# Elevated symptoms of muscle dysmorphia and disordered eating among male gym-goers in Riyadh: a cross-sectional screening study

## TL;DR

Nearly half of male gym-goers in Riyadh showed signs of muscle dysmorphia, often linked with disordered eating, suggesting a need for awareness and support in fitness settings.

## Contribution

This is the first study to screen for muscle dysmorphia and disordered eating among male gym-goers in Saudi Arabia.

## Key findings

- 49.8% of participants screened positive for elevated muscle dysmorphia symptoms.
- Screening positive for muscle dysmorphia was associated with disordered eating symptoms.
- Married or divorced men and those with graduate-level education were more likely to screen positive for muscle dysmorphia.

## Abstract

Muscle dysmorphia (MD) refers to distressing concerns about being insufficiently muscular and is increasingly reported among gym-going men. Evidence from Saudi Arabia is limited. This study estimated the proportion of gym-going men in Riyadh who screened positive for elevated MD symptomatology and examined associations with disordered eating symptoms and sociodemographic factors.

A cross-sectional survey was conducted among male gym-goers in Riyadh. Elevated MD symptomatology was assessed using the Muscle Dysmorphic Disorder Inventory (MDDI), and disordered eating symptoms were screened using the Patient Health Questionnaire–Eating Disorders Module (PHQ-ED). Group differences were examined using appropriate bivariate tests. A stepwise binary logistic regression model was used to identify predictors of screening-positive status for elevated MD symptomatology (MDDI ≥ 39).

Of 303 participants, 49.8% screened positive for elevated MD symptomatology (MDDI ≥ 39). Screening-positive PHQ-ED status was associated with screening-positive MDDI status (Fisher’s exact test, p = 0.030). In the final stepwise multivariable model, marital status and graduate-level education were associated with screening-positive MDDI status. Body mass index (BMI) was not retained in the final stepwise model, and PHQ-ED status could not be evaluated in the multivariable model due to sparse data/complete separation (non-estimable odds ratios).

Nearly half of the surveyed gym-going men screened positive for elevated MD symptomatology, indicating a high symptom burden in this selected sample. These findings should not be interpreted as diagnostic prevalence. Screening-based approaches in gym settings may help identify individuals who report high distress or interference and may benefit from further clinical assessment. Larger studies using probability sampling and structured diagnostic interviews are needed to estimate diagnostic prevalence and clarify associated factors.

The online version contains supplementary material available at 10.1186/s40337-026-01556-3.

Many men worry about not being “muscular enough.” For some people, these worries can become intense and interfere with daily life; this pattern of severe muscularity-related distress is sometimes referred to as muscle dysmorphia. We conducted a survey to understand these concerns among men who attend gyms in Riyadh, Saudi Arabia. We used a screening questionnaire with 303 men. Nearly half of the participants scored above the questionnaire’s screening threshold for elevated symptoms related to muscle dysmorphia. A high score does not constitute a formal medical diagnosis, but it may indicate greater distress or interference that could benefit from further assessment. We also found that screening positive for muscle-related concerns was linked with screening positive for eating-related concerns. Interestingly, men who were married or divorced were more likely to screen positive, and men with higher levels of education (such as a Master’s or Doctor of Philosophy (PhD)) were also more likely to report elevated symptoms. A person’s measured body size or weight was not linked to these concerns, suggesting the issue relates more to body perception than to actual size. These findings support the value of awareness and clear referral pathways in gym settings for individuals reporting high distress or impairment.

The online version contains supplementary material available at 10.1186/s40337-026-01556-3.