BY: Melissa Munn-Chernoff, PhD
DATE: August 17, 2016
Men need to be front of mind when it comes to discussions about eating disorders. Critically, many of the questionnaires used to assess body image and eating problems were created for females, so problems that may occur more frequently in males (e.g., muscle-building) are often overlooked. Thankfully, more articles are emphasizing that body image and eating problems do not discriminate based on sex, and questions included in present research studies specifically ask about more male-typical concerns. A recent article by Calzo and colleagues reminds us of how critical it is to evaluate and discuss body image and eating problems in males.
The study included over 7,000 males between 13 and 26 years old. Many individuals completed questionnaires annually or bi-annually, contributing to nearly 14,000 assessments between 1999 and 2007. Body image and eating questions included items on concerns about muscularity and leanness, purging, overeating, binge eating, and use of muscle-building products. In addition to determining the prevalence of these concerns and behaviors, the authors evaluated whether certain symptoms tended to cluster together and were associated with obesity, depression, binge drinking, and non-marijuana drug use. This was all assessed across 4 age groups: 13-15, 16-18, 19-22, and 23-26 years.
Although, as expected, the prevalence of these behaviors changed across time, 5 groups of individuals based on their symptom levels emerged: (1) Asymptomatic class (these individuals endorsed almost no body image or eating problems and comprised the vast majority of the sample [91-97% across the age groups]); (2) Body Image Disturbance (high levels of concerns about appearance, low levels of eating disorder behaviors [1-6% of the sample]); (3) Binge Eating/Purging (high levels of binge eating, purging, and use of muscle-building products, low levels of appearance concerns [0.1-2.5% of the sample]); (4) Mostly Asymptomatic (low levels of concerns about muscularity, product use, and overeating [3.5-5% of sample]); and (5) Muscularity Concerns (high levels of concerns about muscularity and product use [0.6-1% of sample]).
Across all age groups, differences emerged between the body disturbance/eating problem groups and the control (i.e., Asymptomatic) group. For example, at age 16-18, the Muscularity Concerns and Body Image Disturbance groups had a significantly higher prevalence of drug use and depressive symptoms, respectively, than the Asymptomatic group. There were also some differences between body disturbance/eating problem groups. At ages 13-15, males in the Body Image Disturbance group were significantly more likely to report new cases of obesity, whereas males in the Mostly Asymptomatic group were significantly more likely to report new cases of frequent binge drinking compared with the remaining groups. Males in the Binge Eating/Purging Group were less likely to report new cases of non-marijuana drug use than the other groups. At ages 16-18 and 19-22, the Muscularity Concerns group had a significantly higher prevalence (or reported more new cases) of drug use and had a lower prevalence of depressive symptoms than the Body Image Disturbance group. At ages 23-26, there were fewer new cases of obesity in the Body Image Disturbance group compared with the other groups. Also, the prevalence of drug use and depressive symptoms was highest in the Binge Eating/Purging and Muscularity Concerns groups and lowest in the Body Image Disturbance group.
Although significant findings changed across these developmental periods, which in part reflect changes in the prevalence of body image disturbance and eating problems over time, this study has critical implications. Overall, it highlights the importance of asking questions about leanness, muscularity, and use of products that promote muscle-building in males when assessing body image concerns and eating disorders. Questions such as these will increase our chances of detecting eating problems, with the goal of providing appropriate care before these problems escalate to more severe problems and improving treatment to those who already have an eating disorder.
Calzo JP, Horton NJ, Sonneville KR, Swanson SA, Crosby RD, Micali N, Eddy KT, Field AE (in press). Male eating disorder symptom patterns and health correlates from 13 to 26 years of age. Journal of the American Academy of Child and Adolescent Psychiatry.
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