As a parent, caregiver, or coach, witnessing a child's enthusiasm for fitness is truly remarkable. Given that only 21 to 28 percent of kids aged 6 to 17 engage in 60 minutes of physical activity daily, and with childhood inactivity rates on the rise due to the pandemic, it's crucial to know how to help. When a child expresses a desire to work out more, two important questions arise: "How can I assist?" and "Why?" Maybe they aim to perform better in sports or simply love the way working out makes them feel. But there are also less healthy reasons that might indicate a deeper issue.

Understanding Body Dysmorphia and Muscle Dysmorphia

Body dysmorphic disorder involves a person fixating on a perceived flaw in their physical appearance that others don't notice. This can include aspects like skin, hair, or specific body parts. It leads to negative self-perceptions and can cause various emotional distress. Approximately 2 percent of the population suffers from it, and it's more common in adolescents. Muscle dysmorphia, a subset of body dysmorphia, occurs when a person believes their body is too small or not muscular enough, leading to an obsession with bulking up. Roughly 2 percent of adolescent boys have it, and the rate increases with age. Experts suspect social media use among teens is contributing to its rise. Boys are more likely to be affected than girls, and weight lifters and competitive athletes face a higher risk.

Signs of Muscle Dysmorphia

Some signs are obvious, while others are more subtle. In general, warning signs include when boys become overly preoccupied with their muscles, appearance, weight, food, or exercise to the point where it worsens their quality of life and impairs their social, school, or daily functioning. For example, they may no longer eat with families or friends, skip meals, feel anxious or angry when their exercise routine is disrupted, obsessively check themselves in the mirror, follow high-protein/low-fat diets, be preoccupied with specific body parts like biceps or abs, withdraw from usual activities and friends, regularly use muscle-building supplements like protein powder or creatine, use anabolic steroids, engage in excessive exercise duration and frequency, and be overly focused on muscle- or fitness-centric social media.

Risks of Muscle Dysmorphia

The risks are significant, highlighting the importance of parents, caregivers, and coaches getting kids the help they need. These risks include the development of disordered eating and eating disorders, dehydration and malnutrition, frequent nausea and vomiting, extreme fatigue and lack of focus, muscle and joint injuries, an increased risk of depression, anxiety, obsessive-compulsive disorder, substance use, and suicidal ideation. Steroid use can lead to extreme aggression, irritability, paranoia, as well as kidney, liver, and heart problems.If you notice the warning signs or worse, it's time to have a conversation with your kids. The Body Dismorphic Disorder Foundation recommends avoiding discussions about appearance and focusing on the distress it causes instead. If the problematic behavior persists, it's time to seek professional help. Parents should bring these issues up with a healthcare provider who can assess for an eating disorder and provide appropriate referrals. An interdisciplinary team including a mental health, medical, and nutrition provider is best for supporting eating disorders and muscle dysmorphia.You can also reinforce healthy messages at home. Consider "family meals" as an opportunity to model healthy food choices and encourage open communication about eating behaviors. These shared meals allow parents to monitor their child's eating habits and address any concerns early on. Even one weekly meal counts as "more." Additionally, keep discussions about muscles, weight, and appearance to a minimum. Focus on healthy eating and physical activity rather than appearance. Discourage weight-related or appearance-related teasing within the family to create a positive and accepting environment. Modeling positive behaviors is also crucial. If you engage in harmful dieting or complain about your body, your kids are likely to notice.Visit USADA.org for more information on the risks of steroids, supplements, and other performance-enhancing substances.