The statistics are tough to digest, said Rutgers University–Camden psychologist Charlotte Markey. Among mental health issues, eating disorders are the second deadliest, behind only opioid abuse. And, although much more public attention and research is given to issues around female body image, anywhere between a quarter and a third of eating-disorder patients are boys and men. The most common eating disorder among boys and men is binge eating, characterized by episodes of overeating that are not followed by compensatory behaviors, such as purging, thus making the disorder difficult to detect.
“The majority of these boys and men are unlikely to seek treatment for their eating disorder,” said Markey, a professor of psychology and chair of the Department of Health Sciences. “The fatality rate—already among the highest for any mental-health condition—is higher among men with eating disorders than women.”
But there are answers, and the Rutgers–Camden researcher hopes that males get the message. Markey, the author of three books on body image, has been a frequent media guest and has presented her research virtually at conferences in Ireland and the United Kingdom.
Markey receives messages from parents thanking her for her work and sharing personal anecdotes about how her research has helped them and their children. One popular refrain, she said, is that parents wish they had had that information when they were young. What makes the research so universal, Markey said, is that most people are dissatisfied with their bodies. Body dissatisfaction, in turn, is predictive of eating disorders.
What’s more, Markey said, mental health issues rose significantly over the course of the COVID-19 pandemic. She cites the U.S. Surgeon General’s latest report indicating that the rates of youth anxiety and depression doubled during the first year of the pandemic, with one in four young people suffering from depression and one in five experiencing anxiety. These mood disorders frequently co-occur with eating disorders, which likewise spiked across the pandemic.
“Research suggests a significant increase in hospitalization for, and inquiries about, eating disorder treatment,” Markey said. “And contrary to popular myths, eating disorders don’t affect only teen girls; children of all ages and genders are at risk.”
Markey is especially interested in providing resources for parents. “It’s hard to know how to help and how to say the right thing,” she said. “There is good science on these issues, and I want it to be accessible for kids—and for their parents and caregivers.”
Research shows kids as young as 4 are exhibiting the beginning of body dissatisfaction. In 2000, Markey published a research paper showing that 5-year-old girls were more likely to be concerned with weight than their mothers were. “Kids are actually pretty tuned into these issues at a young age,” Markey said.
So, what is it that many boys see in the mirror? Boys are often concerned about being overweight, Markey explained, but they are even more likely to be concerned about their muscularity—or lack thereof—and height. Boys see social media images and think they should be tall and broad-shouldered with six-pack abs. “That’s just not genetically likely for most boys unless they put a lot of time into going to the gym,” she said. “Even then, these appearance ideals are totally out of reach for most of us.”
This preoccupation with muscularity, Markey continued, is how body dissatisfaction and eating disorders usually go unnoticed among boys. They hit the gym, eat “healthy” foods, and everyone around them thinks they’re just taking care of their health. Internally, however, they harbor discomfort.
“Inside, boys and men may be incredibly upset, discouraged, or dissatisfied with their appearances,” Markey said. “They may watch what they eat or avoid certain foods altogether, or take supplements like protein powders, which are often unsafe for developing bodies.”
While all of this is going on, Markey said, there is a stigma for boys to even appear that they are concerned with their body image. And why wouldn’t they? Society has feminized the topic for decades, she said, and many boys don’t know what body image even refers to.
“They think it’s inherently feminine to consider body image, but it really just asks, ‘Are you comfortable in your own skin?’” Markey said. “How many of us are 100% comfortable? The truth is, not many. But when that discomfort grows strong, there’s almost nothing people won’t do to try to feel better.”
Because of the stigma that boys face, Markey continued, research shows that males are more reluctant to seek mental health and medical help than females. Therefore, boys’ body image concerns go unnoticed by medical professionals who aren’t on the lookout for warning signs. Parents don’t often notice the signs, either.
“I’d be wealthy if I had a dollar for every parent who said, ‘I don’t need to worry about that stuff; I have boys,’” Markey said. “Other parents have asked me why I was even writing a book about body image for boys.”
However, Markey said, it’s the parents who are most likely to figure out that something’s wrong when their boys drastically alter their eating habits, experience large fluctuations in weight, or adopt excessive exercise habits. She hopes her research will provide more information for boys who are afraid to ask questions or seek help. In the end, she hopes that boys will appreciate that they are not alone.
“In some small way,” Markey said, “I want to contribute to normalizing conversations about mental health for boys.”
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