in the USA alone. Their review combines an examination of body image concerns with data on risk for eating problems.
Their analysis revealed that male bodybuilders had more severe body image disturbance and eating problems than a matched athletic control group (4 of 5 studies that met criteria for inclusion).
Four other studies that did not include an athletic control group also indicated such eating and body image problems. The authors noted that there were fewer studies on which to base accurate conclusions for women, but did note that the available research suggests a similar link between bodybuilding, body image, and eating problems for females.
Goldfield et al. (1998) mentioned that the demands of competitive bodybuilding necessarily mandate such behaviors as weight loss prior to a contest and an excessive focus on body shape and body modification. In effect, it is part of the job.
They caution, however, that some individuals who are unhappy with their size or have low self-esteem may "gravitate toward bodybuilding to achieve personal or societal standards of attractiveness" (150). Certainly, the decision to engage in bodybuilding to improve one’s appearance or to meet a personal goal of physical development should not be judged, either positively or negatively, by the professional or lay person. It is a personal and private matter.
Indeed, there is no doubt that physical activity in its many and diverse forms may greatly contribute to enhanced self-esteem. In addition, aerobic and anaerobic exercise strategies are included as a primary component of almost all weight loss programs that are deemed optimal by nutritionists, exercise physiologists, psychologists, dieticians, and other professionals.
The problem, and this is noted by Goldfied et al. (1998), is that preexisting eating or body image disturbances may be exacerbated by such involvement, possibly leading to clinically-severe disorders such as anorexia nervosa, bulimia nervosa, and body dysmorphic disorder.
Ascertaining whether a bodybuilder is engaging in unhealthy behaviors along the path to a more muscular physique will be discussed shortly. First, however, I will review briefly some emerging research on risk factors that may help us understand the desire to add musculature.
Risk Factors and Associated Features
It may be useful to understand whether there are specific interpersonal and/or societal factors that drive someone to be dissatisfied with muscularity and perhaps engage in extreme efforts to approximate a personal or sociocultural ideal. Our own research and that of others has begun to focus on two primary factors.
Teasing
Being teased or receiving negative comments about appearance is one risk factor that has received a great deal of empirical support (Heinberg, 1996; Thompson et al. 1999). A recent study by Pietrobelli and colleagues at the Obesity Research Center at St. Luke’s/Roosevelt Hospital (Columbia University) details the detrimental role of receiving teasing during physical activities (Pietrobelli, Leone, Heymsfield, & Faith, 1998). Subjects were 305 boys and 269 girls, grades 5-8, from a NY public middle school.
The findings indicated that receiving teasing was associated with reduced participation in physical activities, reduced pleasure from exercise, and a lowered sense of control (defined as control related to the physical activity). There were no gender differences in the findings. The authors concluded that efforts to promote physical education in the school setting should contain a component related to awareness of teasing as a problematic interpersonal issue and strategies designed to help children cope with the teasing.
Media Images
A sociocultural component has long been blamed for the excessive concern with appearance found in women. Typically, the media are blamed for perpetuating an impossibly thin ideal as a model for women to emulate, and such images in magazines and on TV have been castigated as causing the widespread use of excessive dieting and bulimic behaviors to achieve the "unachievable."
Interestingly, until very recently, almost no work has been conducted on an evaluation of the cultural images of appearance for men. Certainly, bodybuilding as a sport has been around for quite some time, and these images have been accessible. However, such exposure, via television and magazines, is less than that provided to other high-profile sports, such as football, baseball, and basketball.
In addition, in recent years, a great deal of media attention has been devoted to the bodies of WWF wrestlers – there are currently three cable shows devoted to this "sport." Although there are no studies that have evaluated the evolving muscularity trends for men in the big three sports (baseball, football, basketball), it is generally conceded that, especially over the past 10 years, participants have increased in muscle mass. Indeed, the two highest profile current baseball icons (Mark McGuire, Sammy Sosa) have a high degree of muscle bulk and definition.
Recently, one study entered the void of research in this area, and generated a great deal of media attention and controversy. Pope, Olivardia, Gruber, and Borowiecki (1999) assessed the changing ideals of male body image by examining popular male action toys.
They evaluated the changes in some toys over a 30 year period, and included in their analysis the following figures: GI Joe, Luke Skywalker and Hans Solo (from Star Wars), The Gold Ranger, Ahmed Johnson, Iron Man, Batman, and Wolverine). They measured the waist, chest, and bicep circumferences of the figures and scaled the measures using allometry to approximate the dimensions of a male of 70 in. (1.78m) in height.
Much of their analysis focused on GI Joe, because of the availability of models from 1973 to 1998. The findings indicated a big increase in sizes for the measured body parts from GI Joe Land Adventurer (1973) to GI Joe Extreme (1998). The chest increased in size from 44.4 in. to 54.8 in. and the biceps increased from 12.2 in. to 26.8 in. The authors noted that, extrapolated to a 70 in. (height) male, "GI Joe would sport larger biceps than any bodybuilder in history" (p. 68).
Although the waist increased in size also (31.7 in. to 36.5 in., the authors noted that the latter figure has "the sharply rippled abdominals of an advanced bodybuilder" (p. 67) whereas the early models have far less definition. The Stars Wars duo also acquired "particularly impressive gains in the shoulder and chest areas" (p. 69), however, the presence of clothing precluded the measurement of actual size changes over the years. There was only one "notable exception" to the trend of increased muscularity of models over time, "Mattel Company’s Ken, the boyfriend of Barbie" (p. 70).
These findings should, necessarily, be interpreted with some caution. Only a few action figures were examined. Second, as noted earlier, there is a lack of comparable data from other media models. Third, as always, it is impossible to determine cause and effect – there is no evidence that exposure to male action figures leads boys to develop a negative body image, or pursue a lifetime of bodybuilding.
The authors do suggest that, anecdotally, their impression is that comic strip characters, male models in magazines and male movie actors have also become more lean and muscular in recent years. Follow-up studies should address these and other methodological weaknesses. Perhaps the timing was right for such an overreaction to a very small-scale study with so many limitations.
For the past 20 years, researchers have focused on female dolls, primarily Barbie, as providing unrealistically thin body sizes for girls and women to emulate. Hopefully, the follow-up research will receive as much media attention.
Clinical Problems: Eating Disorders and Body Dysmorphia
As with any avocation that requires exacting standards for meeting an ideal physique (ballet, gymnastics, wrestling, horse jockeys, etc.), there is always the possibility that some individuals who engage in bodybuilding may engage in excessive behaviors or develop problematic traits.
Restrictive intake of calories, especially before competition, may be a symptom that needs monitoring. Purging of food, via self-induced vomiting or laxative abuse, is often part of the bulimic cycle, and is a serious issue necessitating immediate counseling or intervention. A third, relatively new, clinical condition that has recently received a great deal of attention, is body dysmorphic disorder (Thompson et al., 1999). This is a disorder reserved for individuals who have the following characteristics: excessive preoccupation with an aspect of appearance, intense obsessive-compulsive activities centered around the site of concern (i.e., checking, weighing, grooming, etc.), and behavioral avoidant features (i.e., refusal to engage in social activities because of disparagement of the appearance feature.
Research suggests that any aspect of appearance may become the focus of this level of dissatisfaction, leading to severe interference with social and occupational functioning. However, Pope, Phillips and colleagues have found a special type of BDD, which they term "muscle dysmorphia" (Phillips, O’Sullivan, & Harrison, 1997; Pope, Gruber, Choi, Olivardia, & Phillips, 1997).
The central feature of this clinical syndrome is an individual who is preoccupied with muscularity, often believing that he or she is small, weak, or inadequate in this area – a belief that is commonly incorrect, in comparison to an objective rating. The individual may engage in compulsive bodybuilding, weightlifting, and consumption of bulking-up foods and other substances, yet maintain the elevated level of muscularity insecurity.
Research into the prevalence, assessment, and treatment of muscle dysmorphia is just beginning, and it would be premature to conclude that it occurs commonly. However, it may be important to be aware of warning signs. The primary symptom, as hinted at above, is a preoccupation with one’s muscular or size inadequacies, which simply does not fit with the views of others (the objective observer).
The individual continues to maintain that he or she is not well-developed in the area of concern, and is truly distressed by this belief. Behaviorally, the person may engage in excessive and lengthy workouts, designed to "fix" the problem, express great irritation at others who disagree with his appraisal of his shortcomings, and avoid social activities and/or interpersonal commitments.
In extreme cases, the obsession may produce such compulsive workout behavior that the individual may be fired from his occupation and/or lose close personal relationships.
Summary and Recommendations
Clearly, work in this area is just emerging and much of the research has the "pathologizing" flavor of so much of mental health research (i.e., researchers focus on the psychological problems vs. the positive health associations). Nonetheless, it may be important to recognize potential problems related to an unhealthy focus on muscular development and the consequent undesirable behaviors such a desire may produce. Especially for adolescents, guidelines for early detection and sensible training need to be considered. Counselors, mentors, teachers and co-trainers might consider the following strategies:
* Ensure that a non-toxic "teasing" environment exists for gym classes and intervene with both the teased and the perpetrator to resolve this negative type of interpersonal relationship.
* Use educational and "media literacy" strategies to inform children about the representativeness of body sizes perpetuated by toy action figures and sports icons.
* In any training program, for adults and adolescents, set realistic body shape and weight goals.
* Provide information regarding normal and healthy eating practices, as well as clear-cut definitions of the dangers of restrictive dieting and bulimic behaviors.
* In cases of low self-esteem, suggest alternative or complementary routes to building self-competence.
* Consider referral for a mental health evaluation if signs of muscle dysmorphia exists.
