Eating Disorders More Common in Males Than Previously Thought

Boston Children's Hospital suggests that broader diagnostic criteria could help identify illness in boys.

When we think of eating disorders, it’s usually women and girls that come to mind. But a new study by Boston Children’s Hospital published Monday in the journal, JAMA Pediatricschallenges this belief. 

The study looked at 5,527 teenage males from across the U.S. and researchers found that 17.9 percent of adolescent boys were extremely concerned about their weight and physique. These boys were more likely to start engaging in risky behaviors, including drug use and frequent binge drinking, the study says. Evaluations for eating disorders have been developed to reflect girls’ concerns with thinness but not boys’ concerns, which may be more focused on gaining muscles than thinness.

“Males and females have very different concerns about their weight and appearance,” says lead author Alison Field, from Boston Children’s Hospital’s Adolescent Medicine Division.

To better understand how symptoms of eating disorders might be linked to obesity, drug use, and depression in males, Field and her team reviewed responses to questionnaires completed as part of the “Growing Up Today” study. Teens responded to surveys every 12 to 36 months from 1999 through 2010.

According to the surveys, boys tended to be more interested in muscularity than thinness, with 9.2 percent of males reporting high concerns with muscularity, compared with 2.5 percent concerned about thinness, and 6.3 percent concerned with both aspects of appearance.

Males concerned about muscularity and who used potentially unhealthy supplements, growth hormone, and steroids to enhance their physique were approximately twice as likely to start binge drinking frequently and much more likely than their peers to start using drugs, the study says. Boys concerned with thinness were more likely to develop depressive symptoms.

A total of 2.9 percent of all respondents had full or partial criteria binge-eating disorder, and nearly one-third reported infrequent binge eating, purging, or overeating. Anorexia nervosa and bulimia nervosa are characterized by an excessive influence of weight and physique on self-evaluation, with patients focused on being thin or wanting to losing weight.

Field says that most eating disorder assessments reflect this desire for thinness and may overlook boys concerned about their weight and shape but who want to be more muscular. This, according to the report, may be the male equivalent of girls who are very concerned with their weight and who use vomiting or laxatives for weight control.

“Clinicians may not be aware that some of their male patients are so preoccupied with their weight and shape that they are using unhealthy methods to achieve the physique they desire, and parents are not aware that they should be as concerned about eating disorders and an excessive focus on weight and shape in their sons as in their daughters,” Field says.