A first step is paying attention to concerns about leanness, muscle mass, and use of steroid products.
Traditionally, most research on eating disorders has centered on thin, white females, and it is easy to overlook disordered eating among males. The lack of research on males can also be attributed to the mistaken view that men are not at risk, the small numbers of male patients in clinical treatment, and the lack of population-based data on concerns about appearance and disordered eating behaviors among men.
To better define disordered eating among males, Jerel P. Calzo, PhD, and a team of researchers at Boston Children’s Hospital and Harvard Medical School studied males 13 to 26 years of age who were participants in the Growing Up Today Study. That study followed children of women in the Nurses’ Health Study II who were 9 to 14 years old in 1996. All participants completed annual questionnaires from 1996 to 2001 and then every other year after 2001. Dr. Calzo’s group used data from the 1999-2007 questionnaires. The men were asked about their concerns about leanness, thoughts of wanting to be thinner, worries about having fat on their bodies, and feeling fat. They also were asked about the frequency of use of creatinine, amino acids, steroids, growth hormone and anabolic/injectable steroids, except for products used to treat medical conditions.
Study participants also supplied information about using vomiting or laxatives to lose weight or to keep from gaining weight during the past year. Other questions were designed to identify overeating and binge-eating with loss of control. Those who reported binge-eating at least once monthly were followed up with questions about feeling out of control, even if they wanted to stop bingeing. Participants also recorded their weight and height at each study point, and BMIs were coded as overweight at 25 mg/kg2 or greater and obese when BMIs were 30 kg/m2 or greater.
The participants were also asked about drug use, such as use of ecstasy, heroin, cocaine, crystal meth, or amphetamine, and degrees of depression were gauged with the McKnight Risk Factor Survey (Int J Eat Disord. 1999; 25:195). The survey uses a 5-point scale to measure the frequency that participants experienced a particular concern about weight and disordered eating during the past year
Four specific risk groups emerged
Dr. Calzo and colleagues identified one large asymptomatic group (91%-97% in each age group) and 4 other groups with disordered eating symptoms they felt are “of clinical relevance.” The 4 groups included (1) Body Image Disturbance (1% to 6% per age group), (2) Binge Eating/Purging (binge eating and purging and used of muscle-building products; 0.1%- 2.5%); (3) Mostly Asymptomatic (low levels of concern about muscularity, product use and overeating, 3.5% to 5%), and (4) Muscularity Concerns (0.6%). By the age 22, 6% of the males had body image disturbances, which also correlated with a high risk of depressive symptoms throughout adolescence. The researchers also identified a subset of young men in their mid-to late teens who had high levels of muscularity concerns and reported weekly use of muscle-enhancing substances. Like those in the Binge eating/Purging group, the Muscularity Concerns class was prone to use drugs and frequently used binge drinking.
Differences also appeared in different age groups. For example, between 16 and 18 years of age, men in the Muscularity Concerns group had more than 4 times the estimated prevalence of drug use than did men in the Asymptomatic group. And, compared to the Asymptomatic group, the Body Image class had nearly 3 times the prevalence of depressive symptoms. The men in the Muscularity Concerns class had nearly 3 times greater incidence of drug use than the Asymptomatic and Body Image Disturbance group.
Implications for screening
According to the authors, the study findings have real implications for assessing and screening for risk of eating disorders among males. Males are far less likely than females to report concerns about their appearance. The study results underline the importance of being aware of the possibility of concerns about leanness, muscularity, and use of muscle-building products when assessing disordered eating among men in clinical and research settings.