While National Eating Disorders Awareness Week ended March 1, this is an ongoing issue facing girls and boys alike.
Given the nature of what I do for a living (taking care of teenagers with eating disorders), it shouldn’t come as a surprise that I can be rather sensitive to the food messages that we send. The problem is, though, that many of those messages are unconscious habits—we don’t realize we are even sending them. This became obvious when my kids were little. Well-meaning and loving friends and relatives would routinely say things to them like “oh, you are such a good eater” or “you are so good for eating all you food, you should get some extra dessert”, or they would say things to others like “I shouldn’t eat this candy, but I’m going to go ahead and be bad.” The best example was a family favorite called “sinfully delicious dessert”. Don’t get me wrong, it was delicious; but sinful? Not so much. My poor friends and relatives would then have to deal with me going on for a bit about how food is neither inherently good nor bad and how it’s all about moderation and balance. They were kind enough to realize that I can be that way sometimes, and probably thought that this was just an intellectual discussion since, after all, I have two sons. And, after all, eating disorders are really a girl’s issue, right?
Wrong. Although the majority of those with eating disorders are girls and women, eating disorders, body image problems, obsessive exercising, and other problematic behaviors also affect boys and men. We used to think that there were 10 girls affected by eating disorders for every boy, but more recent studies have shown that the ratio is not 10 to 1, but more like 3 to 1. Additionally, problems like anorexia athletica and muscle dysmorphia were only first recognized about 15 years ago. These are problems in which men obsessively exercise. In anorexia athletic, men pay excessive attention to diet and weight in an attempt to meet a specific weight goal to improve their athletic performance to a degree that their self-esteem can be adversely affected. Muscle dysmorphia is a problem in which men feel significant distress and inadequacy due to a perceived lack of musculature and a preoccupation with gaining muscle without fat. Men with muscle dysmorphia may be, to an objective observer, incredibly fit, but perceive themselves as thin and weak. While both of these disorders involve behaviors that could be considered normal to a certain extent, they are carried to such extremes as to become pathological and cause severe emotional distress.
So does calling a concoction of chocolate pudding, cookies, and whipped cream “sinfully delicious” cause eating disorders? No, of course not. But assigning such moral attributes to food perpetuates a culture that can be dangerous for those kids who are at risk. And we should all examine our own habitual messages that we give about food and exercise. Food in moderation keeps us healthy, and exercise in moderation keeps us healthy. These are the messages we should deliver to our kids, girls and boys alike.
Terrill D. Bravender, MD, MPH, is an Adolescent Medicine physician at Nationwide Children’s Hospital and a Professor of Pediatrics and Psychiatry in the Ohio State University College of Medicine.
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