Health Provider Checklist for Adolescent and Young Adult Males

Healthy Eating and Physical Activity

Key Points

  • The prevalence of overweight or obesity among adolescent males is greater than among adolescent females and is rising, whereas obesity rates among female adolescents has stabilized.
  • Males account for an estimated 5 percent to 15 percent of patients with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder.
  • Almost 50% of people with eating disorders meet the criteria for depression. Eating disorders have the highest mortality rate of any mental illness.  Nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
  • A large 2013 study of teenage males 12 to 18 found that those who were worried about their muscularity used possible unhealthy supplements, such as growth hormone and steroids. These males were twice as likely as their peers to binge drink and use drugs, including cocaine, crack, ecstasy or methamphetamines.  Boys worried about being thin were more likely to develop symptoms of depression.

Questions to ask young male patients about Healthy Eating and Physical Activity

Healthy Eating and Physical ActivityOverview

The prevalence of overweight or obesity among adolescent males is greater than among adolescent females and is rising, whereas obesity rates among female adolescents has stabilized.1 Obesity is a risk factor for diabetes, and among 12 to 25 year olds, males have a diagnosed or undiagnosed prevalence of diabetes that is five times that of females.  Obesity is also a risk factor for cardiovascular disease, and children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.2  Disparities in overweight and obesity among AYA males also exist due to racial/ethnic and cultural differences.

In terms of long-term health effects, children and adolescents who are obese are likely to be obese as adults and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. One study showed that children who became obese as early as age 2 were more likely to be obese as adults. 

Overweight and obesity are also associated with increased risk for many types of cancer, including cancer of the colon, esophagus, kidney, pancreas, gall bladder, thyroid and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.3

Eating disorders primarily affect girls and women, but boys and men also are vulnerable. Boys with eating disorders show the same types of emotional, physical, and behavioral signs and symptoms as girls, but for a variety of reasons, boys are less likely to be diagnosed with what is often considered a stereotypically "female" disorder. Males account for an estimated 5 percent to 15 percent of patients with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder.4

Almost 50% of people with eating disorders meet the criteria for depression.5 Eating disorders have the highest mortality rate of any mental illness.6  Nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.7

Like females who have eating disorders, males with the illness have a distorted sense of body image and often have muscle dysmorphia, a type of disorder characterized by an extreme concern with becoming more muscular. Some boys with the disorder want to lose weight, while others want to gain weight or "bulk up." Boys who think they are too small are at a greater risk for using steroids or other dangerous drugs to increase muscle mass.8

Adolescents, especially adolescent males, are increasingly using nutritional supplements. One study examined supplements that were purported to influence performance and body mass. This study highlighted the fact that many nutritional supplements fall within the spectrum of adolescent use, and that this use may be driven by misguided beliefs in their performance-enhancing abilities. Groups at particular risk, such as individuals involved in physical activity to a high degree, were highlighted and the need for gender-specific information was suggested.9   In a related vein, adolescent males can present with an acceptable BMI yet have eating habits that are not in line with USDA standards; for example, because they skip meals or have a high carbohydrate intake. (Rafferty).  Male adolescents can also present as underweight because of their desire for pronounced muscle tone – the desire for “perfect abs”, for example. (Rafferty)

A recent (November 2013) large, prospective study found that eating disorders are more prevalent among adolescent males than previously thought.

The research by doctors at Boston Children's Hospital and published in JAMA Pediatrics,10 found that 17.9 percent of adolescent boys were extremely worried about their weight and physique. This concern was linked to a higher rate of risky behavior, such as drug use and binge drinking.  

Some males ages 12 to 18 who were worried about their muscularity used possible unhealthy supplements, such as growth hormone and steroids. These males were twice as likely as their peers to binge drink and use drugs, including cocaine, crack, ecstasy or methamphetamines.  Boys worried about being thin were more likely to develop symptoms of depression.

The researchers noted that little is known about the prevalence of concerns about physique and eating disorders among boys because most of the research has been conducted among girls.  They also noted that this large group has been understudied in research and may be entirely missed by healthcare providers because they are not captured by the DSM-IV or the DSM-5 diagnostic criteria for eating disorders. 

In 2011, among 9th to 12th grade students, 40% of males and 61% of females were physically active at least 60 minutes per day on less than 5 days.  43% of males and 53% of females did not attend physical education classes in an average week.Physical inactivity increases one’s risk for dying prematurely, dying of heart disease, and developing diabetes, colon cancer, and high blood pressure.11

2 Centers for Disease Control and Prevention.  Childhood Obesity Facts. 2013.

3 Ibid

4 NIH Medline Plus. Males and Eating Disorders. 2013.

5 Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry. 1995.

6 Ibid

7 Neumark-Sztainer, Dianne. I’m, Like, So, Fat!” Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World. Cognitive Behavioral Therapy Book Reviews. 2007.

8 NIH Medline Plus. Males and Eating Disorders. 2013.

9 Bell A, Dorsch KD, McCreary DR, Hovey R. A look at nutritional supplement use in adolescents. J Adolesc Health. 2004

10 Field, AE, Sonneville, KR, Crosby, RD et al. ProspectiveAssociations of Concerns About Physique and the Development of Obesity, BingeDrinking, and Drug Use Among Adolescent Boys and Young Adult MenJAMA Pediatr. Published online November 04, 2013. doi:10.1001/jamapediatrics.2013.2915

11 Centers for Disease Control and Prevention. Physical Activity Facts. 2013.