I recently gave a talk to primary care professionals, on eating disorders in young people, at a national conference, and I was struck by how, this year, compared with previous talks I have given, how many of the questions from GPs were about the young boys and teen males they were seeing in their consulting rooms, with eating or body image issues.
I hope therefore that it might be helpful if I summarise here some key ‘what to watch for’ info and some credible resources you can take a look at, if you are not sure what to do next and are worried about your son’s eating, weight or exercise behaviours.
Is it a ‘phase’?
The main message is that if you are worried that your son (or a young man you know) might be struggling with eating/ weight/ body issues then don’t ‘wait to see what happens’, instead talk to them and ensure they are assessed by a professional, or seek help in another way, as soon as possible. These types of problems are not a ‘phase’ and waiting longer just means that they get worse and worse, so you have further to 'travel' to get better again.
So one of the key messages I always give about eating and body issues is that the sooner you seek help, the better the outcome.
What sort of problems do boys and men struggle with?
Boys and men can have exactly the same eating disorders and weight issues as females, in terms of potentially developing anorexia, bulimia or other eating/ binge/ starving/ over exercising/ compensatory behaviours. For more info on these and how to help, see my previous blogs here and here.
However they are also prone to developing some slightly different harmful behaviours and thought patterns, so I will explain two of the more common worrying issues below, and encourage you to look out for these, and talk to your young person about them, if you are concerned.
Which boys and men are most at risk of struggling with weight, body or eating issues?
The studies tell us that certain groups of boys may be more at risk, but that should not distract us from the fact that any boy can develop problems.
Whilst boys who participate in sports that emphasise thinness (e.g. jockeys, ballet) or fitness (e.g. athletes, dancers) are at particular risk, so are young men subjected to bullying or negative comments from a sports coach, those who identify as non-heterosexual, and those who have been previously obese, or abused in childhood. We also know that perfectionistic traits and high academic pressure and achievement can be linked to eating issues. This all means that we could see eating issues appear in a whole variety of scenarios.
What to watch out for
One of the issues the GPs I spoke with were noticing more was the problem of muscle dysmorphia, where a person perceives themself as not being muscly enough; they are preoccupied with ‘bulking up’, being ‘shredded’ or ‘built’, and terrified of losing weight or withering away. All their exercise is geared towards creating a very muscly shape, and it dominates their activities.
They are obsessed with their body image and tend to plan their other life activities around exercise where they can, or fitting it into their day e.g. at lunchtime, or after school, if their day is dictated to them by education. They may follow unconventional diets to achieve their desired body shape (more on this below) or take supplements to build muscle mass.
In the most serious cases they use anabolic steroids and other medications to alter their natural body shape and be musclier. They may be unaware/ dismissive of the fact that these can have severe and negative health effects or side effects. As a GP I saw everything from the anger outbursts (‘Roid Rage) to the shrunken testicles/ erectile issues which finally made them seek advice after using anabolic steroids.
b. Muscularity Oriented Disordered Eating (MODE)
This is the other behaviour that has increased in the last few years, often made more socially acceptable by the rise of veganism and other dietary trends. (*Veganism can be a way to make an eating disorder socially acceptable, so it is also important to be alert to that, and ensure a balanced diet is still followed).
MODE occurs where all eating is driven by a need to build muscle. High protein diets, blended foods, the demonisation of carbs and fats, the drinking of huge amounts of protein in liquefied form, substitution of food with powders and other supplements. These are all behaviours that occur in this type of eating disorder. Normal activities get interrupted to ensure protein and calories are consumed frequently, or exercise is carried out.
People with MODE get angry and frustrated if this is not possible. For example, if going to the gym or eating their specific foods are not possible because it is Christmas Day. This should be a big red warning flag.
MODE and compulsive exercise often go hand in hand.
What do I do?
If your son is working out every day (and gets upset if he can't do this), or is going to the gym at lunchtime instead of kicking a ball around /hanging out with his mates in a more chilled way, if he’s lifting weights in his room every night, or talks endlessly about his shape or being unhappy with his body, then it is probably time to talk to him about what is going on, and why he feels like this.
He may also be restricting his diet to eat almost only protein, drinking shakes instead of eating food, planning his day around protein snacks, or restricting carbs or fats if he deviates from his training/ rules. If these things are happening, it is time to address these behaviours. It is particularly important to tackle it if the behaviours or thinking interfere with normal activities or family life.
He will possibly not have the insight or life experience to see the negatives of these behaviours and where they can lead. He will not be able to see the things he may be missing out on, or the potential damage from over exercising or unconventional diets.
A caring conversation won’t change things overnight, but slow and steady support and addressing of the issues can hopefully move him back to a healthier, more balanced approach to exercise and eating.
You can’t fix all this by yourself, so if the situation is concerning you, seek further advice from your GP, the school, one of the amazing charities that works in this area, or learn a little more from credible sources like the MyoMinds podcast. Episode 432 of the Food Matters Live Podcast is also about this topic and I was pleased to participate in that one.
Read my previous blog about starting the conversation, and look at Beat or Young Minds for more info on the issues themselves. There is also a wonderful free app that I helped create, called the Eating Disorder Support app.
It is never easy to talk to a young person about their eating or body weight / image issues, but ignoring it, or hoping it will go away doesn't work sadly, and all too often they get into entrenched behaviours and thought patterns that can be even harder to set right.
If you are worried, pick a good time to start a compassionate conversation and let them know you are concerned but interested in what is going on for them. Finding a healthy balance in their life will still let them develop a nice shape, and feel well, without the need for extremes of food or exercise. Making these changes can take time. You can be right there alongside them.