Authors Field AE, Sonneville KR, Crosby RD, et al
Review Date December 2013
Citation JAMA Pediatr: doi:10.1001/jamapediatrics.2013.2915 (Published online Nov 2013)
Most research on eating disorders to date has been focused on females. Little is known about the prevalence of concerns about body image and eating disorders among males and the longer term adverse outcomes, but it has been assumed to be lower than in females. Binge eating disorder is the most common eating disorder among adults and the lifetime prevalence of partial or full binge eating disorder is similar for males (1.6%) and females (2.0%). It is thought that the rate of eating- and weight-related disorders may be underestimated in males due to the fact that the manifestation of concerns about weight and physique are different to those in females, while the diagnostic criteria assume the same symptoms for both sexes.
This longitudinal study aimed to assess the range of concerns with physique and eating disorders among males and to investigate whether those with symptoms related to disordered eating and concern about physique are more likely to become obese, to start using drugs, to consume alcohol frequently (binge drinking), or to develop high levels of depressive symptoms.
The data come from questionnaires sent every 12 to 36 months from 1999 through 2010 to youth in a prospective cohort study, the “Growing Up Today Study”. The analysis included 5527 males aged 12 to 18 years in 1999 from across the United States who responded to the Growing Up Today Study questionnaires. Questionnaires asked about behaviours indicative of eating disorders (binge eating or purging or both (bulimia nervosa) and concerns about weight and physique. Outcomes measures included BMI, depressive symptoms and drug use and binge drinking.
Between 1999 and 2011, in at least one study year, 9.2% of respondents reported high concerns with muscularity but no bulimic behaviours; 2.4%, high concerns with muscularity and use of supplements, growth hormone derivatives, or anabolic steroids to achieve their desired physique; 2.5%, high concerns with thinness but no bulimic behaviours; and 6.3%, high concerns with thinness and muscularity. For eating disorders, 0.8% had partial- or full-criteria bulimia nervosa or purging disorder and 2.9% had partial or full-criteria binge eating disorder but no association with the outcomes of interest. Infrequent binge eating or purging or overeating without a loss of control were reported by 31.0%. However, independent of age and body mass index, males with high concerns about thinness but not muscularity were more likely to develop high depressive symptoms (odds ratio, 2.72; 95%CI, 1.36-5.44). Males with high concerns about muscularity and thinness were more likely than their peers to use drugs (odds ratio, 2.13; 95%CI, 1.31-3.46), and males with high concerns about muscularity who used supplements and other products to enhance physique were more likely to start binge drinking frequently (2.06; 1.58-2.69) and using drugs (2.16; 1.49-3.11).
The study showed that high levels of concern with muscularity are relatively common among adolescent boys and young men. Moreover, males with these concerns who use potentially unhealthy products to improve their physique are at increased risk of adverse outcomes. However, due to differing presentation between males and females and diagnostic criteria focusing on female symptoms and behaviours, boys may not be recognised by their health care providers as having a weight-related or body image disorder.
Points to Note
- This study showed a relatively high proportion of adolescent boys and young men were highly concerned with their weight and physique; with most wanting bigger or more toned and defined muscles rather than thinness (the most common concern for girls).
- Among 16-22 year old males, 8% were very concerned with muscularity and using potentially unhealthy means to achieve the desired physique, such as creatine supplements, growth hormone derivatives or anabolic steroids, which may be equivalent to extreme weight control behaviours in girls.
- Muscularity concerns increased with age and high concerns about muscularity and using products to improve physique predicted later drug use and binge drinking.
- Most eating disorder assessment tools do not measure concerns with muscularity and may be missing males with a potential eating disorder.
- The authors argue that the future revisions of the DSM criteria for eating disorders should allow for a sex difference in presentation so that health care providers do not miss males who may be in need of help.
- Some limitations of the study: the cohort is mainly white and higher socioeconomic status than the general US population so the results may not be generalizable; self-report questionnaires may have over-estimated prevalence; some of the measures used were validated for females not males.