By KRISTIN JAVARAS
Published: November 8, 2013

This week, a paper published by Alison Field and colleagues in JAMA Pediatrics shed light on eating disorder symptoms in teenage boys and young adult men, a topic deserving of growing recognition.

The research included 5,527 young males who were part of the Growing Up Today Study (GUTS). The study started in 1999, when they were between 12 and 18 years old, and the researchers then followed them for 11 years until 2010 when they were 23-29 years old. During the study period, 0.8% of the males reported that they engaged in frequent (monthly or more) binge eating and purging or in frequent purging alone. An additional 2.9% reported that they engaged in frequent binge eating alone. Even among those who did not engage in frequent binge eating or purging, a significant percentage reported that they were concerned with their body image: 6.3% expressed that they were highly concerned about appearing thin and muscular, 2.5% expressed concern about thinness but not muscularity, and 9.2% expressed concern with muscularity but not thinness. A small subset (2.4%) reported that they were very concerned about appearing muscular and used supplements, growth hormone derivatives, or anabolic steroids to achieve their desired body.

Field and colleagues were curious to see whether binge eating, purging and concern about body image predicted later behavioral and emotional problems such as binge drinking, drug use, and depressive symptoms. They also took into account other well-known risk factors for binge drinking, drug use, and depression among teenage boys and young adult men, such as the age, where they lived in the country, and whether they had a sibling who used drugs. Boys and young adult men who were very concerned about thinness (but not muscularity) were more likely to subsequently experience depressive symptoms, and boys and young adult men who had high concerns about muscularity and used anabolic steroids or other products were more likely to subsequently binge drink and to use drugs.

So what do we learn from this study? First, the number of teen boys and young adult men with symptoms of eating disorders (being highly concerned about thinness, engaging in binge eating and/or purging) is higher than many people think. Second, even in teen boys and young adult men who do not have these symptoms, a sizeable portion of them are highly concerned with muscularity, and a subset of them are engaging in potentially dangerous practices (e.g., anabolic steroid use) to achieve their desired body. Although they would not qualify for a diagnosis of an eating disorder based on the current diagnostic system, their efforts to increase their muscle bulk and tone through harmful practices are similar to the efforts to lose weight through extreme dieting or purging that we see in anorexia nervosa or bulimia nervosa. Third, eating disorder symptoms and body image concerns in teen boys and young adult men can be followed by other emotional and behavior problems, such as depressive symptoms, binge drinking, or drug use.

Sadly, males are even less likely to receive treatment for eating disorders than females (Kessler et al., 2013). It’s crucial that we do a better job of alerting caregivers, educators, sports coaches, medical professionals, and teens and young adults themselves that eating disorders can and do occur in boys and men, and providing education about how to recognize the signs and symptoms. Warning signs can include eating less than usual, skipping meals, avoiding entire food groups such as carbs, disappearing into the bathroom after meals, or working out obsessively, whether it’s cardio or weight lifting. (It’s hard to define obsessively, but becoming upset if you can’t work out, or starting to miss out on other activities in order to work out, can signal a problem.) More comprehensive lists of eating disorder symptoms can be found online. It’s also crucial that we do more research focused on understanding eating disorders and body image concerns in boys and men, in order to help develop and tailor even more effective treatments for these problems that bring so much pain and suffering to so many.

References:

Field, AE, Sonneville, KR, Crosby, RD, Swanson, SA, Eddy, KT, Camargo, CA, Horton, NJ, Micali, N (2013). Prospective associations of concerns about physique and the development of obesity, binge drinking, and drug use among adolescent boys and young men. JAMA Pediatrics. doi:10.1001/jamapediatrics.2013.2915

Kessler, RC, Berglund, PA, Chiu, WT, Deitz, AC, Hudson, JI, Shahly, V, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Benjet, C, Bruffaerts, R, de Girolamo, G, de Graaf, R, Maria Haro, J, Kovess-Masfety, V, O’Neill, S, Posada-Villa, J, Sasu, C, Scott, K, Viana, MC and Xavier, M (2013). The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biological Psychiatry 73, 904-914.

photo credit: Kevin Lallier via Creative Commons