Body dissatisfaction is an increasing concern among young people, with clinicians observing a notable rise in such issues among boys. Historically, body image concerns were primarily associated with girls. Dr. Jason Nagata, an eating disorder researcher at the University of California, San Francisco, states that negative body image attitudes in boys often stem from feeling insufficiently muscular. A segment of these young men develops an intense preoccupation with getting larger and more muscular, a condition known as bigorexia.\n\n## Understanding Bigorexia\nBigorexia is defined by an individual's preoccupation or obsession with the idea of not having enough muscularity, even when their physique is objectively normal or muscular. This condition was initially described in a 1993 case report involving nine muscular bodybuilders who became so engrossed in working out that it led to social withdrawal and avoidance of situations where they might appear smaller. It was first termed 'reverse anorexia' due to its contrast with anorexia, where patients often appear visibly thin. Dr. Nagata emphasizes that it is difficult to identify muscle dysmorphia solely by physical appearance, as affected individuals can come from a range of body sizes and shapes.\n\n## Contributing Factors and Risks\nThree primary factors contribute to the rise of muscle dysmorphia and the drive for muscle gain in men: family, peers, and media. Studies indicate that media influence is the most significant predictor. Social media platforms, in particular, showcase idealized bodybuilder physiques, leading to comparisons and diminished self-confidence among young men, such as 16-year-old Dashiell Frederickson. George Mycock, a graduate student studying the condition, suggests that social media's design, which tends to amplify extreme body ideals, exacerbates these trends.\n\nIndividuals with bigorexia face heightened risks of disordered eating, steroid use, and suicidal ideation. Severe cases of disordered eating may necessitate hospitalization, and longitudinal studies in Canada show an increasing proportion of boys among such patients. This highlights a pressing need for clinicians to be educated on this trend.\n\n## Diagnostic Challenges and Demographics\nBigorexia was added to the DSM in 2013 as a body dysmorphic disorder. However, its classification creates diagnostic complexities, particularly when co-occurring with eating disorder symptoms, as eating disorders and body dysmorphic disorders are considered mutually exclusive within current diagnostic frameworks. Dr. Nagata advocates for bigorexia to be recognized as an eating disorder to address this discrepancy.\n\nDr. Nagata estimates that approximately one-third of teenage boys in the U.S. are attempting to build muscle. However, the exact prevalence of bigorexia is difficult to ascertain due to limited awareness and diagnostic challenges. Certain groups, such as transgender men, are identified as being at higher risk due to their desire to achieve a more masculine physique.\n\n## Conclusion\nWhile exercise provides numerous health benefits, Mycock cautions that an over-reliance or addiction to it, or when it becomes a person's entire identity, can become problematic. He stresses the importance of public health messaging that acknowledges the potential dangers of excessive exercise, much like how side effects are communicated for other beneficial substances.