Should You Be Concerned About Your Son?

By Scott Griffiths

Ask 100 boys who they want to look like, and they will name athletes, fitness models, and bodybuilders. All of them will be muscular. Boys will also use the word toned, but what boys mean when they say toned and what girls mean when they say toned is different. This isn’t speculation – the research testing what boys and girls mean when they say they want to be lean and toned is clear. Boys want to be conspicuously muscular. The kind of muscles that are visible through clothing, that bulge, that have visible striations, lines, or veins, and which align with the endlessly positive portrayals of muscular men as desirable and “hot”. Conspicuous muscles are the keystone for boys just as thinness is the keystone for girls. Boys learn that a muscular body is desirable at very young ages: as young as 6 and 7 years old.

What does an eating disorder look like when the sufferer wants to be conspicuously muscular instead of conspicuously thin? Let’s start with the commonalities. Often, there is an over-focus on appearance: countless hours of mental and physical energy dedicated to the pursuit of “my best self”, a self that is always more muscular, more toned, “better”, “self-actualised”, “the best that I can be”, enshrining the underlying (but often unspoken) value that being physically attractive – or “hot” – is necessary, important, worth striving for, and worth suffering for. Money is spent on supplements: protein powder, creatine, pre-work outs, testosterone boosters (the list of products is endless). Gym memberships, fitness trackers, calorie counters, home workout equipment, personal training; the industry catering to our body anxieties is vast and diverse. Wholesale redirection of resources and energy to the pursuit of a different (better) body, appearance, and, by extension, better self, is common and core to eating disorders in boys and girls alike, encouraged by cultural and capitalist forces that feel omnipresent.

Minor differences are plentiful. When it comes to dieting, boys focus on protein while girls focus on fat. In the minds of boys and men, protein is synonymous with muscle. I’m willing to bet that you, my reader, also implicitly associate protein with muscle. Savvy marketing departments of companies that sell products to boys and men spend millions on this automatic association. For boys, maximising protein is parallel to girls reducing their calories and reducing fat. Next time you’re out shopping for groceries, take notice of the colour schemes of protein-fortified and calorie-reduced foods: the former tend to be blue and black, masculine colours that marketers think will appeal to boys, while the latter tend to be red and pink, feminine colours for girls.

Major differences stretch the boundaries of what we think eating disorders are. If someone with an eating disorder wants to lose weight and be thinner, they might take laxatives or diuretics. They won’t work, neither works fast enough to prevent calorie absorption, but their use is common enough that using these products is considered core to what an eating disorder is. Most eating disorder symptom questionnaires explicitly mention these. But what if the goal is to be more muscular? Anabolic steroids, the most basic of which is simply synthetic testosterone, the male sex hormone, are muscle-building. Unlike laxatives and diuretics, steroids are wildly effective. So effective, in fact, that around one-third of those who use anabolic steroids become psychologically dependent; held hostage by the seductive allure of rapidly growing one’s musculature when on steroids and the horrible anxiety of watching one’s muscles shrink when coming off. Can this be an eating disorder? We are talking about conspicuously muscled, sometimes larger-than-life individuals, often men, who eat lots of food, meticulously control their diet, work-out hard, and use anabolic steroids to help them achieve their goals. The answer, in my opinion, is yes. Yes, for whom the above pursuits create the significant life impairment that is core – and necessary – for an eating disorder diagnosis: personal misery, troubled and deteriorating relationships, poor performance at school, university, and at work… there are innumerable ways that lives come apart when an eating disorder takes hold, and it is this coming apart that makes the entire package a disorder requiring intervention.

Some readers may be wondering: What about boys and men who are larger? Boys and men who binge-eat, or are diagnosed with binge-eating disorders, for whom countless hours of energy are spent on an interminable quest to be thinner, smaller, acceptable, worthy (these values become synonymous for so many). Boys and men in larger bodies still desire a lean and muscular body as their ideal. They will seek to convert as much of their body mass to muscle as they can; to shred and cut as much as possible. They do want to become thinner, but not thin in the way that women and girls want to be thin.

Does your son have an eating disorder? Should you be concerned? A useful starting point for questions like these is: Is he suffering? We live in a world that encourages and commodifies enhancing our physical appearance – making ourselves look better. Whether this aligns with your personal values or not (I have much to say about this, but I don’t want to digress), a boy or young man desiring to look better, and working out and dieting to achieve and satisfy this desire, is not intrinsically wrong or disordered. In my experience, these desires and insecurities are ubiquitous among boys and young men. To be clear, I am not saying this state of affairs is desirable; rather, I am trying to help you picture, for you and the men in your life, the blurred line that separates pursuits from pathologies and desires from disorder. Encourage the boys and men in your life to be kind to themselves. Validate their experience and feelings that physical appearance is important, that having anxieties about something our culture compels us to treat importantly is entirely normal, reasonable, and expected, that seeing how society rewards being hot and punishes being ugly (can a fear of becoming fat be truly irrational when society treats fat people so poorly?) is a powerful motivator.

But, as with everything in life, there must be balance. It’s not healthy to berate yourself in the mirror, to call yourself ugly or hideous or disgusting, to constantly check your reflection, to spend money you can’t afford on supplements, to feel like you can’t stop using steroids, to feel like you’ll be unlovable or never find a partner unless you look a certain way, to be riddled with guilt and anxiety because you broke your diet or missed a workout, to constantly seek reassurance from others that you’re muscular, or not fat, or not thin, or not ugly. It’s not healthy to push through physical injuries or stomach discomfort (“no pain no gain”) because the consequences of not working out or dieting are more dire, to avoid otherwise fun and joyful social situations because you might have to expose your body (like going to the beach), or limiting your sex life (lights off, clothes on, no grabbing or touching certain body areas). Other behaviours that sometimes pair with eating disorders among boys include picking actual (or imagined) specks of fat from already-lean mince-meat, batch-cooking meals and refusing to eat other food, exclusively viewing food as fuel with no care or consideration given to its taste or personal enjoyment, unpalatable food concoctions that meet pre-specified macro-nutrient breakdowns (e.g., “I must eat meals that are 40% protein, 40% carbs, 20% fat) but are unpleasant to eat, and continuing to eat food or take supplements that cause gastro-intestinal distress but pushing through anyway because the perceived benefits of these outweigh the distress (e.g. creatine, a supplement which, while effective, causes nausea in a substantial minority of the general population).

My team researches how strikingly different eating disorders can look like for different populations – in this blog post, men versus women – but the blurred line that demarcates what is and is not an eating disorder is the same; is the person suffering? If you think the answer is more yes than no, then you should intervene, keeping in mind that a young person in the throes of an eating disorder may actively conceal or downplay their suffering, re-interpret their suffering as positive or beneficial, or simply be unaware of the extent to which their thoughts and behaviours are making them miserable. If you’re unsure, monitor the situation and calibrate your response as necessary. If they’re not suffering, continue encouraging them to be kind to themselves and to value themselves for reasons other than physical appearance. It’s the best you can do. Remember to be kind to yourself, too.