Where much attention on adolescent body image problems has focused on girls, new research shows vulnerability among boys, including conditions such as muscle dysmorphia. By Jo Hartley.

Boys and body image

Restrictive eating and excessive training are being seen in boys at a younger age.
Restrictive eating and excessive training are being seen in boys at a younger age.
Credit: Khosrork / iStock

It’s 7am on a Monday. In the hallway, my son is doing push-ups and crunches. He finishes and announces it’s time for his protein. He’s only seven years old. Experts tell me he’s not alone.

“Over the past few years we’ve seen an increase in boys experiencing body dissatisfaction and it’s starting as early as five and six,” says Christine Morgan, chief executive of The Butterfly Foundation, which supports people with eating disorders and body image issues. “These boys are connecting what they look like with their self-worth and it’s becoming their focus.”

In 2017, the ABC surveyed 47,000 Australian children aged between six and 18 about their worries. The results highlighted body image concerns among boys. At age seven, 57 per cent of boys were worried about their bodies. This increased to 65 per cent at age nine and to 73 per cent by age 18. Similarly, at age seven, 26 per cent of boys wanted to change their bodies, increasing to 33 per cent at age 13 and 39 per cent by age 18.

Traditionally, the spotlight of body image issues has been focused on girls, with the assumption that they were more susceptible. However, this is starting to change.

Victoria University is developing an Australian-first secondary school program for teenage boys dissatisfied with their bodies. The aim is to prevent them from turning to steroids and sport supplements to achieve the body they desire.

“The rate of supplement use has increased over the past 10 to 12 years, with boys using much more intense and serious products than before,” says lead researcher Dr Zali Yager. “But there’s nowhere in the health curriculum that discourages this. Previously, the majority of programs have been developed for girls, and were designed to prevent eating disorders. We now know that the developmental trajectory for boys is quite different, as are the body change techniques they use to either gain muscle or lose weight.”

Victoria University’s Three-Dimension (3D) Project is in the early stages of development, and Yager and her team have had interest from schools, teachers, parents and professionals who want to be involved to ensure the program’s efficacy.

“In three years’ time, we’ll have an evidence-based program that’s been tested with adolescent boys, including some online gamified activities and teacher education resources that will be freely available online,” Yager says.

The Butterfly Foundation is also developing a useful resource for raising awareness of boys’ body image issues. Its pilot body esteem project is aiming to start in second term of this school year, and while similar to the 3D Project, it’s different in its objectives.

“Our project explores the influences underpinning body dissatisfaction for males and how we can open up conversations about this,” says Danni Rowlands, national manager of prevention services at the foundation.

The project’s downloadable video includes eight chapters incorporating interviews with young males and expert voices. Teacher-guided questions aim to encourage discussion after the viewing.

“Our society is obsessed with looks, and males now consider their appearance as a reflection of their value and success,” Rowlands says. “There’s a perception that a strong male is muscly, and it’s these kinds of messages we need to debunk. Traditionally, guys who train religiously and eat restrictively are viewed as disciplined, whereas girls doing it are a cause for concern. But now we’re seeing these behaviours in males at a younger age, it’s setting off warning bells.”

Mitch Doyle, 27, is a strong advocate for programs such as this. He was 11 when he was diagnosed with anorexia, and his suffering lasted just over a decade.

“There was a complete disconnect between my body and mind and I loathed it,” he says. “I just wanted to look a certain way and fit in. I thought I wasn’t thin enough or good enough for anything.”

Despite his diagnosis and subsequent treatment, Doyle’s relationship with his body remained tumultuous until he turned 23. “There would be times when I’d feel okay, but then I’d relapse and that could last between six and 12 months. Any change or significant shift in my life was a trigger because, again, I’d feel like failing meant I wasn’t good enough.”

Doyle says his initial suffering stemmed from being bullied. However, as he got older, the media also played a role.

“We live in a culture where this projected ‘ideal’ body image reinforces the idea that you’re not enough. It makes you feel like you’re constantly falling short, even though the image is fake,” he says. “Body dissatisfaction doesn’t know an age, face or gender and the more that we make this ungendered, the more males will start to come forward to reduce stigma. Stigma keeps these issues hushed and this is what we need to reduce.”

A University of Sydney study in 2016 found that males report feeling less worthy if they ask for help. Consequently, this is associated with an increased likelihood of eating disorders remaining undiagnosed. The research also showed that, in the long term, unaddressed issues can increase susceptibility for psychological distress and be damaging for a male’s quality of life.

Sarah McMahon, psychologist and director at BodyMatters Australasia, says both boys and men have increasingly been targeted for advertising and marketing as the “market” for female products is considered saturated. “Most marketing and advertising relies on building discontentment to be effective and we know this has an impact on how males feel,” she says. “It coincides with the broader issue for males regarding what it means to be masculine.”

A common outcome of chasing masculinity is muscle dysmorphia, informally known as “bigorexia” or “reverse anorexia”, where sufferers become focused on putting on muscle for fear of being underdeveloped.

“True prevalence is hard to determine as it’s difficult to get men to acknowledge their problem,” McMahon says. “Muscle dysmorphia can remain invisible because the sufferer may look and act the picture of health and go to great lengths to hide the extent of their behaviour. Like anorexia, at least initially, behaviours and physical changes are congratulated, which means that the very thing that requires diagnosis is being rewarded in the early stages of illness.”

While there is a clear anecdotal link between muscle dysmorphia and steroid abuse, the research on this is very much in its infancy, largely because muscle dysmorphia is not yet officially recognised as a diagnosis.

If body image issues in boys are not treated appropriately, it appears there’s a good chance they will continue into adulthood. Direct impacts of disordered behaviour, such as steroid abuse during adolescence, can lead to physical health issues such as stunted growth and hormonal changes that can reduce fertility.

On a psychological level, research suggests that if a person tries to “fix” their appearance with a physical intervention, the mental issue is reinforced and will become worse.

Understanding the extent of adolescents’ body image issues is at the core of a new world-first comprehensive study being conducted by Macquarie University. Twelve thousand students in the Hunter region of New South Wales are participating in the EveryBODY study which, over the next three years, will help researchers identify the prevalence of and risk factors associated with body image disorders.

As well as traditional disorders, the study will investigate night eating syndrome, muscle dysmorphia and orthorexia – an obsession with “healthful” eating – as well as behaviours including steroid and amphetamines use and cheat meals for boys and girls who are on strict weight-gain or -loss diets.

“We have no contemporary Australian data for how common eating disorders are in adolescents, and no study worldwide has ever explored the prevalence of problems such as muscle dysmorphia,” says Dr Deborah Mitchison, lead researcher at Macquarie University’s Centre for Emotional Health.

“We’ll be the first longitudinal study worldwide to investigate emerging potential risk factors, including cyberbullying and time invested engaging in appearance-based activities on social media,” Mitchison says.

While education at school is important in highlighting and addressing these issues, parents also need to play a role. The Butterfly Foundation’s Christine Morgan says parental role-modelling and positive body image conversations with children can be significant.

“We need to work together to teach boys that their value is not judged on their size or shape. We need to educate them that men’s ‘health’ magazines with a man with ripped abs on the cover does not translate to health and is not the ‘norm’,” she says. “Children need to know that our bodies have been given to us to live our lives and not define it, and that health is about working with our body, not against it.”


Butterfly Foundation National Helpline 1800 334 673

This article was first published in the print edition of The Saturday Paper on April 7, 2018 as "Man in the mirror".

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Jo Hartley is a freelance journalist.

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