When I tell people I work with parents of kids who have eating disorders, so many people respond, "Well, I'm glad I have boys so I don't have to worry about THAT!" Um...
Boys get all the same eating disorders as girls, and then they also are at risk for the things Dr. Ganson shared here, like muscle dysmorphia and a disordered relationship with food/exercise that doesn't always fit neatly into the commonly known ED diagnoses.
When boys do get treatment for an eating disorder, they tend to be sicker because EDs in boys just aren't on people's radar—often not until there is a medical crisis situation. Raising awareness for parents, coaches, and even doctors is so important. Thank you for this episode!
I absolutely think we need to build our vocabulary and comfort level when it comes to talking about body image with boys. And one more tidbit I'll share that often gets left out of the conversation around eating disorders: body image concerns don't always precede an eating disorder. Weight loss (or lack of expected gain) can kick off an eating disorder regardless of how the weight loss happened. So a boy (or any child) doesn't have to be on a diet (or trying to get "cut" with "clean eating," etc.) to get into caloric deficit; it can also happen from things like medication (such as stimulant meds for ADHD), surgery (especially oral surgery), prolonged stomach flu or other illness, or any other disruption in their food intake (from grief, trauma, depression, food insecurity)—or increased activity without adequate refueling.
Thank you for this! I have been wanting something on this topic because my brother-in-law has some pretty serious issues -- behaviors that in a woman absolutely would have been flagged as disordered eating. And then the past week my seven-year-old (assigned male at birth, nonbinary but fully enmeshed in boy culture) has been talking about wanting to get "swole" (well, half the time he says "swollen"), and I'm like, where is this coming from? He says he wants to ready himself for battle. I don't know. We pay attention to the Pokemon and Minecraft YouTubers he watches and none of those guys are particularly muscular.
In my BIL's case it's particularly obvious that men don't get diagnosed because they're men in that his behaviors are not primarily around looking muscular etc -- the ways he restricts himself are much more like women with eating disorders do, and while he certainly exercises a fair bit, it's definitely not oriented to bulk in any way. And I just cannot believe that medical professionals looking at a woman as thin as he is, who shows signs of being cold all the time like he does, with a diagnosed anxiety disorder (given the correlation between anxiety and eating disorders), would not be asking some questions. Every family meal is everyone keeping an eye on how much he eats and their mother relentlessly trying to get him to eat more, but no one except me and my husband ever acknowledging that this is a medical issue. I don't want to share too many details about what he'll eat because it could be triggering, but like at Thanksgiving he'll eat what I'd consider to be a very restricted meal for a non-holiday. I described it to a friend who's a former anorexic and she gasped and said "if he's eating like that in front of people, it's bad."
At one point last year my husband begged his brother to talk to a professional about his eating, and his brother kind of chuckled condescendingly and said "I can make you feel better about this. I keep very careful track of what I eat." And I was like "yeah, that doesn't make me feel better. you know who often tracks their food intake most carefully? people with eating disorders." Like, my dude, calorie-counting does not mean you have a healthy relationship to food!
Thank you for this conversation!!! I know we focus so much on dysmorphia with girls--dolls, filtering, social media etc.-and with good reason. But if you have boy you see their ideal body messaging stuff starting so early as well. I am thinking right off the bat of a Spider-Man toy my kids got when they were little. Spider-Man was supposed to be a teen, right? This one had these thick muscular thighs, a tiny snatched waist, big chest etc. It was starting to edge into Tom of Finland territory. There were a lot of capital C Choices made about his idealized anatomy that I thought were interesting for what was just a plastic superhero toy.
My boys are 15 and 12. Over the years, I have been very clear about the following:
a) the superhero actors are on steroids (or “supplements”, wev)
b) every single person on TV or movies are wearing makeup and wigs, and are being flatteringly lit. They get this with filters on social media, but I had to explain there are analog versions for other kinds of media 🤣
c) unless you are doing something dangerous, like PEDs & restriction/overtraining, your genetics dictate muscle size and fat distribution.
Here’s the other thing about the preteen boys and size/fat distribution. The only time you make new brain cells after you are born is about a year before puberty starts. You make a million new brain cells! Those are made of fat, so the body starts collecting it, as well as to prepare for all the pubertal growth.
I feel like culturally we’re aware of this wrt to female puberty, but less so for males. That could just be my perspective as someone who went through female puberty and only had a sister.
Anecdotally, every tall man I know, fat or thin, was chubby btw 10-14, including their very thin, very tall father. My older son suddenly had a bubble butt at 11, while my younger has more of a Buddha belly atm.
Thank you, thank you for this. My older son is 8 and he’s always been a pretty minimal eater, lots of taste and texture sensitivities etc. He also is my real attention-craving kid, and I don’t mean that to have a bad connotation, but just like, my younger one is happy to go off into a world of make-believe with other kids or alone, and just gives zero fucks what any adult around is doing; whereas my older guy always naturally gravitates towards the parents, the teachers, the camp counselors – even at a birthday party, you find him up on the deck with the adults – he badly wants to be the focal point of any nearby adult’s attention, a lot of the time. And so lately, after he has had a big growth spurt and stretched out even more, my mom – his grandma – keeps making these…comments. “If you don’t eat more of your quesadilla, you’re going to get TOO SKINNY.” “Your legs are ridiculously skinny! Have a few more chicken nuggets!”
She isn’t saying it like a praise-worthy thing (which is, at least, a departure from my own childhood – maybe that’s because we were all girls, maybe it’s because times have changed or she has changed, who knows) but it’s still a THING. And I can hear it landing somewhere inside of him. I can see it in how he notices these comments. "Grandma said I'm getting too skinny," he will tell me, almost with a tinge of awe in his voice. "Grandma doesn't understand that bodies change shape and size often, as people grow and get older, and that bodies usually know what they need," I will reply, and he will shrug, accepting this non-commitally, and I am sometimes tempted to believe that this is enough, that it could actually be that easy. But I know that somewhere inside of himself those comments are combining with the cultural bullshit negativity we have around the word “fat” (which we proactively work to counteract, with middling success) and I can see a world where “skinny” becomes not just a culturally desirable thing (even for a boy – for a shy boy who is totally uninterested in athletics or superheroes, at least) but an emotional security blanket of a sort that earns him attention, if that makes sense.
His body is his body! He goes through times where he eats an enormous quantity of pasta with butter, and then he goes through times where a whole slice of pizza is too much. I try hard not to make these into value judgments or correlate them to the size of his body and it is making me so uncomfortable to have my mom making these comments. But it is so uncomfortable to bring up with her, a classic boomer woman, loyal to Noom in her 70s. This interview is the motivation I need to take those comments as seriously as if she were saying, “If you keep drinking chocolate milk, you’re going to get fat!” (actual thing she said to me, in high school, when I developed the BODY-RUINING HABIT of drinking a glass of chocolate milk before bed each night - and something I would, at least, NEVER accept her saying to my kids)
Then, of course, my younger son is 100% about the superheroes and I live in fear of him growing into a tween who cares deeply about masculine body bullshit, and comes at the body issues from the opposite angle. It’s all just so much, sometimes.
FWIW to your distinction on craving attention, I think of it as adult-oriented kids vs. kid-oriented kids -- actually one of my kid's camps asks something like "does your kid gravitate to adults or other kids," so I think it's not uncommon. And it can change over time. Mine is much more kid-oriented now than he was a couple years ago.
Terrific insights. I really enjoyed this episode. I have two boys. I often think about raising them up not only to have a happy relationship with food but also helping them think critically about the expectations they might be telegraphing to friends who are girls right now, to friends in the future, also to girls they might date/partner with (if they are straight). Now that I've listened I'm realizing, yeah, boys are definitely at risk for disordered eating themselves! It's so obvious, and so overlooked.
Another great person to follow/learn from in this area is Jason Nagata, a pediatrician and associate professor at UCSF. Like Kyle, he's one of the (very) few people w expertise in boys/men and eating disorders. (He's @jasonmnagata on Twitter). I interviewed him earlier this week for an upcoming ON BOYS podcast episode.
Riding home from camp with a car full of 12/13 year old boys this weekend and the diet, calorie, anti-fat talk was rampant... it is hard to know how to respond without sounding like you're shaming. We absolutely need to work on our comfort level and language around this :/
When I tell people I work with parents of kids who have eating disorders, so many people respond, "Well, I'm glad I have boys so I don't have to worry about THAT!" Um...
Boys get all the same eating disorders as girls, and then they also are at risk for the things Dr. Ganson shared here, like muscle dysmorphia and a disordered relationship with food/exercise that doesn't always fit neatly into the commonly known ED diagnoses.
When boys do get treatment for an eating disorder, they tend to be sicker because EDs in boys just aren't on people's radar—often not until there is a medical crisis situation. Raising awareness for parents, coaches, and even doctors is so important. Thank you for this episode!
I absolutely think we need to build our vocabulary and comfort level when it comes to talking about body image with boys. And one more tidbit I'll share that often gets left out of the conversation around eating disorders: body image concerns don't always precede an eating disorder. Weight loss (or lack of expected gain) can kick off an eating disorder regardless of how the weight loss happened. So a boy (or any child) doesn't have to be on a diet (or trying to get "cut" with "clean eating," etc.) to get into caloric deficit; it can also happen from things like medication (such as stimulant meds for ADHD), surgery (especially oral surgery), prolonged stomach flu or other illness, or any other disruption in their food intake (from grief, trauma, depression, food insecurity)—or increased activity without adequate refueling.
Such good points! Thanks Oona!
Thank you for this! I have been wanting something on this topic because my brother-in-law has some pretty serious issues -- behaviors that in a woman absolutely would have been flagged as disordered eating. And then the past week my seven-year-old (assigned male at birth, nonbinary but fully enmeshed in boy culture) has been talking about wanting to get "swole" (well, half the time he says "swollen"), and I'm like, where is this coming from? He says he wants to ready himself for battle. I don't know. We pay attention to the Pokemon and Minecraft YouTubers he watches and none of those guys are particularly muscular.
In my BIL's case it's particularly obvious that men don't get diagnosed because they're men in that his behaviors are not primarily around looking muscular etc -- the ways he restricts himself are much more like women with eating disorders do, and while he certainly exercises a fair bit, it's definitely not oriented to bulk in any way. And I just cannot believe that medical professionals looking at a woman as thin as he is, who shows signs of being cold all the time like he does, with a diagnosed anxiety disorder (given the correlation between anxiety and eating disorders), would not be asking some questions. Every family meal is everyone keeping an eye on how much he eats and their mother relentlessly trying to get him to eat more, but no one except me and my husband ever acknowledging that this is a medical issue. I don't want to share too many details about what he'll eat because it could be triggering, but like at Thanksgiving he'll eat what I'd consider to be a very restricted meal for a non-holiday. I described it to a friend who's a former anorexic and she gasped and said "if he's eating like that in front of people, it's bad."
At one point last year my husband begged his brother to talk to a professional about his eating, and his brother kind of chuckled condescendingly and said "I can make you feel better about this. I keep very careful track of what I eat." And I was like "yeah, that doesn't make me feel better. you know who often tracks their food intake most carefully? people with eating disorders." Like, my dude, calorie-counting does not mean you have a healthy relationship to food!
Oh gosh. So so tough.
Thank you for this conversation!!! I know we focus so much on dysmorphia with girls--dolls, filtering, social media etc.-and with good reason. But if you have boy you see their ideal body messaging stuff starting so early as well. I am thinking right off the bat of a Spider-Man toy my kids got when they were little. Spider-Man was supposed to be a teen, right? This one had these thick muscular thighs, a tiny snatched waist, big chest etc. It was starting to edge into Tom of Finland territory. There were a lot of capital C Choices made about his idealized anatomy that I thought were interesting for what was just a plastic superhero toy.
Agh yes. Spider-Man is a rich text -- he wasn’t always that built! (Also thin of course but more nerdy boy thin...)
My boys are 15 and 12. Over the years, I have been very clear about the following:
a) the superhero actors are on steroids (or “supplements”, wev)
b) every single person on TV or movies are wearing makeup and wigs, and are being flatteringly lit. They get this with filters on social media, but I had to explain there are analog versions for other kinds of media 🤣
c) unless you are doing something dangerous, like PEDs & restriction/overtraining, your genetics dictate muscle size and fat distribution.
Here’s the other thing about the preteen boys and size/fat distribution. The only time you make new brain cells after you are born is about a year before puberty starts. You make a million new brain cells! Those are made of fat, so the body starts collecting it, as well as to prepare for all the pubertal growth.
I feel like culturally we’re aware of this wrt to female puberty, but less so for males. That could just be my perspective as someone who went through female puberty and only had a sister.
Anecdotally, every tall man I know, fat or thin, was chubby btw 10-14, including their very thin, very tall father. My older son suddenly had a bubble butt at 11, while my younger has more of a Buddha belly atm.
The fat to brain growth pathway is fascinating and SO important.
Thank you, thank you for this. My older son is 8 and he’s always been a pretty minimal eater, lots of taste and texture sensitivities etc. He also is my real attention-craving kid, and I don’t mean that to have a bad connotation, but just like, my younger one is happy to go off into a world of make-believe with other kids or alone, and just gives zero fucks what any adult around is doing; whereas my older guy always naturally gravitates towards the parents, the teachers, the camp counselors – even at a birthday party, you find him up on the deck with the adults – he badly wants to be the focal point of any nearby adult’s attention, a lot of the time. And so lately, after he has had a big growth spurt and stretched out even more, my mom – his grandma – keeps making these…comments. “If you don’t eat more of your quesadilla, you’re going to get TOO SKINNY.” “Your legs are ridiculously skinny! Have a few more chicken nuggets!”
She isn’t saying it like a praise-worthy thing (which is, at least, a departure from my own childhood – maybe that’s because we were all girls, maybe it’s because times have changed or she has changed, who knows) but it’s still a THING. And I can hear it landing somewhere inside of him. I can see it in how he notices these comments. "Grandma said I'm getting too skinny," he will tell me, almost with a tinge of awe in his voice. "Grandma doesn't understand that bodies change shape and size often, as people grow and get older, and that bodies usually know what they need," I will reply, and he will shrug, accepting this non-commitally, and I am sometimes tempted to believe that this is enough, that it could actually be that easy. But I know that somewhere inside of himself those comments are combining with the cultural bullshit negativity we have around the word “fat” (which we proactively work to counteract, with middling success) and I can see a world where “skinny” becomes not just a culturally desirable thing (even for a boy – for a shy boy who is totally uninterested in athletics or superheroes, at least) but an emotional security blanket of a sort that earns him attention, if that makes sense.
His body is his body! He goes through times where he eats an enormous quantity of pasta with butter, and then he goes through times where a whole slice of pizza is too much. I try hard not to make these into value judgments or correlate them to the size of his body and it is making me so uncomfortable to have my mom making these comments. But it is so uncomfortable to bring up with her, a classic boomer woman, loyal to Noom in her 70s. This interview is the motivation I need to take those comments as seriously as if she were saying, “If you keep drinking chocolate milk, you’re going to get fat!” (actual thing she said to me, in high school, when I developed the BODY-RUINING HABIT of drinking a glass of chocolate milk before bed each night - and something I would, at least, NEVER accept her saying to my kids)
Then, of course, my younger son is 100% about the superheroes and I live in fear of him growing into a tween who cares deeply about masculine body bullshit, and comes at the body issues from the opposite angle. It’s all just so much, sometimes.
FWIW to your distinction on craving attention, I think of it as adult-oriented kids vs. kid-oriented kids -- actually one of my kid's camps asks something like "does your kid gravitate to adults or other kids," so I think it's not uncommon. And it can change over time. Mine is much more kid-oriented now than he was a couple years ago.
That’s such lovely and helpful phrasing!
Yes! He has definitely always been very adult-oriented - that is a good way to phrase it.
Terrific insights. I really enjoyed this episode. I have two boys. I often think about raising them up not only to have a happy relationship with food but also helping them think critically about the expectations they might be telegraphing to friends who are girls right now, to friends in the future, also to girls they might date/partner with (if they are straight). Now that I've listened I'm realizing, yeah, boys are definitely at risk for disordered eating themselves! It's so obvious, and so overlooked.
Another great person to follow/learn from in this area is Jason Nagata, a pediatrician and associate professor at UCSF. Like Kyle, he's one of the (very) few people w expertise in boys/men and eating disorders. (He's @jasonmnagata on Twitter). I interviewed him earlier this week for an upcoming ON BOYS podcast episode.
Thank you for addressing!!
Riding home from camp with a car full of 12/13 year old boys this weekend and the diet, calorie, anti-fat talk was rampant... it is hard to know how to respond without sounding like you're shaming. We absolutely need to work on our comfort level and language around this :/