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HEALTHY-NUTRITION NATURAL SPORT

A muscle-building obsession in boys: What to know and do

A shadowy, heavily-muscled superhero in a red cape strikes an action pose against a red and orange background; concept is body dysmorphic disorder

By the time boys are 8 or 10, they’re steeped in Marvel action heroes with bulging, oversized muscles and rock-hard abs. By adolescence, they’re deluged with social media streams of bulked-up male bodies.

The underlying messages about power and worth prompt many boys to worry and wonder about how to measure up. Sometimes, negative thoughts and concerns even interfere with daily life, a mental health issue known body dysmorphic disorder, or body dysmorphia. The most common form of this in boys is muscle dysmorphia.

What is muscle dysmorphia?

Muscle dysmorphia is marked by preoccupation with a muscular and lean physique. While the more extreme behaviors that define this disorder appear only in a small percentage of boys and young men, it may color the mindset of many more.

Nearly a quarter of boys and young men engage in some type of muscle-building behaviors. “About 60% of young boys in the United States mention changing their diet to become more muscular,” says Dr. Gabriela Vargas, director of the Young Men’s Health website at Boston Children’s Hospital. “While that may not meet the diagnostic criteria of muscle dysmorphia disorder, it’s impacting a lot of young men.”

“There’s a social norm that equates muscularity with masculinity,” Dr. Vargas adds. “Even Halloween costumes for 4- and 5-year-old boys now have padding for six-pack abs. There’s constant messaging that this is what their bodies should look like.”

Does body dysmorphic disorder differ in boys and girls?

Long believed to be the domain of girls, body dysmorphia can take the form of eating disorders such as anorexia or bulimia. Technically, muscle dysmorphia is not an eating disorder. But it is far more pervasive in males — and insidious.

“The common notion is that body dysmorphia just affects girls and isn’t a male issue,” Dr. Vargas says. “Because of that, these unhealthy behaviors in boys often go overlooked.”

What are the signs of body dysmorphia in boys?

Parents may have a tough time discerning whether their son is merely being a teen or veering into dangerous territory. Dr. Vargas advises parents to look for these red flags:

  • Marked change in physical routines, such as going from working out once a day to spending hours working out every day.
  • Following regimented workouts or meals, including limiting the foods they’re eating or concentrating heavily on high-protein options.
  • Disrupting normal activities, such as spending time with friends, to work out instead.
  • Obsessively taking photos of their muscles or abdomen to track “improvement.”
  • Weighing himself multiple times a day.
  • Dressing to highlight a more muscular physique, or wearing baggier clothes to hide their physique because they don’t think it’s good enough.

“Nearly everyone has been on a diet,” Dr. Vargas says. “The difference with this is persistence — they don’t just try it for a week and then decide it’s not for them. These boys are doing this for weeks to months, and they’re not flexible in changing their behaviors.”

What are the health dangers of muscle dysmorphia in boys?

Extreme behaviors can pose physical and mental health risks.

For example, unregulated protein powders and supplements boys turn to in hopes of quickly bulking up muscles may be adulterated with stimulants or even anabolic steroids. “With that comes an increased risk of stroke, heart palpitations, high blood pressure, and liver injury,” notes Dr. Vargas.

Some boys also attempt to gain muscle through a “bulk and cut” regimen, with periods of rapid weight gain followed by periods of extreme calorie limitation. This can affect long-term muscle and bone development and lead to irregular heartbeat and lower testosterone levels.

“Even in a best-case scenario, eating too much protein can lead to a lot of intestinal distress, such as diarrhea, or to kidney injury, since our kidneys are not meant to filter out excessive amounts of protein,” Dr. Vargas says.

The psychological fallout can also be dramatic. Depression and suicidal thoughts are more common in people who are malnourished, which may occur when boys drastically cut calories or neglect entire food groups. Additionally, as they try to achieve unrealistic ideals, they may constantly feel like they’re not good enough.

How can parents encourage a healthy body image in boys?

These tips can help:

  • Gather for family meals. Schedules can be tricky. Yet considerable research shows physical and mental health benefits flow from sitting down together for meals, including a greater likelihood of children being an appropriate weight for their body type.
  • Don’t comment on body shape or size. “It’s a lot easier said than done, but this means your own body, your child’s, or others in the community,” says Dr. Vargas.
  • Frame nutrition and exercise as meaningful for health. When you talk with your son about what you eat or your exercise routine, don’t tie hoped-for results to body shape or size.
  • Communicate openly. “If your son says he wants to exercise more or increase his protein intake, ask why — for his overall health, or a specific body ideal?”
  • Don’t buy protein supplements. It’s harder for boys to obtain them when parents won’t allow them in the house. “One alternative is to talk with your son’s primary care doctor or a dietitian, who can be a great resource on how to get protein through regular foods,” Dr. Vargas says.

About the Author

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Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

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HEALTHY-NUTRITION NATURAL SPORT

Easy ways to shop for healthful, cost-conscious foods

A dark background with brightly colored foods, such as tomato, orange, mushroom, cheese, eggs, celery, watermelon, salmon

Three months into the year is a good time to recalculate if you’ve been slacking on your resolution to eat healthy. And if you’ll be leaving home base or school soon and foraging for yourself (plus or minus roommates), it’s a great time to learn about healthy, low-cost choices for your grocery list.

The basics: A weekly shop

A healthy diet is rich in vegetables, fruits, legumes (beans or lentils), whole grains, nuts, seeds, lean proteins, and low-fat dairy products. Trying to fill your cart with all of those goodies can feel overwhelming. But just think in terms of twos.

“Get two fruits and two vegetables of different colors, and two types of lean protein — such as fresh, frozen, or canned fish, chicken or lean ground turkey, or plant-based options,” suggests Nancy Oliveira, a registered dietitian and manager of the Nutrition and Wellness Service at Harvard-affiliated Brigham and Women’s Hospital.

Oliveira also recommends getting two foods in each of these categories on your weekly shopping trip:

  • plant proteins, such as canned or dried beans, tofu, tempeh, veggie burgers, or unsalted nuts or seeds
  • whole grains, such as whole-grain bread, whole-grain pasta, brown or black rice, quinoa, or farro
  • dairy or nondairy milk items, such as nonfat Greek yogurt or cheese.

Go ahead and add one or two healthy treats or snacks, such hummus or dried apricots.

Do you need to choose organic foods?

Organic produce is grown without synthetic fertilizers and pesticides, which are linked to many health problems. While US scientists debate whether foods grown with organic fertilizers (such as animal waste) are safer for your health, other countries, including European Union nations, have banned or phased out synthetic pesticides still used in the United States.

That doesn’t mean that everything you buy must be organic. But try to stay away from conventionally grown produce with thin skins, such as strawberries, spinach, kale, peaches, and grapes. They tend to absorb more chemicals compared to produce with thick skins, such as avocados or pineapples.

The Environmental Working Group creates an annual list to help shoppers avoid high-pesticide produce, and another one that highlights the least contaminated produce.

Buying cost-conscious fresh food and staples

Healthy food, especially organic produce, has a reputation for being expensive. But it doesn’t have to be. Just do a little comparison shopping, and follow Oliveira’s tips to save money on a grocery run:

  • Shop in a smaller store with fewer choices.
  • Never enter a store hungry, since you might buy more than you normally would.
  • Carry a shopping list and stick to it.
  • Go directly to the aisles you need. Avoid browsing elsewhere, which may lead to extra purchases.
  • Be flexible, have several options within your food categories, and go with sale items.
  • Always check the day-old produce cart that offers perfectly edible fresh produce at 50% to 75% off regular prices.
  • Buy unseasoned canned or frozen whole foods such as vegetables, chicken, or fish (salmon, sardines, tuna), which are often cheaper than fresh versions.
  • Wait for sales of healthy nonperishable staples like quinoa, brown rice, whole-grain pasta, and high-fiber cereals.
  • Use coupons and coupon apps.

Easy healthy snacks to reach for

Move on from easy grab-n-go snacks, which are typically processed foods. They often contain unhealthy ingredients and promote overeating. Instead, Oliveira suggests keeping healthy snacks on hand, such as:

  • unsalted mixed nuts
  • string cheese
  • grapes and berries (rinse before eating)
  • clementines, bananas, or other fruits that don’t need washing
  • a rice cake with nut butter or hummus
  • fat-free Greek yogurt
  • a peeled hard-boiled egg.

“To save money, buy certain foods in larger amounts when possible, such as an 8-ounce bar of cheese that you slice into small cubes and store in a sealed container in the fridge,” Oliveira says.

Crowdsource shopping tips and savings

Don’t be shy about asking for shopping tips from friends and family members who’ve already developed shortcuts, and grocery store staffers who can offer insider advice.

You can also turn to apps for help. Oliveira recommends two faves:

  • Mealime is a meal-planning app with simple, healthy plant-based recipes that automatically create grocery lists for the ingredients.
  • List Ease creates lists for grocery runs. You can search for items to add or scan barcodes to add to lists.

“And if you prefer not to use apps, just jot down notes after a quick pantry or fridge inventory, or text yourself every time you remember something you need,” Oliveira advises. “With a little practice, you’ll quickly work out the best system for you.”

About the Author

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Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Categories
HEALTHY-NUTRITION NATURAL SPORT

Why eat lower on the seafood chain?

A white plate with fresh silvery sardines with sliced lemon, parsley, garlic cloves, and olive at the ready to cook

Many health-conscious consumers have already cut back on hamburgers, steaks, and deli meats, often by swapping in poultry or seafood. Those protein sources are better than beef, and not just because they’re linked to a lower risk of heart disease, diabetes, and cancer. Chicken and fish are also better for the environment, as their production uses less land and other resources and generates fewer greenhouse gas emissions.

And choosing seafood that’s lower on the food chain — namely, small fish such as herring and sardines and bivalves such as clams and oysters — can amp up those benefits. “It’s much better for your health and the environment when you replace terrestrial food sources — especially red meat — with aquatic food sources,” says Christopher Golden, assistant professor of nutrition and planetary health at the Harvard T.H. Chan School of Public Health. But instead of popular seafood choices such as farmed salmon or canned tuna, consider mackerel or sardines, he suggests.

Why eat small fish?

Anchovies, herring, mackerel, and sardines are all excellent sources of protein, micronutrients like iron, zinc, and vitamin B12, and heart-healthy omega-3 fatty acids, which may help ease inflammation within the body and promote a better balance of blood lipids. And because you often eat the entire fish (including the tiny bones), small fish are also rich in calcium and vitamin D, says Golden. (Mackerel is an exception: cooked mackerel bones are too sharp or tough to eat, although canned mackerel bones are fine to eat).

Small fish are also less likely to contain contaminants such as mercury and polychlorinated biphenyls (PCBs) compared with large species like tuna and swordfish. Those and other large fish feed on smaller fish, which concentrates the toxins.

It's also more environmentally friendly to eat small fish directly instead of using them to make fish meal, which is often fed to farmed salmon, pork, and poultry. Feed for those animals also includes grains that require land, water, pesticides, and energy to produce, just as grain fed to cattle does, Golden points out. The good news is that increasingly, salmon farming has begun using less fish meal, and some companies have created highly nutritious feeds that don’t require fish meal at all.

Small fish in the Mediterranean diet

The traditional Mediterranean diet, widely considered the best diet for heart health, highlights small fish such as fresh sardines and anchovies, says Golden. Canned versions of these species, which are widely available and less expensive than fresh, are a good option. However, most canned anchovies are salt-cured and therefore high in sodium, which can raise blood pressure.

Sardines packed in water or olive oil can be

  • served on crackers or crusty, toasted bread with a squeeze of lemon
  • prepared like tuna salad for a sandwich filling
  • added to a Greek salad
  • tossed with pasta, either added to tomato sauce or with lemon, capers, and red pepper flakes.

Golden is particularly fond of pickled herring, which you can often find in jars in supermarkets, or even make yourself; here’s his favorite recipe.

Bivalve benefits

Bivalves are two-shelled aquatic creatures that include clams, oysters, mussels, and scallops. Also known as mollusks, they’re good sources of protein but are quite low in fat, so they aren’t as rich in omega-3’s as small, fatty fish. However, bivalves contain several micronutrients, especially zinc and vitamin B12. Zinc contributes to a healthy immune system, and vitamin B12 helps form red blood cells that carry oxygen and keep nerves throughout the body healthy. While most Americans get enough B12, some may not.

And from a planetary health perspective, bivalves are among the best sources of animal-based protein. “Bivalves can be ‘nature positive’ because they don’t require feed and they filter and clean up water,” says Golden.

Be aware, however, that bivalves can become contaminated from runoff, bacteria, viruses, or chemicals in the water. So be sure to follow FDA advice about buying and preparing seafood safely.

Although we tend to think of coastal cities as the best places to find seafood, it’s available throughout the United States. For less-common varieties, try larger Asian markets, which often carry a wide variety of fish and bivalves, Golden suggests.

Aquatic plant foods

You can even go one step further down the aquatic food chain by eating aquatic plant foods such as seaweed and kelp. If you like sushi, you’ve probably had nori, the flat sheets of seaweed used to make sushi rolls. You can also find seaweed snacks in Asian and many mainstream grocery stores. The truly adventurous may want to try kelp jerky or a kelp burger, both sold online.

Nutrients in seaweed vary quite a bit, depending on species (kelp is one type of brown seaweed; there are also numerous green and red species). But seaweed is low in calories, is a good source of fiber, and also contains iodine, a mineral required to make thyroid hormones. Similar to terrestrial vegetables, seaweeds contain a range of other minerals and vitamins. For now, aquatic plant foods remain fringe products here in the United States, but they may become more mainstream in the future, according to Golden.

About the Author

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Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD