By Takashi Hirata, M.D., Medical Associates of Davie at Hillsdale and Forsyth Medical Center

When someone says “body image,” most of us probably think of a teenage girl looking in the mirror and not liking what she sees. The word “anorexia” may then come to mind. But body image doesn’t have as much of a gender divide as you might think. Boys feel the pressure to look good, too, and the feeling that they don’t quite measure up to their peers or celebrities can take a big toll in the form of depression, eating disorders and other problems.

As a primary care physician with primary focus on adolescents, I see the effects of negative body image among girls much more often than in boys. In fact, girls and young women account for the majority of eating disorders. But the 10-15 percent represented by boys and young men should still give us pause. It says that boys are getting the same message that girls are: You’re not ok as you are.

And the implications are just as dangerous as they are for girls. This is complicated by the fact that much of boys’ body image is closely tied to their physical performance, in addition to appearance itself. Boys with poor body image tend to over-exercise, become interested in bodybuilding, and abuse performance-enhancing products such as energy drinks, supplements and even steroids–a potentially deadly choice. Many boys simply struggle with depression, low self-esteem and social isolation because they perceive themselves as being somehow imperfect. What’s to blame?

The big culprit is common to boys and girls: media promotion of an unattainable body image. If your son is interested in sports, he is likely being hit with images portraying celebrity athletes as superhuman, which leads many boys to think they should be pursuing the same goal of perfection. Movies, television and video games that are marketed heavily to males also show unrealistically fit bodies. As a result, many boys believe they need to be “buff,” complete with bulging biceps and six-pack abs. That’s unrealistic for most grown men–much less an adolescent!

But it doesn’t have to be about hero worship. A boy may simply be comparing his body to another boy’s and thinking, “That’s how I should look,” or “I should be able to do that.” When he is unable to, his self-esteem, which may already be fragile, takes a hit, potentially leading to unsafe dieting or exercise.

Pressure from peers, coaches, parents–even himself–to overachieve in a sport can also play a role. Trying to be the best at all costs can lead to an obsession with perfecting his body in order to perform better.

At this point, you might be thinking, “Is there something wrong with my son’s interest in physical fitness?” Not if it’s in moderation. We should all be getting 30 minutes of heart-pumping exercise at least five days a week–every day if possible–and staying away from unhealthy foods. The problem starts when the focus is on conforming to an ideal–not about having a healthy body.

So how do you tell the difference? Look for signs such as:
• Making negative comments about his own body or comparing his body to someone else’s
• Sudden changes in appetite, such as eating less
• Fluctuations in his weight
• Frequently weighing himself
• Over-exercising or obsession with building muscle
• Anxiety, depression or mood swings
• Social withdrawal

If you notice these kinds of symptoms, don’t assume your son is “going through a phase.” Even though it may be an uncomfortable subject, it’s up to you to start the conversation. Address the problem gently. Start with a statement like, “I’ve noticed that you’re eating less lately. Is there anything you’d like to talk about?” as opposed to, “I’m worried. What’s going on?” Let him know that you’re there to listen and help, not be the boss.

I also recommend talking with your child’s doctor, who can help you decide what steps you should take and if treatment is needed. In the meantime, there’s plenty you can do to help ensure that your son develops a healthy body image:

• Maintain a healthy family lifestyle with a nutritious diet and lots of family exercise. Put the focus on having fun and feeling good!
• Encourage your son to get involved in activities he enjoys. Stress the importance of having fun and doing his best—not achieving perfection.
•When you see harmful body images on television or other media, point out why these are unrealistic and dangerous to pursue.
• Practice what you preach—avoid making negative comments about your appearance and pursuing your own perfect body through extreme dieting and exercise.

For more information about teens and body image, visit www.kidshealth.org.