Characteristics of Hungarian male weightlifters

In the third study we examined Hungarian male weightlifters and explored the prevalence rate and various psychological characteristics of MD and AAS use within this high risk population. However, it is worth mentioning some general characteristics of the total sample since this is only the second study among male weightlifters in Hungary. Since the previous study was conducted ten years ago (Túry et al., 2001), it is also useful to compare our results with the results of the first Hungarian study to follow time trends. If we compare the anthropometric data of the participants of the previous and the present studies, the differences are notable. Participants in the currents study had the mean age of 27.8 (SD = 7.40) years, which is significantly higher than in the previous study reported by Túry et al. (2001), 26.2 years; t(303)=3.800, p < .001. The mean body height of our study sample was 179.5 cm (SD = 6.05), which was significantly lower than the mean body height of the participants in the study of Túry et al. (2001), 180.7 cm, t(304) = 3.391, p = .001. The body weight, BMI, and desired body weight of the male weightlifters in our sample were significantly higher compared to the study results of Túry et al. (2001). Ten years ago the body weight of the male weightlifters was 83.2 kg and their BMI was 25.5. By 2011 their body weight increased to 87.5 kg and their BMI to 27.1, t(303) = 5.176, p < .001 and t(303) = 6.955, p < .001, respectively. Weightlifters in 2001 reported a desired body weight of 87.2 kg. Despite of the higher body weight of the weightlifters in 2011, they still would like to increase their body weight and reported a desired body weight of 90.7 kg, t(303) = 4,213, p < .001.

The difference of the means between the actual and desired body weight of the participants in the previous (4 kg) and present study (3.2 kg) did not differ significantly, t(303 )= 1.455, p = .147.

More interestingly, the number of males who are dissatisfied with their body weight significantly increased in this population. In 2001, 43% of the male weightlifters were satisfied with their body weight; however in 2011 only 9.5% of the participants reported weight satisfaction, χ²(2) = 144.461, p < .001. Conversely, the number of those males

who wanted to lose or gain some weight increased from 2001 to 2011. In 2001, only 16% of the weightlifter males wanted to lose some weight; by 2011 this number raised to 31%. Ten years ago the number of weightlifter males who wanted to gain weight was 41%; by 2011 this number increased to 60%. Moreover, in the study of Túry et al.

(2001) only 4.3% of the male weightlifters wanted to achieve notable weight gain (at least 5 kg); in the present study we found significantly higher rate, since almost half of the participants (48.4%) reported a desire to gain notable weight, χ²(1) = 1433.801, p <

.001.

These results are in line with previous international studies suggesting increasing body dissatisfaction among males over the last few decades (Berscheid et al., 1973; Cash et al., 1986; Garner, 1997; Grieve et al., 2006; Mishkind et al., 1986; Pope, Phillips, et al., 2000; Vartanian et al., 2001). The populations in the present and the previous studies are consisted of male weightlifters, therefore results should not be generalized to the general Hungarian male population. Nevertheless, our results comparing to the previous results highlight the changing trends in male body image concerns and body size ideals.

Considering that we examined these trends ten years after, the changes are dramatic.

Several studies pointed out the prevalence of exercise dependence among weightlifters (Hale et al., 2010; Hurst et al., 2000; Smith et al., 1998; Smith & Hale, 2004). In the present study we also examined the prevalence rate of exercise dependence among Hungarian male weightlifters. According to the results, 9.2% of the male weightlifters were at risk for exercise dependence and further 61.2% were symptomatic non-dependent. In a recent Hungarian study, the prevalence rate of exercise dependence categories in exercising population were: 44.8% asymptomatic, 52.0% nondependent symptomatic exercisers, and 3.2% at risk for exercise dependence (Mónok et al., 2012).

Results indicated that the prevalence rate of exercise dependence was significantly higher in the present sample of male weightlifters compared to the result of the above-mentioned study, χ²(2) = 54.918, p < .001. However, the prevalence rates in our study were significantly lower compared to the international prevalence rates. Hale et al.

(2010) examined the prevalence rate of exercise dependence among male weightlifters and power lifters. According to the results 15.1% (n = 22) of the participants were

identified as at risk for exercise dependence, 77.4% (n = 113) as symptomatic non-dependent, and 7.5% (n = 11) as nondependent asymptomatic. The prevalence rate of exercise dependence (both ‘at risk’ and ‘symptomatic non-dependent’) in the study of Hale et al. (2010) was significantly higher compared to the prevalence rate in our study population (based on both the new cut-off scores suggested by Mónok et al. (2012): χ²(1)

= 215.374, p < .001; and the original cut-off score: χ²(1) = 99.757, p < .001. Lejoyeux et al. (2008) found 42% (n = 125 out of 300) prevalence rate of exercise dependence among clients of a fitness room. This prevalence rate is also significantly higher compared to our results, χ²(1) = 134.173, p < .001.

Research evidence also suggests that weightlifters are at increased risk for developing an eating disorder (Anderson et al., 1995; Goldfield et al., 1998; Mangweth et al., 2001). In our sample of male weightlifters, 8.5% was likely to have an eating disorder (AN or BN). Since 31% of the participants would like to lose weight and 60% would like to gain weight, the presence of eating disorder symptoms in this sample of male weightlifter is not surprising. Furthermore, they also have an increased preoccupation with their body image, food and exercise, which may also increase the risk for developing eating disorder symptoms (Mangweth et al., 2001).

5.3.2 Prevalence of muscle dysmorphia among Hungarian male weightlifters

The first purpose of the study was to identify a group of male weightlifters with unique features of MD, which can be distinctive from non-muscle dysmorphic weightlifters and to set out a prevalence rate of MD among Hungarian male weightlifters. Study results differentiated three groups (normal weightlifters, low risk MD group, and high risk MD group) of male weightlifters, instead of two (MD and non-MD group of weightlifters).

This result was not surprising, as Hildenbrandt et al. (2006) identified five groups (muscle dysmorphic, muscle concerned, fat concerned, normal behavioral, and normal) within their sample of male weightlifters with the use of the same statistical method (LCA). In the present study we were able to identify a group of weightlifters who displayed the characteristics of MD, called the high risk MD group. Although, this group was not a clinically diagnosed group with MD, they displayed the symptoms of MD conceptualized by Thompson et al. (1999) and fulfilled the diagnostic criteria of

MD described by Pope et al. (1997). Based on these characteristics, the high risk MD group was distinctive from the other two groups of male weightlifters. According to the results of the latent class analysis, the estimated prevalence rate of MD was 18.0% (n = 55) in this sample of male weightlifters (in the study we referred them as high risk MD group). A further 51.6% (n = 157) displayed elevated levels of MD symptoms; thus, these male weightlifters could be characterized as the low risk MD group. Future research should focus on the at-risk groups and analyze the potential risk factors of MD.

Finally, 30.2% (n = 92) of the participants could be described as normal weightlifters as they did not show the symptoms of MD.

There is only one study available in Hungary that can be comparative to our study results. In this previous Hungarian study Túry et al. (2001) found significantly lower prevalence rate of MD (4.3%) among male weightlifters using interview technique, χ²(1)

= 140.525, p < .001. However, the prevalence rate of MD in this study is significantly higher compared to the 8.3% prevalence rate reported by Pope et al. (1993), χ²(1) = 38.298, p < .001, and the 10% prevalence rate found by Pope & Katz (1994), χ²(1) = 22.118, p < .001. The comparison of our results with other studies is difficult as the findings in different studies are heterogeneous in terms of the study sample (e.g., weightlifters, bodybuilders, power lifters, men with body dysmorhic disorder), study design (e.g., questionnaire or interview based), and outcome measures (several measures of MD symptoms are available). Since the prevalence rate in the present study is a questionnaire based one, and the differentiation of the MD group based on a specific statistical method, we suggest this rate as a tentative prevalence rate. Although Hildenbrandt et al. (2006) found similarly high prevalence rate (16.9%) among male weightlifters, with the use of LCA, χ²(1) = .308, p = .579. Some authors also noted that the prevalence rate of MD is underestimated and many men might suffer from subclinical forms of MD even in the general population (Goodale et al., 2001;

Olivardia, 2001; Pope, Phillips, et al., 2000), results should be treated carefully.

Since our study sample was a special population consisted of male weightlifters, the generalization of the results is restricted to the male weightlifter population and can not be extended to the general population. Despite of the limitations, the present study is the

first national study assessing the prevalence of MD in high risk population of male weightlifters with a larger sample size. Although studies relating to MD in Central-Eastern European region are still lacking, our results suggest that MD is prevalent in Hungarian male weightlifters.

5.3.3 Determination of the tentative cut-off score of the Muscle Appearance Satisfaction Scale

To our knowledge, no cut-off score for the MASS is available; thus, the present study also aimed to determine a tentative cut-off score for the measure. Considering the high risk MD group as a ‘gold standard’, sensitivity and specificity analyses were performed.

According to the results, we proposed a score of 62 as an appropriate cut-off point for the MASS to distinguish between MD and non-MD cases among male weightlifters.

Given that we used a nonclinical sample of MD cases, the proposed cut-off score is still a tentative cut point. Additionally, this cut-off score may vary in different research studies and may also depend on culture and other variables. In the future, it would be particularly interesting to examine the proposed cut-off score in other studies. The use of clinical MD sample for this purpose would be highly instructive.