Ashlee Williams, MD (Host): Body image is one of the most complex parts of the teen experience, and today supplements, workout routines and influencer driven wellness advice are everywhere, making it harder than ever for young people to know what's safe, what's hype, and what truly supports their health.

 Welcome to the Healthier You Podcast.

I'm Dr. Ashlee Williams, and today I'm talking with Dr. Mutsa Nyakabau, a board-certified pediatrician about how online content shapes the expectations teens place on themselves, and how we can help young people build a healthier relationships with their bodies, find balance in a high pressure environment, and make informed decisions about fitness and nutrition.

Dr. Nyakabau, thanks so much for being here.

Mutsa Nyakabau, MD: Thank you for having me. I'm looking forward to having this discussion.

Host: It's a very important discussion. Let's just start with the basics. What are the most common body image concerns you see in your practice as a pediatrician and have these changed over the past few years with the rise of social media?

Mutsa Nyakabau, MD: So the body image concerns that I see very commonly, change a little bit, whether we're talking about our young ladies or the young gentlemen. So for my young ladies, I see, preoccupation with thinness, with flawless skin, and for my young boys this, preoccupation with having this hyper-masculine physique. Now this has evolved over time because in bygone days when you think of your Cindy Crawford magazines, and those pressures to look thin, and in the bygone days of Arnold Schwarzenegger, the muscle magazines, the curated images that teenagers seem to see, have started to evolve this idealized image, where the young ladies get and the young gentleman get this almost biologically impossible ideal that they have to aspire to.

So for example, my young girls not only have to worry about being thin now, but they also have to worry about being thin and also having exaggerated glutes, which is unattainable, by most, if not a large number of my young ladies. For the young gentleman, it is having this hyper-masculine physique and 6% body fat.

Having large muscles with large vascularity, a V taper, being 6'2". All of these different attributes have become more and more unattainable. And this is propagated, by what's a lot of my young people are seeing very frequently on social media and social media platforms.

Host: Thank you for that. Can you talk about how influencer culture has changed teens ideas of what's healthy?

Mutsa Nyakabau, MD: So influencer culture, has propagated this concept called the filtered reality gap. This gap between online appearance, and what the teenager sees in front of the mirror. So why is this unique?

It's a unique challenge because the pressures of physical appearance before, were based on an idealized image you would have your model in New York with an airbrushed picture who was someone far away who had a team of various people who made them look the way that they look. But now teenagers in this day and age see their schoolmates, their classmates, their teammate, who with one single click and a few AI guided touchups looks absolutely stunning online. This makes the idea of this unattainable image seem closer to our teens and enhances the frustration if they're not able to meet that ideal. So that proximity that they have to these influencers is what makes it very impactful towards their mental health and their wellbeing.

Now, in the influencer culture is this parasocial relationship because the teenagers actually see the influencers as their friends. With the influencer culture, the teen looks at their TikTok, sees the the influencer walking their dog, eating breakfast, going through their routine so they feel very close.

So the guardrails that one might have, those mental guardrails that allow a little bit of skepticism when a product is being sold aren't there. They are more inclined to view advice from an influencer as advice and not a sales pitch, which makes it very difficult to resist the urge to follow what the influencers do. In fact, a lot of my teams aspire to do what the influencers do.

Host: I agree. Filters have helped set up unrealistic expectations, so we know that influencers can promote supplements on their social media pages. So let's talk about supplements. What are the current recommendations around protein powders or pre-workout supplements for teen athletes? And can you talk a little bit about the risk?

Mutsa Nyakabau, MD: Absolutely. Absolutely. So, let's start with protein powders. Whey protein is a very common one that I see a lot of my young and active teenagers engaging with. Now the idea is to get more protein to help facilitate muscle gain. The gains is what the teenagers say, I've got to get those gains.

Everything is driven around the gains and the research around protein powders actually says that they're not very necessary. A lot of teens need about one and a half grams per kilogram of weight per day to meet the requirements of an active teenager. Now, teenagers are able to gain about two to three times that just by eating good complex foods and with eating regular foods, teenagers are able to get micronutrients in addition to just isolated protein that might have proprietary blends and high sugars, which actually lend more to being unhealthy, as opposed to being healthy. So the research says protein powder's not particularly necessary, even though a lot of my teenagers feel the need to use them quite regularly. Now something for example, like creatine or something like a pre-workout. Creatine is very controversial in that a lot of the studies surrounding creatine are for people who are 18 years and above. It is not ideally recommended for anyone who is below 18 because we do not have any long-term studies for safety, even though it can be efficacious for activities that require explosive power, like sprinting or power lifting. And there are some short term studies that show some short term safety, but the concern from the American Academy of Pediatrics, the American Sports Medicine Society is that we do not know over time what creatine in particular does on the developing body. So we try our best to err on the site of caution to make sure that there is nothing that affects our teens because they're growing and developing.

Now pre-workout is a hard no for various reasons. Pre-workouts are used by a lot of our teens to get this buzz and to get this boost of energy to facilitate their workouts. And they can contain between 200 to 400 grams of caffeine. Now that can cause some strain on the cardiovascular system.

Think about this. A 14-year-old is going to do their workout somewhere between four o'clock and seven o'clock in the evening, and they're going to take a large dose of 200 to 400 milligrams of caffeine. This impacts sleep. Sleep is important for the teenage brain, for hormonal regulation, and for the ability to engage effectively in workouts.

So what does the teenager do the next day when they're tired because they don't have good quality sleep because they have had caffeine late in the day. Again, caffeine has a half-life of about five to six hours. So it's still in the system when they're trying to get that deep sleep that facilitates tissue repair, and hormonal regulation, and learning and consolidating memories.

It hinders the next day. And because it hinders the next day, what do we need to do to get that boost again? Take more pre-workout. So the risks far outweigh the benefits, as far as pre-workouts are concerned. And one caveat that I must mention is none of these substances are FDA-approved. So what they say, they contain, they could contain, they could not.

That's debatable. Who knows? One of the things that is the buzzword with a lot of supplements is proprietary blend. Proprietary blend is just an excuse that some companies use to put other chemicals without quantifying the exact amounts, in a proprietary blend that gives some effect. But these can be negative effects, especially for our teenagers.

Host: Wow. That's really good to know. So let's say the parent notices their teen has changed their workout and diet routine. What are some red flags that parents should look out for that some of these changes are unhealthy?

Mutsa Nyakabau, MD: Thank you. That's a very good question because the red flags might be a little more subtle than what some people might realize.

If you think of someone who, for example, there's something called orthorexia. An obsession with clean eating, counting macros, knowing exactly how much is in each and every meal. This might be taken by some parents as being very organized, very proactive, but it actually represents some pathology because there is no reason a teenager should be worried about how many grams of carbs are in the apple that they just ate, so that they can make sure that they burn enough calories later on. It develops this relationship where some teens feel they have to earn their food, their meals, and there's so much anxiety that surrounds it that some teenagers can't engage in food in a very healthy way that encourages growth and personal development.

Now there is something else called muscle dysmorphia, bigorexia is, a common term that's used to describe it. Think of your teen who flexes very frequently every time they, they catch a mirror, they pinch their skin to see if they what percent body fat they have. They, cover themselves with baggy clothes when they feel that even though they look good, even though they look fit and strong, they do not feel that they've accomplished that size or that definition that they want, and they might even miss social engagements because of this concern.

Some teens, in spite of being sick, in spite of being injured, will sometimes push and train through that sickness and injury out of a fear of losing out on that workout. If you see an unhealthy relationship where a teen just cannot go without doing that workout, that's another sign to be concerned. Now, some more concerning signs and features might include things like decreased energy, having bone fractures in a teen who has not had any major trauma, that indicates that the body's leaching so much out of the bones because our diet, our workouts are so stringent that the body's breaking down essentially.

In our girls having irregular periods, having brittle nails, all of these things can be signs that even if they might seem that your, your child is being self-aware, self-conscious, being proactive, that something wrong is actually happening.

Host: So, I think we can both agree that the adolescent lesson time period is a very intense time in life where there's just so many changes going on. What can parents or caregivers do to support their teen's body image?

Mutsa Nyakabau, MD: Very good. And the adolescent time, like you said, is a time of developing that sense of personal identity and that time involves a lot of our teens moving away from authority figures and going towards the group. And so, offering various ways of support, such as letting them know that you are there for them.

And it doesn't have to be intrusive. Just say, Hey. I'm here if you need me. A lot of my teens, when I see them in the clinic, just knowing that their parents are there is a lot of reinforcement that they need when they're struggling, when things are really not going well, they know that there's that person I can go to, there's that person I can rely on.

Interesting engagement or exercise that I, I sometimes recommend to parents is, Hey, when your child's on TikTok on Instagram, co-view you with them. Look at what they're looking at together. And what this does is it provides an opportunity to say, Hey, that young lady's making that pose doesn't look comfortable.

Or when that young lady wakes up, do you think she looks like that all of the time? It gives these opportunities to model how to question social media so that they're not just passive recipients of the volumes of curated information that is just being foisted on them and that they're actively engaging and they're seeing how to engage with this material effectively.

 Something that I try and tell parents a lot of times is reframe how you praise your teens as well. Something like, Hey, you look good, might have the unintended effect of propagating that asphyxiation with how I look, my appearance, focusing on just everything on the outward side.

Something that can just change that orientation might be something like, Hey, I see that you've been working really hard. I see that you're getting stronger. Praising the effort, praising the dedication, the commitment. That teaches them to validate effort and not, place as much emphasis on how I look or what my appearance is.

Be also very careful how you speak about your own body as a parent, because teenagers really value more what you do than what you say, and if we've heard teenagers say, oh, but you are not doing that, or you are doing that, it's a common thing. They really do take what we do, how we model behaviors to heart.

So you gotta fake it till you make it parents. If you speak poorly about yourself, that's how they learn to speak about their own body. So model positive talk about your own appearance so that they learn to love themselves, and that is something that you can be a good example for. One last thing is, family meals.

I cannot emphasize enough how family meals, as annoying as they might seem to your teenager; family meals, ground your teenager into what healthy eating looks like. It gives opportunities for conversation, for community. It grounds them and allows them opportunities to express concerns should they choose to.

But that door is always open. And the family meal is something through research that shows, that consistency, that safety, that a lot of teenagers need in spite of them seeking independence.

Host: Wow. This was really great information Dr. Nyakabau. We learned a lot about how digital culture impacts teen body image and what we can do to help. Here are the top takeaways.

 Social media amplifies image pressures. Teens see edited content from peers and influencers that set unrealistic standards. This constant comparison can increase self-criticism and anxiety.

 Boys and girls experience pressure similarly. The ideas that teens aspire to may differ, but they're often shaped by online trends rather than real health.

Fitness influencers and supplements can be misleading. Teens may trust influencers promoting products that aren't regulated or proven safe. This can lead to unnecessary or risky supplement use.

Warning signs of unhealthy habits include restrictive eating, excessive exercise, obsessive tracking, mood changes, and withdrawal from social activities.

Modeling healthy habits matter. Encourage open conversations, media literacy, balanced nutrition, and enjoyable exercise.

Seek professional help early if anxiety or disordered behaviors emerge. For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to subscribe and share it with others. Have questions or health topics you'd like for us to address in a future episode, let us know in the comments.

Thank you, and from all of us at Kaiser Permanente, be well.