Reprinted from Eating Disorders Review
November/December 2004 Volume 15, Number 6
©2004 Gürze Books
Although the incidence of eating disorders is significantly lower among teenage boys than teenage girls, boys are more likely than girls to develop behavioral problems associated with their pursuit of greater muscularity, according to Drs. Lina A. Ricciardelli and Marita P. McCabe of Deakin University, Victoria, Australia. In addition, biological, psychological, and sociocultural factors apparently are all associated with disordered eating among teenaged boys. These researchers recently published a thorough review of the literature to uncover risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys (Psychol Bul 2004; 130:179).
Higher BMIs increase social pressure to be thin
Just as for girls, higher body mass index (BMI) among boys leads to increased social pressure to be thin and to dissatisfaction about the body, which can lead to dieting, negative affect, and increased risk for eating pathology (Stice 2002). However, the importance that boys attach to weight loss may be different from the meaning it has for teenage girls, according to the authors. Weight loss for boys may be associated with decreasing fat and increasing lean muscle mass, whereas for girls it usually focuses on slimness.
Pubertal growth leads to a normal increase in body fat and broader hips for girls, and as a result girls move further away from society’s ideal body shape for women. Thus, many girls report higher dissatisfaction and a poorer self-image that may lead them to disordered eating.
In contrast, at puberty boys add muscle and their shoulder width increases, which are right in line with characteristics that fit the “ideal” cultural message for men’s body shape and size. The timing of puberty rather than puberty itself may play a role in body satisfaction for boys—delayed puberty or puberty out of sync with peers may lead to feelings of alienation and depression (Petersen and Taylor, 1980).
Girls who mature early have been found to be at the greatest risk of body dissatisfaction, and also tend to be less popular, have poorer self-esteem and higher levels of depression than later-maturing girls. Late-maturing boys have been found to be more likely to have higher levels of body dissatisfaction, are less popular with their peers, have more conflict with parents, and show more depressive symptoms.
There is no overall evidence that body dissatisfaction and body image concerns predict disordered eating in adolescent boys (Gardner et al, 2000). Only one study reported a moderate relationship between concerns about body image and disordered eating, as assessed by the Eating Attitudes Test (Keel et al, 1971). As the authors of the current study noted, studies that assess the validity of body image scales currently used with adolescent boys are also needed.
The authors note that the extensive literature on factors that contribute to body dissatisfaction among teenaged boys show that some boys seek a larger and more muscular body, while others want to lose body fat and develop a leaner and more muscular body (Middleman, Vanquez and DuRant, 1998).
Sexual orientation, particularly for adult men, has been identified as an individual risk factor that can contribute to the development of eating disordered attitudes and behavior. Several studies, for example, have reported that adult gay men are more concerned with body weight and shape, report higher levels of body dissatisfaction, higher levels of dieting and greater bulimic symptoms than do heterosexual men. Although adolescents have been included in some of the past studies (Williamson and Hartley, 1998), there are discrepancies between the studies, which might be explained by the fact that gay identity is not always well defined at adolescence (Cass, 1984).
Researchers have suggested that boys may be less influenced by sociocultural pressures to lose weight than are girls. Sports and athletic activities can play an important role in promoting psysical, mental, and social development during childhood and adolescence, particular for boys (Weiss, Smith, and Theebom, 1996). Hausenblasus and Carron (1999) have described the type of athlete who may be at greater risk of developing disordered eating. These are athletes involved in sports in which weight classifications apply (wrestlers, rowers), or where weight or small body size is important for success (distance runner, cyclists), or where subjective evaluation and aesthetic ideals exist (figure skaters, gymnasts, divers). Levels of disordered eating have been found to be particularly high among adolescent male runners and teenaged male wrestlers.
Family and peer risk factors
Positive family and peer relationships may serve as a protective factor against development of an eating disorder in both teenaged boys and girls. Three studies have shown an association between weight concerns and poor relationships with parents.
In one, concerns about overeating were associated with lower perceived intimacy with the father, whereas concerns about undereating were related to lower perceived intimacy with both the father and mother. Neumark-Sztainer et al (2000) found that disordered eating was associated with perceived poor family communication, low levels of parental caring, and low peer support.
In contrast, four cross-sectional studies and one longitudinal study conducted with teenaged males have not shown evidence of a relationship between parent and peer relations and attitudes and behaviors associated with disordered eating (Leon et al, 1994; Vincent and McCabe, 200, Wertheim et al, 1992; Wichstrom, 2000). Other sociocultural variables include teasing about weight or shape and physical or sexual abuse (Shisslak and Crago, 2001).
Clearly, according to the authors, far more research with larger groups and prospective, longer-term studies are needed to continue to clarify the causes of disordered eating among teenage boys.