Boys and their bodies: recognizing eating disorders in males

Eating disorders effect boys as well as girls

When you read the terms anorexia and bulimia, what comes to mind? If you’re like most people your brain probably conjures up images of smokey-eyed, waif-thin European models, or maybe the teenage girls who emulate them here in America. But according to a recent report from Pediatrics, eating disorders affect a far more diverse group of people than many realize. For instance, did you know that males now account for ten percent of the eating disorder population? Or that the number of reported eating disorders is growing among all races and classes, at younger and younger ages?

“Unfortunately, boys and men aren’t immune from our media’s influences and our society’s pressure to have an unrealistic body shape and size,” says Laura Edwards-Leeper, PhD, of Children’s Hospital Boston’s Primary Care Center. “There is also the misconception that boys are naturally more confident, have greater self-esteem and better body images, and therefore are at less of a risk of developing eating disorders. This may lead to less caution and sensitivity when discussing weight issues with boys, which may be problematic for many kids.”

Like their female counterparts, boys who develop eating disorders often say they feel a social pressure to slim down. An increased awareness about the dangers of obesity may intensify those feelings, especially if the pressure comes from sources outside of mainstream media. (Is the media’s obsession with obesity increasing eating disorders?)

“Well-intentioned medical providers, teachers, coaches and parents can inadvertently cause great harm when trying to address issues of weight with boys, sometimes even being the straw that breaks the camel’s back,” says Edwards-Leeper. “Consider how the comment ‘You could stand to lose a little weight,’ might be taken by an already insecure young adolescent with poor body image and low self-esteem. That kind of message can be particularly damaging if it’s coming from multiple sources.” (Our Dr. Claire McCarthy recently wrote about how she talks with her five children about weight.)

Laura Edwards-Leeper, PhD

Even with a focused and sensitive support system, many people with food issues find that getting proper treatment isn’t always easy. The American Psychiatric Association (APA) rigidly defines the behaviors that constitute an eating disorder.

As a result, thousands of individuals with severely disordered eating habits—many of which warrant medical treatment—aren’t officially classified as having an eating disorder. For example, if an overweight person severely restricts his diet in an unhealthy way, he can’t be diagnosed as having Anorexia Nervosa because of his size, which contradicts the APA stance that an anorexia patient refuses to maintain a body weight at or above what is considered average. Another anorexia criteria is an “intense fear of gaining weight or becoming fat, even though underweight,” which also doesn’t apply to individuals who are already overweight.

But with or without an eating disorder diagnosis, there is still plenty that health care providers and parents can do for children with an unhealthy relationship with food. Children’s Targeting Lifestyle Change (TLC), is a family-based program that works on helping children feel good about themselves and their bodies through a combination of physical activities, counseling and education.

“In my opinion, the best approach for working with both boys and girls around all issues of weight—whether it be overweight or underweight—is to focus more on helping them improve self-esteem, confidence and body image,” says Edwards-Leeper. “As adults, if we’re successful in making kids feel better about themselves, they’re likely be more motivated to incorporate long-term healthy changes into their lives.”

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