AASP Blog

Major Point: Seemingly healthy behaviors such as careful monitoring of food intake and regular exercise may actually be signs of body image disturbance, disordered eating, or an eating disorder in teens.

With the rise of sedentary behavior and obesity in American youth, most parents are pleased when their son or daughter takes an interest in being physically active. Indeed, regular participation in sport, recreation, or exercise can lead to a variety of positive social, psychological, and physical outcomes for youth. Unfortunately, societal pressures to achieve the "perfect" body and attain optimal performance may have unhealthy consequences for adolescents. These consequences include body image disturbances, disordered eating, eating disorders, and substance abuse. It is thus important to be aware that some seemingly healthy behaviors exhibited by your physically active teen may actually lead to harmful outcomes. Here are five warning signs that your teen's efforts to get in shape or improve performance may be detrimental to his/her health. It is important to note that the presence of one of these signs does not necessarily indicate that your son or daughter has an eating disorder or is abusing substances.

1. Preoccupation with Bodily Appearance
It is certainly not out of the ordinary for adolescents to be concerned with their appearance. However, frequent comments regarding their weight or shape, comparisons to athletes on TV or models in fitness magazines, and questions such as, "Do I look fat," or "Do I look any bigger?" may be indications of an unhealthy preoccupation with the size and shape of their body. Spending an excessive amount of time in front of the mirror, and daily use of the scale to check body weight are further signs that your teen is at-risk for a body image or eating disorder.

2. Strange Eating Behaviors
Extreme changes in food consumption may indicate that your teen is making an effort to gain or lose an unhealthy amount of weight. Failure to eat, eating an excessive amount, sticking to a rigid diet (e.g., only eating carrot sticks and crackers), or meticulous tracking of calories and nutrients may be attempts to drastically alter body weight and/or composition. Physically active adolescents who are concerned with appearance and performance may also use supplements such as Creatine, protein powder, weight gain shakes, or "fat burning" pills and liquids in attempts to gain weight, gain muscle mass, or lose fat. Teens may even choose to substitute supplements for regular meals. It is important to understand that although many supplements are advertised as being healthy, the long-term health consequences of usage for many dietary supplements are unknown.

3. Drastic Changes in Appearance
Changes in food consumption and/or the use of supplements and other performance enhancing substances may result in changes in the appearance of your child. Teens who restrict their diet will likely lose a large amount of weight in a short period of time. Hair loss and pale skin may be apparent in teens suffering from eating disorders such as anorexia and bulimia nervosa. Alternatively, teens who eat in excess and/or use supplements in an attempt to gain weight, strength, and muscle mass will likely exhibit drastic gains in weight and muscle mass. Boys who turn to anabolic steroids in an effort to gain muscle mass may develop acne, as well as breast tissue. Girls who use steroids may develop facial hair and experience a reduction in breast size.

4. Drastic Changes in Personality
Along with changes in appearance, personality changes may also occur as your son or daughter attempts to gain or lose weight. Uncharacteristic moodiness, aggravation, or fatigue, are signs that your teen's dietary changes are having a negative influence on his/her well being. Teens who use anabolic steroids to gain muscle mass and improve performance may become overly combative, a side effect known as "roid rage." Further, the cessation of steroid use may lead to depression.

5. New Priorities
A key sign that your teen has an unhealthy interest in sport or exercise is when people and activities that were once highly valued become secondary to the goal of improving appearance or performance. For example, teens who wish to gain muscle mass may consistently choose strength training over social gatherings with friends and family. Invitations to go out to eat, even to their favorite restaurant, may be rejected by teens adhering to a strict diet. School performance may also suffer among teens who prioritize workouts over homework or studying.

Conclusion
Although the epidemic of obesity in youth and adolescents highlights the need for increased physical activity in this population, societal demands for the "ideal" physique and a "win-at-all-cost" mentality may influence physically active adolescents to adopt unhealthy beliefs and behaviors. Several warning signs that your teen's efforts to achieve societal standards may be detrimental to their health are offered. Extreme changes in your teen's behavior, coupled with the presence of multiple warning signs, are cause for concern. In this case, you should approach your teen in a non-confrontational manner and inform him/her of your concerns. Avoid threats and accusations, and emphasize the fact that you are concerned about her/his health. Depending on the result of this conversation, you may wish to consult your teen's doctor, school psychologist, or another licensed mental health professional for advice on how to proceed.

References
Beals, K.A. (2004). Disordered eating among athletes: A comprehensive guide for health professionals. Champaign, IL: Human Kinetics.

Pope, H.G., Phillips, K.A., & Olivardia, R. (2000). The Adonis complex: How to identify, treat, and prevent body obsession in men and boys. New York: Simon & Schuster.