The focus on teenage weight issues tends to center around girls, but boys are not immune to body image pressures. In two new studies, researchers found that teen boys of a healthy weight who think they are too skinny have a higher risk of being depressed, compared with other boys - even those who think they are overweight.
The findings, which were published in the American Psychological Association's journal Psychology of Men & Masculinity, also suggest this fear of being underweight prompts many young boys to turn to steroids.
The Centers for Disease Control and Prevention (CDC) notes that an estimated 3.5% of children and adolescents between the ages of 2 and 19 are underweight, which, in many cases, can be due to underlying health conditions.
While childhood obesity is a health problem, leading to heart disease, diabetes, asthma and sleep apnea - among other conditions - it can also cause psychological stress that stems from social stigmatization, the CDC adds.
In the latest set of studies - led by Aaron Blashill, staff psychologist at Massachusetts General Hospital and faculty member at Harvard Medical School - the researchers found that teenage boys who think they are underweight and who are victims of bullying are more likely to use steroids and feel depressed, compared with other boys their age.
Underweight perceptions prompt highest depressive symptoms
New research found that boys who think they are too skinny have higher levels of depressive symptoms than their peers who think they are overweight.
In one study, Blashill and his team analyzed a large US sample of 2,139 teen boys who were 16-years-old in 1996 and who were followed for 13 years.
During this time, the researchers surveyed the boys three different times in 6-year intervals to evaluate depressive symptoms, body image perceptions and body mass index (BMI).
The boys who identified themselves as being underweight - but who were actually of an average weight or higher - had the highest levels of depressive symptoms.
And these symptoms were consistent throughout the whole study, which ended when the boys were around 30-years-old.
Commenting on their findings, Blashill says:
"These studies highlight the often underreported issue of distorted body image among adolescent boys. Teenage girls tend to internalize and strive for a thin appearance, whereas teenage boys tend to emphasize a more muscular body type."
Steroid use predicted by bullying about body size
Blashill and his team conducted a second study, which used data from a 2009 survey of 8,065 high school boys in the US. The researchers found that 4% of these boys reported using steroids at some point in their lives, and 3% of them reported that they were underweight.
The boys who classified themselves as being underweight were more likely to have been bullied and reported more depressive symptoms, which the researchers say predicted steroid use.
"We found that some of these boys who feel they are unable to achieve that often unattainable image are suffering and may be taking drastic measures," Blashill says.
He suggests that clinicians working with depressed teenage boys - especially those who are bullied based on their body weight - should be aware of the potential risk of these boys using steroids.
"Unfortunately, there is little evidence-based research on effective therapies for steroid use among adolescent boys," says Blashill, adding:
"However, cognitive-behavioral therapy has proven to be effective for body image concerns and could be helpful for boys considering using or already using steroids."
The CDC has provided a BMI percentile calculator specifically for children and teens to determine whether they are in a healthy weight range, though physical fitness is an important component of staying healthy.
Medical News Today recently reported that teens who are physically active have a lower risk of heart attacks later in life.