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What parents need to know about the hidden body image issues in boys

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When she was in college, it was the girls with the eating and negative body issues, says a mother of twins in New Hampshire. So she was surprised when she noticed her daughter, now 17, “doesn’t struggle at all” with her body image. Instead, it’s her son, a competitive athlete, who constantly talks about how he doesn’t like how he looks.

“When he’s in his season for sports, he’s very fit,” she said. (The Washington Post is withholding her name to protect her children’s identities.) “Then that will end, and he’ll gain weight, then he won’t like how he looks and tries to lose weight. I just see this pattern of not being happy with his body, and he sees himself in a warped way.”

Her son restricts his eating, sometimes to one meal of lean protein and vegetables plus a small smoothie per day, for a week or two, while working out consistently. He’ll go back to more regular eating, and the cycle starts again. “He’ll say directly: ‘I hate my body. I hate how I look,’” she says. “And he’s just a beautiful kid.”

For decades, parents have understandably focused their worries about negative body image on their daughters, who are exposed to an avalanche of body pressures early on, such as through princess culture or Barbie’s tiny waist. But boys grow up under similar influences and pressure to be stronger, leaner, taller. Despite the popular image of eating disorders and body shame as a threat unique to girls, experts and clinicians who work with children are sounding alarms about boys, who they say are probably underdiagnosed.

“We’ve had this artificial sense that it doesn’t affect guys,” says Stuart Murray, director of the eating disorders program at the Keck School of Medicine at the University of Southern California. “What we know now is eating disorders are increasing in boys and men but can present differently” than they do in girls.

The more common manifestation of eating disorders in boys is “muscularity-oriented,” Murray says. Boys worry about getting enough protein, so they can be strong and build muscle, but they are desperate to stay lean. This is a nearly impossible combination.

The quest to get fit can lead to restricting calorie intake, exercising obsessively and following dangerous trends, such as “dry scooping,” the practice of swallowing a scoop or more of protein powder, supposedly to help gain more energy to work out. “There are whole layers that boys are facing that we’re just starting to understand,” Murray says.

This extreme dieting is as detrimental as typical anorexia or bulimia, experts warn, although it may masquerade as simply trying to be “fit”: “They want to modify their bodies, they have discomfort about weight and shape and body image, the same as girls,” says Lauren Smolar, vice president of mission at the National Eating Disorders Association. “But they display a little differently.”

One mother, who spoke on the condition of anonymity to protect her child’s identity, said her son suddenly started focusing on his body last summer, when he turned 16. He asked for a gym membership and now goes to the gym six days a week and eats only high-protein foods, including shakes and powders. “He rarely eats sweets or anything ‘unhealthy,’” she said in an email. “He feels those are empty calories.”

The change in him — almost an obsession — has her concerned. “It saddens me that … he has a very specific, curated, conventional view of what is ‘attractive’ and that he is putting in such a huge amount of effort and time and attention to change the way he looks to conform to this one-size-fits-all mold,” she said. And although she said she supports exercise and healthy eating, “this feels bordering on extreme, though he has always been an intense and hyper-focused kid.” She hasn’t spoken to his doctor yet, because, she says, it “doesn’t feel necessary at this stage.” But she is talking to her son about it, registering her concern. “I hope that the talks create a safe space for him to come to me if he starts becoming worried about his own behavior,” she said.

From young ages, boys are surrounded by men with extreme bodies — just look to Sports Illustrated covers or stars such as Dwayne “The Rock” Johnson — which may lead boys into body dysmorphia territory, where they want to be “Dorito-shaped” or build muscle when their bodies aren’t yet made to do so.

“The earlier you start with addressing things, the better,” says Joel Jahraus, chief medical officer at Monte Nido & Affiliates, an eating disorder treatment platform. “I’ve been in eating disorder work for 35 years. It’s remarkable the number of boys and men coming to treatment at this time, and the age is dropping lower all the time.”

When he was about 5, Eileen Grimes’s son started talking about Gaston’s big muscles in the movie “Beauty and the Beast.” It was just enough for her to think she should keep an eye on his feelings about his own body, much as she would with her daughter.

When her son, now 8, recently told her he only wanted to eat salads so he could “get rid of this fat” on his belly and said he wanted to run more and grow big muscles, “it broke my heart,” she said.

A study of boys ages 11 to 18 by the Californian Journal of Health Promotion found that 24.1 percent of the boys who were in the “healthy BMI” category of the study said they were dissatisfied with their body shape. Although the study was small, with just 149 participants, the results are not surprising to many experts.

It can be hard for caregivers to know when a boy has an eating disorder, says Nicole Cifra, adolescent medicine fellow at the University of Rochester and spokesperson for the American Academy of Pediatrics. She has changed the way she addresses it with her male patients, making sure to tell them right away that “I take care of boys, too, and you’re not alone. You are not the only one going through this, [but it’s] talked about less among males than females.”

Being aware of how negative body issues affect boys is a good start, says Charlotte Markey, co-author of “Being You: The Body Image Book for Boys” and psychology professor at Rutgers University. “What’s really interesting is boys don’t have the vocabulary to talk about this issue,” she says. Boys have “concerns about how they look and are perceived in particular about masculinity and muscularity. But they don’t voice these concerns like girls will. So they just sit with it.”

Murray says parents need to watch out for intensive caloric restriction and rigid dietary rules. Is your son taking his own food to a party? Is he canceling plans because he is so “committed to an aesthetic body goal”?

Caregivers need to recognize when their children are simply acting differently, especially if it’s gradual, says Katherine Ort, chief of service for child and adolescent psychiatry at Hassenfeld Children’s Hospital at NYU Langone. For instance, are they pulling away from friends? Isolating? Letting go of their favorite activities? “I think noticing changes from their baseline, that’s one thing I’ve seen parents struggle with, particularly when we’re spending so much time at home together. It’s hard to see when you’re at home together all the time.”

Talking with boys about body image is as necessary as talking with girls. “Normalizing the conversation is critically important,” Murray says. “Oftentimes, what goes along with the pursuit of muscularity is hypermasculinity. That makes it harder; if they’re higher on the masculinity spectrum, talking about the body is a female domain, and so hard to do.”

Markey says a lot of caregivers and medical professionals aren’t asking the right questions of boys. Instead of asking about weight loss, she says, parents need to ask a different question: “Are you concerned about bulking up?”

Murray also suggests caregivers talk to their boys from a young age about how the body works. “It’s important we emphasize the functionality of our body, that it’s not an aesthetic,” Murray says. “If we get into the waters of 8-year-olds being quite articulate about what they want their body to look like, that terrifies me.”

Markey hopes we change the culture around talking to boys about their bodies and help them question “appearance ideals,” she says. “Boys are seeing this more than ever on social media right now. So it’s important from a young age to say this isn’t realistic, and not what you should expect from yourself.”

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