Performance-enhancing Drugs and Body Image

Margaret Ferrier Excerpts

Tuesday 21st February 2023 Westminster Hall

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Until we were rudely interrupted by that vote, I was saying that we need to talk about steroids in the UK because, as the Priory Group has said:

“we are sleepwalking into a…crisis.”

As a GP, I know that the obesity epidemic has been a real problem, but part of the nation is actually getting fitter while part of it is getting fatter. I will concentrate on the part that is getting fitter, because of those who go the gym—mainly men—we know that one in 10 suffer from bigorexia. What am I talking about? Bigorexia is body dysmorphia—the idea that someone’s muscles are not big enough, no matter how much they eat or train. It is important to understand that this is a growing epidemic in our country; even more importantly, it is quite prolific in the gay community. I will break the issue down into three sections. I will talk a little bit about how I came to this topic, the drivers behind it, and, most importantly, what needs to be done.

Growing up, I was a fairly normal kid. At the age of 14 or 15, I was playing sport and was reasonably academic, but I was an outlier, because for my 15th birthday I had saved up £500 to buy a multigym. In my head, I wanted to improve my rugby, get girls, fight off bullies and improve my body image. Surprisingly, I was the under-16s first-team captain, but the other three aims fell to one side. Looking back, I think, “How many other young men feel like this?” That was 25 years ago. I think the points I mentioned are the driving forces behind why men want to go to the gym and improve their body image. Society says to them, “We need to be perfect”, but what is that perfect image?

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Social media and reality TV have played a huge part in promoting unrealistic body ideals, which we often do not think about when it comes to men’s self-esteem. Does the hon. Member agree that there should be some greater controls around edited, unrealistic imagery?

[Dr Evans]

The hon. Member is spot on. The advent of social media over the last 20 years has really brought home that idea of body image. With the likes of Instagram, if a man is interested in using a gym, they are sent hundreds of images in 30, 40 or 50 seconds. Each individual image in itself is not the issue, but the cumulative effect of repeatedly being sent such images is a problem.

I would argue that the way to solve the problem is through the social media companies’ algorithms, to ensure that there is transparency about what people are being sent. Facebook talked about diet pills aimed at young girls being a real problem. If we do not deal with male body image and body dysmorphia, this will be the next iteration of that problem.

As a doctor, over the last 10 to 15 years I have started to see more and more young men coming into my clinics and asking to be prescribed protein powders or creatine, and asking, “How do I bulk up?” I also started to see more and more men in their 20s, 30s and 40s who were using steroids and having side effects, including bad acne, scarring acne, mood problems and depression. I have even seen some men who have had strokes, heart attacks, liver problems, kidney problems and erectile dysfunction, none of which are really talked about when it comes to steroids.

The problem with steroids is that they work, so people use them and see a drastic improvement. People who want to build muscle will see that improvement, take the cycle of whatever substance it happens to be and then plateau, which is very hard for them to deal with because they no longer see the gains they were initially getting under their regime. They say, “Oh, I’ll only use it once”, but once becomes twice, twice becomes thrice, and so on.

--- Later in debate ---

[Margaret Ferrier]

The hon. Member mentions aggression. A common side effect of steroids is roid rage, which means that it is not just those who choose to use steroids who are impacted, but everyone around them, too, and that can lead to serious life-ruining consequences all around. Does the hon. Member agree that greater understanding of side effects is an imperative part of tackling the abuse of these drugs?

[Stuart C. McDonald]

The hon. Member makes a valid point. One report I read suggested that when engaging with people who are already using steroids, sometimes the most persuasive factor in getting them to reconsider and move away from this conduct comes from speaking to them about the consequences for their mental health rather than the physical consequences. That appears to have more influence when it comes to behaviour. The hon. Member makes an interesting point.

Alone, most steroids are taken in pill form. If needle sharing is involved, there are other risks in terms of HIV and hep C. Use of counterfeits also further complicates risk. Of course, another consequence if they are used in sport is that unfairness is created and sporting integrity is undermined. As has been set out, the drugs are regulated under the Medicines Act 1968 and classified as class C under the Misuse of Drugs Act 1971.

The question rightly posed to us today is: what more can we do? I speak from a position of weakness, but I agree that first and foremost, we all need to improve our knowledge of the issue. Evidence has to be at the heart of the approach, as the hon. Member for Bosworth has said, so how better can we understand the scale, incidence and causation of the problems that have been highlighted and thereby better craft a response?

As the hon. Member highlighted, last August the Health and Social Care Committee reported on the impact of body image on mental and physical health and recommended a national review of the growing use of anabolic steroids as it relates to body image. That seems to me to be an essential first step. That research will then shape our response, which will have to use a public health approach and education to tackle demand and to try to close off access as best we can. That, of course, will involve a cross-departmental approach, which was another important point made by the hon. Member.

On education and campaigning, there are two sides to the coin. First, we need to look at the material and propaganda influencing and driving people to a place where they feel it is necessary or desirable to access IPEDs. That includes media and social media, as hon. Members have said, with the all-prevalent perfect body images in the press, on TV and increasingly on social media and in online advertising. If anyone shows a remote interest in trying to keep fit or even just losing a few pounds, they suddenly find themselves bombarded on Instagram or Facebook or whatever else with relentless images of what has been referred to in the past as the “Love Island” look, which to me seems pretty much unachievable for anyone who cannot spend every waking hour in the gym or unless they use IPEDs.

The Health and Social Care Committee dealt with that point in its report, calling on the Government to work with advertisers to feature a wider variety of body aesthetics and with industry and the Advertising Standards Authority to encourage advertisers and influencers not to doctor their images. The Committee said that

“the Government should introduce legislation that ensures commercial images are labelled with a logo where any part of the body, including its proportions and skin tone, are digitally altered.”

Those seem to be valuable suggestions that are certainly worth considering. The hon. Member for Bosworth pointed out that there has been some progress, but there is further to go.

As well as tackling the images and messages that promote the use of IPEDs, Government also need to raise awareness of the risks and how to minimise harm. Again, various Committee recommendations seem sensible, advocating for a campaign co-ordinated

“through existing steroid user support groups and targeted at areas of highest risk, such as gyms with a high proportion of body builders.”

We need to tackle head on the idea that these things are some sort of equivalent to supplements. They are in a different category altogether. The Committee also heard evidence stressing the importance of education about body image for young people, in terms of both critical thinking and appraising images, as well as self-worth. Again, the Government should strengthen those areas in education settings.

A report by the Scottish Drugs Forum noted the significance of close friends as a source of IPEDs. It suggested that peer education programmes could be an important way of overcoming that, with community members cascading positive health messages. And this is not just about education; mental health strategies need to be revisited as well, and we need to think about how we can support people struggling with self-esteem amid a bombardment of images.

Finally, we also need to consider appropriately targeted harm reduction advice and drugs services. There are many examples of good work out there. Yorkshire and the Humber has a regional steroid and IPED reference group and a workers forum of more than 30 people and with every district represented. In Glasgow, an image and performance enhancing drugs clinic provides testing, needle exchange services, consultation and advice on harm reduction and alternatives. Edinburgh, too, has a steroid clinic based in the harm reduction team of NHS Lothian. It provides advice services, equipment and testing, psychological services, and support to stop with mental and physical assistance. There is good work happening in the different parts of the United Kingdom. We should learn from that, and seek to ensure that more people around the various countries can benefit from it. Those are just a few ideas.

I will close by thanking the hon. Member for Bosworth again for bringing forward this debate. None of us have all the answers; I certainly do not—far from it. He had lots of ideas. He highlighted that there are pros and cons to some of them. Some of them are quite bold or controversial, but they are definitely worth discussing. His central point was that we need to have evidence to make the discussion as fully informed as possible. We should revisit this topic, and ensure that we continue to drive forward as we seek to address what is a growing public health issue.