“When asked to conjure an image of a patient living with an eating disorder, I imagine many people picture a young, thin woman. This reflects two common stereotypes: that eating disorders only affect women, and that all people with eating disorders are low-weighted. In fact, clinical experience and an evolving field of research show that many males struggle with eating disorders,” says Scott Hadland, MD, MPH, fellow in Adolescent Medicine at Boston Children’s Hospital.
Similarly, parents and health care providers may see gay, lesbian and bisexual youth in terms of their sexual identities and forget that these teens may face body image and weight control issues as well.
Two recent studies published by researchers at Boston Children’s debunk these stereotypes and may change the way parents and providers think about eating disorders and risky weight control behaviors in all teens.
Stereotypes and other differences
Alison Field, ScD, also from Boston Children’s Adolescent Medicine Division, reviewed responses of 5,527 teenaged males to a health survey sent every 12 to 36 months from 1999 through 2010 to understand how eating disorders might affect boys.
Field’s study, recently published in JAMA Pediatrics, reported that nearly 10 percent of boys were very concerned about muscularity, and a total of 17.9 percent were extremely concerned about their weight and physique. Boys who were very concerned with muscularity and using potentially unhealthy products to achieve their desired physique were twice as likely to start binge drinking frequently and start using drugs.
“Males, just like females, may have an unhealthy concern with their weight and shape and resort to unhealthy behaviors to achieve a desired physique. However, for males that may mean becoming more muscular, so the risky weight control behaviors may include using growth hormone, steroids or supplements,” explains Field.
This may be the male equivalent of girls who are very concerned with gaining weight and who use vomiting or laxatives as means to lose or maintain weight. Standard eating disorder assessments target these behaviors and attempt to identify patients overly focused on being thin or losing weight. As a result, doctors who use these tools can overlook boys who engage in risky weight control behaviors or with an eating disorder.
In addition to an emphasis on muscularity rather than thinness, experts have observed other differences among boys and sexual minorities. Body image concerns may not be primary, says Hadland. “Restrictive eating and purging may be a way of feeling in control or coping with stress.”
Hadland focused on a different population in his study of risky weight control behaviors, such as fasting for more than 24 hours, using diet pills and vomiting or using laxatives.
“We suspected these behaviors were higher among sexual minority (gay, lesbian and bisexual) youth.” The researchers reviewed data from 12,984 high school students who responded to the Massachusetts Youth Risk Behavior Survey in odd years from 2003 to 2009 for the study recently published in Journal of Adolescent Health.
They compared gay, lesbian and bisexual youth with heterosexual teens and found that risky weight control behaviors are common among all teens. One in 10 heterosexual males and two in 10 heterosexual females fasted for 24 hours or longer, used diet pills or vomited, or misused laxatives in the month preceding the survey.
These behaviors are even more common in sexual minority youth, with approximately one in three reporting these behaviors.
“My hope is that we begin to recognize just how common risky weight control behaviors are—including food restriction, misuse of diet products, self-induced vomiting and laxative misuse. This is true for all youth, but it is especially important for sexual minority youth. It is increasingly important for health care providers to recognize the wide range of presentations of eating disorders among all youth, regardless of gender or sexual orientation.”