Many Young Men Engage in Disordered Eating

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People consume protein powder, supplements and pills to bulk up. Photo courtesy UCSF News.

Adolescents who see them­selves as puny and who exercise to gain weight may be at risk of so-called muscularity-oriented disordered eating behaviors, say researchers led by UCSF Benioff Children’s Hospitals.

The researchers found that 22 percent of males and 5 percent of females ages 18-to-24 exhibit these disordered eating behav­iors, which are defined as includ­ing at least one of the following: Eating more or differently to gain weight or bulk up, and use of di­etary supplements or anabolic steroids to achieve the same goal.

Left unchecked, these behav­iors may escalate to muscle dys­morphia, characterized by rigid diet, obsessive over-exercising and extreme preoccupation with physique, say the researchers in their study publishing in the Inter­national Journal of Eating Disor­ders on June 20, 2019.

“Some eating disorders can be challenging to diagnose,” said first author Jason Nagata, MD, of the UCSF Division of Adolescent and Young Adult Medicine. “Un­like anorexia nervosa, which may be easily identified by parents or pediatricians, disordered eating to increase bulk may masquerade as healthy habits and because of this, it tends to go unnoticed.”

At its most extreme, it can lead to heart failure due to insufficient calories and overexertion, as well as muscle dysmorphia, which is associated with social withdraw­al and depression, Nagata said.

The 14,891 young adults in the study, who came from through­out the United States, had been followed for seven years. The researchers wanted to see if the early data, when the participants’ average age was 15, revealed something about their percep­tions and habits that may serve as warning signs.

They found that boys who exercised specifically to gain weight had 142 percent higher odds of this type of disordered eating; among girls, the odds were increased by 248 percent. Boys who perceived themselves as being underweight had 56 per­cent higher odds; in girls the odds were 271 percent higher. Smok­ing and alcohol use in boys, and smoking in girls, increased odds moderately.

Additionally, being of Black race bolstered odds by 66 percent in boys and 181 percent in girls.

Non-heterosexual identity, which the participants had been asked about when they reached adulthood, was not found to be a risk factor, the researchers said.

In young adulthood, 6.9 per­cent of males reported supple­ment use to gain weight or build muscle and 2.8 percent said they used anabolic steroids. Use by young women was significantly lower at 0.7 percent and 0.4 per­cent respectively.

“Supplements are a black box, since they are not regulated,” noted Nagata. “In extreme cases, supplements can cause liver and kidney damage. Anabolic steroids can cause both long-term and short-term health issues, includ­ing shrunken testicles, stunted growth and heart disease.”

Nagata said that clues that in­dicate behaviors may approach muscle dysmorphia include a highly restrictive diet that omits fats and carbohydrates, compul­sive weighing and checking of appearance, and extensive time dedicated to exercise that may cut into social activities.

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