Body-Image Pressure Increasingly Affects Boys

Cultural ideals are becoming an equal opportunity anxiety-inducer, and eating disorders are increasingly common in men. But the symptoms in men and women don't look the same.

Culturally, we’re becoming well attuned to the pressure girls are under to achieve an idealized figure. But researchers say that lately, boys are increasingly feeling the heat.

A new study of a national sample of adolescent boys, published in the January issue of JAMA Pediatrics, reveals that nearly 18 percent of boys are highly concerned about their weight and physique. They are also at increased risk for a variety of negative outcomes: Boys in the study who were extremely concerned about weight were more likely to be depressed, and more likely to engage in high-risk behaviors such as binge drinking and drug use.

The trend toward weight obsession among boys is cause for worry, says Dr. Alison Field, an associate professor of pediatrics at Boston Children’s Hospital and the lead author of the study. “You want people to be concerned enough about their weight to make healthy decisions,” she says, “but not so concerned that they’re willing to take whatever means it takes—healthy or unhealthy—to achieve their desired physique.”

Of the boys who were highly concerned with their weight, about half were worried only about gaining more muscle, and approximately a third were concerned with both thinness and muscularity simultaneously. Meanwhile, less than 15 percent were concerned only with thinness. Those statistics reflect a major difference between boys and girls when it comes to weight concerns: whereas girls typically want to be thinner, boys are as likely to feel pressure to gain weight as to lose it.

“There are some males who do want to be thinner and are focused on thinness,” Field says, “but many more are focused on wanting bigger or at least more toned and defined muscles. That’s a very different physique.”

If boys are increasingly concerned about weight, changing representations of the male form in the media over the last decade or two are at least partly to blame. “We used to really discriminate—and we still do—against women” in terms of media portrayals, says Dr. Raymond Lemberg, a Prescott, Arizona-based clinical psychologist and an expert on male eating disorders. “If you look at the Miss America pageant winners or the Playboy centerfolds or the runway models over the years, there’s been more and more focus on thinness.”

But while the media pressure on women hasn’t abated, the playing field has nevertheless leveled in the last 15 years, as movies and magazines increasingly display bare-chested men with impossibly chiseled physiques and six-pack abs. “The media has become more of an equal opportunity discriminator,” says Lemberg. “Men’s bodies are not good enough anymore either.”

Even toys contribute to the distorted messages youngsters receive about the ideal male form. Take action figures, for example, which Lemberg suggests are the male equivalent of Barbie dolls in terms of the unrealistic body images they set up for young boys. In the last decade or two, action figures have lost a tremendous proportion of fat and added a substantial proportion of muscle. “Only 1 or 2 percent of [males] actually have that body type,” says Lemberg. “We’re presenting men in a way that is unnatural.”

In the face of the ideals they’re bombarded with, it’s no surprise that adolescent boys, like waves of girls before them, are falling prey to a distorted image of themselves and their physical inadequacies: Previous research suggests that up to 25 percent of normal weight males nevertheless perceive themselves to be underweight.

And given their perception of themselves as too small, it’s also no surprise that boys are searching out means to bring their bodies into conformity with the muscular ideal. A 2012 study of adolescents revealed that muscle-enhancing behaviors are pervasive among both middle school and high school-age males: More than a third reported downing protein powders or shakes in an effort to boost their muscularity; in addition, almost 6 percent admitted to using steroids and 10.5 percent acknowledged using some other muscle-enhancing substance.

Pharmaceutical-grade injectable steroids are a definite concern, says Dr. Rebecka Peebles, co-director of the Eating Disorder Assessment and Treatment Program at the Children's Hospital of Philadelphia, but they’re not the biggest worry, given that they’re difficult to obtain. Of more concern are the “natural” powders or shakes that teens can pick up at their local GNC. The problem, Peebles says, is that “natural” in this case simply means unregulated. “They actually can include all kinds of things in them,” says Peebles. In some cases powder or shake supplements “are actually anabolic androgens and just packaged as a natural supplement.”

The consequences can be severe: Long-term use of steroids is associated with depression, rage attacks, suicidal tendencies, and cardiomyopathies. And the negative effects can be particularly significant for adolescents, since their bodies are going through a period of major growth and development.

In many cases, of course, weight concerns among young males remain at relatively benign levels, and when teens attempt to control their weight, they often do so in comparatively innoccuous ways. But when adolescents demonstrate an extreme focus on physique and begin to engage in potentially dangerous behaviors, it can be a signal of an eating or weight-related disorder—in males just as much as in females.

“The misunderstanding has been the generalization that eating disorders are a woman’s issue,” says Lemberg. “What studies have shown is that, in the last 15 years or so, more men have eating disorders than ever before.” The oft-cited figure is that only about 1 in 10 eating disorders occur in males, but according to Lemberg, newer research suggests that the real ratio is probably closer to 1 in 4.

Although awareness of the risk of weight disorders among males is growing, there is still a problem with under-recognition, Field says, primarily because of the assumption that the disorders look the same in males as they do in females. Current assessments for eating disorders focus on the classical presentation typical of females, but since young men are often more concerned with gaining muscle than becoming thin, they typically don’t present as underweight, as girls often do. They’re also not as likely to starve themselves, use laxatives or induce vomiting; instead, they’re much more likely to engage in excessive amounts of exercise and steroid abuse. “Instead of wanting to do something unhealthy to get smaller, they’re using unhealthy means to become larger,” Field says.

But though the presentation might be different, excessive worries about weight, especially in combination with high-risk behaviors, are no less concerning in males than in females. According to Field, it’s time to sit up and take note of the boys. “Pediatricians and adolescent medicine docs and parents [need] to become aware that they should be listening as much to their sons’ conversations about weight as their daughters’.”