Men and Body Image: Are Males Satisfied with Their Body Weight?

Men and Body Image: Are Males Satisfied with Their Body Weight? ADAM DREWNOWSKI, PHD, AND DORIS K. YEE, MA Dissatisfaction with body image is thought to be a key factor in the etiology of eating disorders among women. In contrast, men are reported to be generally satisfied with their body weight and body shape. The present survey study examined the relative desire for thinness or weight gain among 226 male and female freshman students. Most 18-year-old women (85%) wished to lose weight. Men expressed conflicting views regarding desire for thinness and were almost evenly split between those who wanted to lose weight (40%) and those who wished to gain weight (45%). The proportion of men and women who expressed no desire for weight change was comparable. Men and women who wished to lose weight shared negative body perceptions: both groups viewed themselves as overweight, and both expressed dissatisfaction with body shape. However, men used exercise for weight control while women resorted to restricted calorie diets. A key risk factor for eating disorders may be dieting itself. INTRODUCTION An estimated nine out of 10 anorectics and bulimics are women (1-3). In contrast, eating disorders among men are reported to be infrequent, and there are limited data regarding their etiology and the nature of risk factors (4, 5). Several theorists suggest that sociocultural pressures toward thinness in women may account for the differential prevalence of eating disorders among women and men (6, 7). Contemporary society is said to value thinness as a standard of attractiveness (8), and these norms are applied more strongly to women than to men (8). The central role of body weight in the From the School of Public Health and Department of Psychiatry, Medical School (A.D.), and the Department of Psychology (D.K.Y.), University of Michigan, Ann Arbor, Michigan. Address reprint requests to: Dr. Adam Drewnowski, School of Public Health, The University of Michigan, Ann Arbor, MI 48109. Received for publication November 28, 1986; revision received April 13, 1987. perception of body image has been documented in several studies. Women tend to see themselves as overweight even if they are not; they are less happy with their body shape and diet more often than men to achieve the thin ideal (9). Dissatisfaction with body weight, reported to be much more pronounced among women than among men (9, 10), is thought to be the key risk factor in the etiology of eating disorders (8). Studies on sex differences in the perception of body image confirm that women are more likely than men to describe themselves as overweight (1, 9), worry about being or becoming fat (11), and express greater concern with dieting and body weight (12). In a figure drawing test, college-age women rated their current figures as heavier than the desired or ideal figure (13). In contrast, men's ratings of their current figures corresponded to the ideal. In other studies also, men were described as relatively satisfied with their current body weight (14) and body shape (13, 15). The reported satisfaction with body image is believed to protect the American 626 Psychosomatic Medicine 49:626-634 (1987) Copyright 1987 by the American Psychosomatic Society, I Published by Elsevier Science Publishing Co. Inc. 52 Vanderbilt Avenue. New York, NY 10017 0033-3174/87/503 50

MEN AND BODY IMAGE male from eating disorders. However, not all men may be alike in this respect. A recent survey showed that fully 41% of men (and 55% of women) were dissatisfied with their weight, while 44% of men (and 63% of women) were afraid of becoming fat (9). It has also been suggested that certain male subcultures that emphasize slimness and weight loss may promote body dissatisfaction, and thus put men at increased risk for eating disorders (8). Middle-aged male runners preoccupied with dieting and body weight have been compared to women with anorexia nervosa (16). Male swimmers and wrestlers striving to maintain weight standards have been examined for a potentially higher prevalence of bulimia (4). Dissatisfaction with body image in the male can also operate in the direction of weight gain. Studies with high school and college students indicate that the chief male concern at that age is to gain weight, size, and strength. Consequently, males at that age often perceive themselves as underweight or too thin (17, 18). It may be assumed that boys who want to gain weight are less interested in gaining weight per se than in becoming more muscular and equate muscularity with added weight (15). Studies on "ideal" somatotypes (19) confirmed that almost 70% of college-age men were dissatisfied with their body somatotype and preferred the more muscular ideal. If a population of males includes approximately equal numbers of those who seek thinness (weight loss) and those who seek muscle (weight gain), then the desires of the two groups are in direct opposition, and their average is zero. The observed congruence of current and ideal body weight, far from implying satisfaction, may be the outcome of combining two opposing (and dissatisfied) groups. In the present study, we examined the relative desire for thinness or weight gain among 18-year-old men and women. Virtually all the women and almost half of the men, including many at normal body weight, listed desired weights that were below their current weights. The desire for weight loss was then correlated with body image variables and with dieting and exercise habits. METHODS The data were obtained using a questionnaire that was distributed to a random sample of 231 freshman students (100 men and 131 women) attending a required English composition class at a large university in the Midwest. The students knew ahead of time that they would be asked to fill out a brief health survey at the beginning of the class period. The questionnaire instrument addressed physical stature, current weight, desired weight, satisfaction with body shape, self-perception of overweight, and the extent of dieting and physical exercise. Participation in the study was strictly voluntary. Students were asked not to put their names on the questionnaires and were assured that their responses would be confidential and not released to any university authorities. The study was conducted with the approval of the human rights review committee and the approval and cooperation of the university administrators and the health service. The present data are based on responses of 226 individuals (98 men and 128 women) who returned the questionnaire and represent a response rate of 97.8%. TABLE 1. Mean Vital Statistics for Respondents Men In = 981 Women In = 128] Age (yr) 18.7 (1.2)" 18.5 (0.9) Height (in) 70.9 (2.5) 65 3 (2.8) Weight (Ib) 163.6 (24 1) 127.5 (16.7) BMI, body mass index. "Numbers in parentheses are standard deviations. BMI (kg/nv) 22.8 (2.7) 20.9 (2.3) Psychosomatic Medicine 49:626-634 (1987) 627

A. DREWNOWSKI and D. K. YEE Data from the respondents are summarized in Table 1. The subjects' mean weights were appropriate for their age and sex (21) and closely matched median weights of 20-year-old white men (160.5 lb) and women (127,5 lb) from upper-income families in the Ten State Nutrition Survey (1972). In accordance with previous studies (22), normal body weight was statistically defined as falling within the 15-85th percentile distribution of body weights for sex and age, where the 85th percentile cutpoint corresponds to 115% of relative desirable weight (21). The present weight cutpoints were based on a reference population (a subset of the Ten State Nutrition Survey) that closely matched the present respondents for age, sex, race, and socioeconomic status (20). By this standard, 93 women (73%) and 80 men (81%) in the present sample were defined as being of "normal weight." The stated desire for weight change was expressed as a function of weight corrected for height. The chosen measure of body mass index (BMI = weight/height 2 ) is in adults independent of stature and moderately well correlated with body fatness. The present mean BMI values for men (22.8) and women (20.9) were well within the normal-weight range. RESULTS Body Image In agreement with previous studies, we found that gender is a significant predictor of perceived overweight and dissatisfaction with body shape. As shown in Figure 1, 48% of all women and 26% of all men described themselves as overweight. In contrast, 20.9% of the men but only 3.1% of the women described themselves as underweight. This difference between the sexes was statistically significant [x 2 (4, N = 223) = 25.27, p < 0.001]. Figure 2 shows that women also were less satisfied with body shape than were men [x 2 (4, N = 224) = 20.60, p < 0.001]. These findings, consistent with previous reports (1, 9, 11, 13), have usually been interpreted in terms of differential socio- O 20 40 60 PERCENT OF RESPONDENTS Fig. 1. Sex differences in self-perception of overweight. 628 Psychosomatic Medicine 49:626-634 (1987)

MEN AND BODY IMAGE Rarely Sometime Always 0 20 40 PERCENT OF RESPONDENTS Fig. 2. Sex differences in satisfaction with body shape. cultural pressures on the sexes with respect to desirable body weight and body shape. As expected, women dieted far more frequently than did men [x 2 (4, N = 225) = 45.83, p < 0.001]. As seen in Figure 3, approximately three out of five women (59.4%) had followed a reduced calorie diet at some point during the previous month. This figure far exceeds a previous report (23) that 40% of 18-year-old girls are usually on a diet. Body image variables were the key determinants of dieting. The frequency of dieting among women was more strongly correlated with perceived overweight (r = 0.33, p < 0.001) and dissatisfaction with body shape (r = 0.42, p < 0.001) than with self-reported body weight (r = 0.19, p < 0.05). Current and Desired Body Weights The difference score between current and desired weight (delta) was used as a quantitative measure of the individual desire for thinness or weight gain. Positive values of the current/desired discrepancy indicate a desire for weight loss, while negative values indicate a desire for weight gain. Delta scores were more strongly correlated with body weight for women (r = 0.70, p < 0.001) than for men (r = 0.32, p < 0.001). Identical results were obtained with delta scores plotted against values of body mass index (wt/ht 2 ), a measure of weight corrected for height, as shown in Figure 4. Delta scores and body mass indices were more strongly correlated for women (r = 0.80, p < 0.001) than for men (r = 0.46, p < 0.001). Satisfaction with current body weight (zero delta score) is indicated by a broken line. Only eight women were totally satisfied with their body weights. The majority (n = 109 or 85%) expressed a desire to lose weight, and only four women wished to be heavier than they were. The average woman who wanted to be thinner weighed Psychosomatic Medicine 49:626-634 (1987) 629

A. DREWNOWSKI and D. K. YEE Never 1 3 days 4 7 days 1-2 weeks >2 weeks Males Females 0 20 40 60 80 100 PERCENT OF RESPONDENTS Fig. 3. Sex differences in frequency of dieting. FEMALES 40 MALES 30-9. 10 O "20.. - 20- -10- -20- -30- -40-16 18 20 22 24 26 28 18 20 22 24-26 28 30 32 34 6 BODY MASS INDEX Iwt/ht'l BODY MASS INDEX <wt/ht? l Fig. 4. The relationship between desire for thinness or weight gain and body mass index (kg/m 2 ), shown separately for males and females. 630 Psychosomatic Medicine 49:626-634 (1987)

MEN AND BODY IMAGE 128.5 lb and desired to lose 9.7 lb. As might be expected, women expressing greatest desire for thinness (positive delta score) also reported greater frequency of dieting (r = 0.32, p < 0.001). The desire for weight change among males was not linked to the frequency of dieting. Men were almost equally divided between those wishing to lose and those wishing to gain weight. Men who wanted to lose weight (n = 44 or 45%) weighed a mean of 170.7 lb and wished to lose 7.6 lb. Men who wanted to gain weight (n = 39 or 40%) weighed a mean of 157.8 lb and wished to gain 11.1 lb. The average delta score for the male population was a desired weight gain of only 1.1 lb. However, this seeming satisfaction with body weight relative to females may be entirely misleading: only 10 men showed a true congruence between their current and desired weights, as defined by a zero delta score. The desire for thinness, shown by most women and almost half the men, was reflected in differential patterns of diet and exercise. As shown in Table 2, women who wished to lose weight dieted more frequently than did the men [x 2 (4, N = 153) = 15.54,,p < 0.01]. In contrast, men who wished to lose weight exercised more frequently than did the women [x 2 (2, N = 153) = 4.72; p < 0.10], though this difference was only marginally significant. These data suggest that women attempt to achieve the thin ideal predominantly by dieting, whereas men are more likely to turn to exercise for weight control. Desire for Weight Loss The desire for further thinness among normal-weight women is thought to be a risk factor for eating disorders (8). Additional analyses were therefore conducted with men and women in the previously denned range of normal weight. A comparison of actual and perceived weight categories showed that normal-weight women viewed their weights as about right (51%) or overweight (47%) and that only 2% considered themselves to be underweight. In contrast, normal-weight males viewed themselves as about right (59%), overweight (29%), or underweight (16%). Almost nine out of 10 normal-weight women (89.2%) wished to be thinner than they were, in agreement with previous reports. However, contrary to expectations based on previous studies (e.g., 14), over half (52.6%) of normal-weight men also expressed a desire to lose weight. Both men and women who wished to lose weight expressed similar negative body perceptions. As might be expected, both men and women who wished to lose weight TABLE 2. Sex Differences in the Frequency of Dieting and Exercise Among Men and Women Wishing to Lose Weight Days on Diet (per month) Physical Activity Men Women Men Women N 31 4 4 4 1 % 70.5 9.1 9.1 9.1 2.3 N 40 17 15 21 16 % 36.7 15.6 13.8 19.3 14.7 N 15 15 14 % 34.1 34.1 31.8 N 56 33 20 % 51.4 30.3 18.4 Never 1-3 days 4-7 days 1-2 weeks >2 weeks <30 min/day 30-60 mm/day >60 min/day Psychosomatic Medicine 49:626-634 (1987) 631

A. DREWNOWSKI and D. K. YEE tended to see themselves as overweight (52.0% women; 52.6% men) and no longer differed significantly in self-perception of overweight [x 2 (4, N = 124) = 2.04, p > 0.10] or dissatisfaction with body shape [X 2 (4, N = 124) = 7.62, p > 0.10]. Some of the misperceptions of body image previously thought to be characteristic only of young women appear to be shared by a subpopulation of young men. Even so, men and women wishing to lose weight showed different patterns of diet and exercise. Whereas 63.9% of the women had followed a reduced-calorie diet during the previous month, only 29.3% of the men had done so [x 2 (4, N = 124) = 13.89, p < 0.01]. In contrast, 65.9% of the men (and 50.5% of the women) reported more than 30 minutes of exercise per day. Pervasive dieting reported among weightconscious college women was not observed among weight-conscious college men. DISCUSSION The present data show that 18-year-old college men were almost evenly split between those who wished to lose and those who wished to gain body weight. The ideals of the two groups were in direct opposition, presenting a deceptive picture of overall satisfaction with current body weight. The small percentage of respondents who expressed no desire for weight change was comparable for both women and men. Satisfaction with body image and body weight does not appear to be an intrinsic male characteristic, as implied in some previous studies (13). Studies on body image have shown that women are more likely than men to see themselves as overweight and to express dissatisfaction with body shape (1, 13). These observations were confirmed in the present study. However, a comparison of women who wanted to lose weight (i.e., most women) with only those men who also wanted to lose weight (about 50% of the men) showed that some of the differences in body image variables between the sexes in this sample were no longer statistically significant. The subjects' body weights in this study were based on self-report rather than measurement, and the current-ideal discrepancies are, strictly speaking, measures of attitude. However, self-reported weights obtained in a neutral context are fairly accurate, and any bias operates almost invariably in the direction of underreporting. The present findings have several implications for the study of eating disorders. First, diverse sociocultural pressures including advertising and the mass media are thought to promote an increasingly thin ideal of the female body and to contribute to the misperception of body weight. Perception of self as overweight, regardless of actual weight, and desire for further thinness have long been regarded as risk factors for eating disorders among women (24). In contrast, men have been held to be largely immune from such pressures. A comparable emphasis on weight standards and thin body ideal is thought by some investigators to be restricted to selected male athletes or homosexual men (8). Our study shows that over half (55%) of normal-weight 18-year-old men in the Midwest expressed a desire to lose weight. Their self-perceptions of overweight were indistinguishable from those of weight-conscious women. Further studies are needed to determine what psychological, sociocultural, or demographic factors might explain why men of comparable weight, stature, and body 632 Psychosomatic Medicine 49:626-634 (1987)

MEN AND BODY IMAGE fatness express conflicting motivations and was much below that reported by women, desires regarding weight loss or weight gain. It may be that the key difference between The question also arises whether nor- the sexes with respect to the etiology of mal-weight males who desire thinness and eating disorders is not dissatisfaction with see themselves as overweight do in fact body weight but rather actual behaviors constitute a population at risk for eating related to diet and exercise. As noted predisorders. There are no prevalence esti- viously by Polivy and Herman (25), the mates for anorexia or bulimia among this chief risk factor for eating disorders may subgroup, and it is unclear whether some be dieting itself, of the risk factors specified for women are applicable to men as well (8). Although This research was supported by grants this group dieted more than did the total from the Michigan State Department 0/ male population, the prevalence of dieting Mental HeaJth and the Ruth Mott Fund. REFERENCES 1. Halmi KA, Falk JR, Schwartz E: Binge-eating and vomiting. A survey of a college population. Psychol Med 11:697-706, 1981 2. Pope HG, Hudson JI, Yurgelun-Todd D, Hudson MS: Prevalence of anorexia nervosa and bulimia in three student populations. Int J Eat Disord 3:45 51, 1984 3. Pyle RL, Mitchell JE, Eckert ED, Halvorson PA, Neuman PA, Goff GM: The incidence of bulimia in freshman college students. Int J Eat Disord 2:75-85, 1983 4. Enns M, Hinz K, Clark J, Grinker J, Cohen A, Drewnowski A: Body composition, body size estimation and attitudes towards eating in male college athletes. Psychosom Med 49:56-64, 1987 5. Herzog DB, Norman DK, Gordon C, Pepose M: Sexual conflict and eating disorders in 27 males. Am J Psychiatry 141:989-990, 1986 6. Garner DM, Garfinkel PE, Olmsted, MP: An overview of sociocultural factors in the development of anorexia nervosa. In Darby PL, Garfinkel PE, Garner DM, Coscina DV (eds), Anorexia Nervosa: Recent Developments in Research. New York, Alan R. Liss, Inc., 1983, pp 65-82 7. Schwartz DM, Thompson MG, Johnson CL: Eating disorders and the culture. In Darby PL, Garfinkel PE, Garner DM, Coscina DV (eds). Anorexia Nervosa: Recent Developments in Research. New York, Alan R. Liss, Inc., 1983, pp 83-94 8. Striegel-Moore RH, Silberstein LR, Rodin J. Toward an understanding of risk factors for bulimia. Am Psychol 41:246-263, 1986 9. Cash TF, Winstead BA, Janda LH: The great American shape-up. Psychology Today 20(3):30-37, 1986 10. Berscheid E, Walster E, Bornstedt G: The happy American body: A survey report. Psychology Today 7(6):119-131, 1973 11. Kelly JT, Patten SE, Johannes A: Analysis of self-reported eating and related behaviors in an adolescent population. Nutr Res 2:417-32, 1982 12. Drewnowski A, Riskey D, Desor JA: Feeling fat yet unconcerned: Self-reported overweight and the restraint scale. Appetite: Journal for Intake Research 3:273-279, 1982 13. Fallen AE, Rozin P: Sex differences in perceptions of desirable body shape. J Abnorm Psychol 94:102-105, 1985 14. Leon GR, Carroll K, Chernyk B, Finn S: Binge eating and associated habit patterns within college students and identified bulimic populations. Int J Eat Disord 4:43-57, 1985 15. Huenemann RL, Shapiro LR, Hampton MD, Mitchell BW: A longitudinal study of gross body composition and body conformation and their association with food and activity in a teen-age population. Am J Clin Nutr 18:325-338, 1966 16. Yates A, Leehey K, Shisslak CM: Running-An analogue of anorexia? N Engl J Med 308:251-255, 1983 Psychosomatic Medicine 49:626-634 (1987) 633

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