I read an interesting article in a fashion magazine that discussed how women are no longer alone in fretting about facing themselves in the mirror during that dreaded swimsuit season.

More men are becoming just as anxious about their weight and appearance. Advertisements and other media images increasingly feature men who are leaner, yet more muscular and wearing fewer clothes.

Perhaps the most impressionable and most vulnerable to being influenced by these images are adolescent boys and young men — some of whom have become drawn to the world of celebrity athletes, bodybuilders, and even such reality-television stars as Mike “The Situation” Sorrentino
 from the onetime much-publicized hit series, Jersey Shore, with his “six-pack abs.” 

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In one survey of more than 11,000 youngsters aged 9 to 16 years, more than one-fourth of boys (27%) reported making an effort to look like media figures.1 In another study, a team of sociologists found that underweight boys are extremely distressed — much more so than are overweight boys — and are at greater risk of depression than are overweight girls.2

As a result, clinicians are seeing more boys who suffer from eating disorders and/or from complications related to inappropriate diets, supplement use and steroid use. 

In a survey of nearly 2,800 adolescents from 20 urban middle and high schools, more than two-thirds of boys reported changing their eating habits to increase their muscle mass or tone, and nine out of 10 boys exercised to accomplish the same goal.3

Although this may not seem cause for concern, compulsive dieting and exercising are detrimental to the development of young minds and bodies. Moreover, nearly half of the boys reported some unhealthy behavior related to muscle dysmorphia, with nearly 35% using protein powders or shakes, about 6% using steroids and almost 11% using another type of so-called muscle-enhancing product.

The investigators noted that boys of Asian descent and boys on sports teams are most likely to practice these muscle-enhancing behaviors. Overall, participation in these activities has jumped dramatically in recent years. Pressure from coaches and other boys frequently exacerbates the problem. 

The use of non-FDA-regulated protein supplements (powders and shakes) and steroids can have serious adverse effects. Their illegal status for this purpose aside, anabolic steroids can cause cardiac problems, psychiatric issues, severe acne and short stature, and can affect male genital development and fertility.

In light of these data, clinicians should regularly question their adolescent male patients, as well as the parents about the boy’s nutritional habits and exercise routines and his use of any muscle-enhancing agents — especially steroids.

Also, it is important for health-care providers to help educate patients, parents, teachers and coaches about the potential dangers of these practices and explain that certain media images and behaviors by star athletes are not the norm and should not be emulated.

We must learn to strike a balance between healthy eating plus appropriate physical training versus an unhealthy, unrealistic obsession with being lean and muscular and “manly.”


  1. Taveras EM et al. J Adolesc Health. 2004; 35(1):41-50.
  2. Frisco ML. J Health Soc Behav. 2010;51(2):215-228.
  3. Eisenberg ME. Pediatrics. 2012;130(6):1019-1026.