WASHINGTON – High levels of concern with muscularity, or with both muscularity and thinness, were relatively common – and were associated with a risk of adverse outcomes – among adolescent boys participating in the ongoing Growing Up Today Study.
Male adolescents may not be recognized as having body shape concerns or weight-related disorders because of their gender and what likely are gender-specific presentations. This analysis of the GUTS cohort, however, should put such concerns and disorders on the radar screen for pediatricians and other clinicians, Alison E. Field, Sc.D., reported at the annual meeting of the Pediatric Academic Societies.
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The Growing Up Today Study revealed adolescent males are concerned with thinness and muscularity.
The Growing Up Today Study – a National Institutes of Health–funded prospective cohort study established in 1996 to assess factors that influence weight change – has involved approximately 16,800 children (approximately 9,000 girls and 7,800 boys) who are offspring of women participating in the separate Nurses Health Study 2.
Questionnaires sent every 12-24 months to the boys participating in GUTS have assessed concerns with thinness, concerns with muscularity, use of products to enhance physique, bulimic behaviors, weight and height, depressive symptoms, drug use, and binge eating and drinking. To assess concerns about muscularity, for instance, boys were asked, "How frequently do you think about wanting to tone or define muscle?"
The analysis presented at the PAS meeting involved 5,527 male adolescents who had returned at least two questionnaires between 1999 and 2010. The boys ranged in age from 12 to 18 years in 1999.
Thinness itself was the least common concern. It was a significant concern of about 2% of boys aged 13-15 years, and the prevalence of the concern decreased in older age groups.
The prevalence of concerns and behaviors that included muscularity, on the other hand, was much higher, reported Dr. Field of the department of pediatrics at Harvard Medical School, Boston.
"Particularly troubling," Dr. Field said, was the prevalence of muscularity concerns coupled with the reported use of "potentially" unhealthy products (creatine supplements) and "definitely" unhealthy products (growth hormone or steroids). The prevalence grew from approximately 2% among 13- to 15-year-old boys, to about 7% among 16- to 18-year-old boys, to almost 9% among young men aged 19-22.
"A lot of these young men who are using unhealthy products to bulk up won’t be huge – not yet," said Dr. Field. "These are hard issues to assess, but it will be important for clinicians to probe."
Adolescent boys commonly want more muscularity, she said, but "we’re talking here about defining yourself around your physique and being willing to take on whatever it takes to achieve that."
Dr. Field and her coinvestigators used lagged analysis techniques to determine whether these concerns and behaviors led to certain adverse outcomes and risky behaviors.
Boys with thinness concerns, they found, were 2.5 times more likely than their peers without weight concerns to develop a high level of depressive symptoms (the top quartile of the Center for Epidemiologic Studies Depression Scale [CES-D] self-report scale) in the next 1-2 years.
Those with high concerns about both muscularity and thinness were more likely than their peers to start binge drinking frequently (odds ratio, 1.6) and using drugs (OR, 2.5) within the next 1-2 years, as were boys with high muscularity concerns who used supplements and other products to enhance physique (OR, 2.4 and 2, respectively).
The analysis also offers a window into the issue of eating disorders in males. Bulimia nervosa was rare across age groups, as was purging disorder until young adulthood, when the prevalence grew to just under 1% among males aged 23 years and older. The prevalence of meeting partial or full criteria for binge eating disorder (which for this analysis meant binge eating at least monthly), however, was much higher and grew with age, from almost 0.5% among boys aged 9-12, to more than 2% in the 19- to 22-year-old age group.
Research on disordered eating among males is tricky because most scales and other research tools have been validated for females only.
In terms of diagnosis, "the DSM-5 criteria [for eating disorders] have been improved for females, but we may not be capturing the problem for males," Dr. Field said. More discussion is needed, she said, on the possibility of gender differences.
Dr. Field reported no relevant financial disclosures.