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Original Investigation |

Prospective Associations of Concerns About Physique and the Development of Obesity, Binge Drinking, and Drug Use Among Adolescent Boys and Young Adult Men

Alison E. Field, ScD1,2,3,4,5; Kendrin R. Sonneville, RD, ScD1,4; Ross D. Crosby, PhD6; Sonja A. Swanson, ScM3; Kamryn T. Eddy, PhD7; Carlos A. Camargo Jr, MD, DrPH2,3,5,8; Nicholas J. Horton, ScD9; Nadia Micali, MD, PhD10
[+] Author Affiliations
1Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
2Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
3Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
5Department of Medicine, Harvard Medical School, Boston, Massachusetts
6Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo
7Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
8Department of Emergency Medicine, Massachusetts General Hospital, Boston
9Department of Mathematics and Statistics, Smith College, Northampton, Massachusetts
10Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, England
JAMA Pediatr. 2014;168(1):34-39. doi:10.1001/jamapediatrics.2013.2915.
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Importance  Relatively little is known about the prevalence of concerns with physique and eating disorders among males and their relation to subsequent adverse outcomes. A broader range of eating disorders needs to be defined to diagnose these illnesses appropriately in males.

Objective  To investigate whether males with psychiatric symptoms related to disordered eating and concern about physique are more likely to become obese, to start using drugs, to consume alcohol frequently (binge drinking), or to develop high levels of depressive symptoms.

Design, Setting, and Participants  The data come from questionnaires sent every 12 to 36 months from 1999 through 2010 to youth in a prospective cohort study, the Growing Up Today Study. The analysis included 5527 males aged 12 to 18 years in 1999 from across the United States who responded to the Growing Up Today Study questionnaires.

Main Outcomes and Measures  Development of obesity and high levels of depressive symptoms and initiation of drug use and binge drinking at least monthly.

Results  From 1999 through 2011 in at least 1 study year, 9.2% of respondents reported high concerns with muscularity but no bulimic behaviors; 2.4%, high concerns with muscularity and use of supplements, growth hormone derivatives, or anabolic steroids to achieve their desired physique; 2.5%, high concerns with thinness but no bulimic behaviors; and 6.3%, high concerns with thinness and muscularity. For eating disorders, 0.8% had partial- or full-criteria bulimia nervosa or purging disorder and 2.9% had partial or full-criteria binge eating disorder but no association with the outcomes of interest. Infrequent binge eating or purging or overeating without a loss of control were reported by 31.0%. However, independent of age and body mass index, males with high concerns about thinness but not muscularity were more likely to develop high depressive symptoms (odds ratio, 2.72; 95% CI, 1.36-5.44). Males with high concerns about muscularity and thinness were more likely than their peers to use drugs (odds ratio, 2.13; 95% CI, 1.31-3.46), and males with high concerns about muscularity who used supplements and other products to enhance physique were more likely to start binge drinking frequently (2.06; 1.58-2.69) and using drugs (2.16; 1.49-3.11).

Conclusions and Relevance  High concerns with muscularity are relatively common among adolescent boys and young men. Males with these concerns who use potentially unhealthy products to improve their physique are at increased risk of adverse outcomes but may not be recognized by their health care providers as having a weight-related disorder because of the sex-specific presentation.

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Age-Group–Specific Prevalence of Concerns About Weight and Physique

Questionnaire respondents expressed high levels of concern about aspects of physique (thinness and muscularity) and whether they used appearance-enhancing products (ie, supplements, growth hormone derivatives, or anabolic steroids) more than once per month. Data are obtained from 5527 respondents in the Growing Up Today Study.

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