Los Angeles-based dietitian David A Wiss outlined the parameters of the disorder at the recent SCAN meeting in Huron Ohio. The group is the Sports, Cardiovascular and Wellness Nutrition subset of the American Academy of Nutrition and Dietetics. The meeting, which concluded Sunday, is the 30th annual gathering of the group.
Flip side of anorexia coin
Wiss outlined muscle dysmorphia as a disorder in which the afflicted individual believes that they are insufficiently muscular and will do almost anything to find time to work out to build more muscle mass. It is a form of obsessive/compulsive disorder that is somewhat akin to anorexia. The anorexic, who might be already in a state of extreme emaciation, looks in the mirror and sees a fat person. The muscle dysmorphia sufferer, who might already have exaggerated musculature, sees a 90-lb weakling.
“22% of males with muscle dysmorhpia formerly met criteria for anorexia. They have replaced an earlier preoccupation with being too fat with a new one of being too small,” Wiss said.
Among the warning signs of the disorder are eating in private, extreme sensitivity to comments about body weight, excessive checking of body parts, such as running a measuring tape around the biceps multiple times a day. Sufferers also tend to have negative associations with certain body parts, such as obsessing about calves that are deemed too small.
Muscle dysmorphia sufferers will also commonly pursue their obsession to the detriment of family or social relationships, Wiss said. The perception of muscularity becomes their prime good, to the detriment of most other parts of their life. It is this dysfunctional imbalance that helps a nutritionist (or a psychiatrist) differentiate between a driven athlete and a disordered one.
“I really think these issues are highly under-addressed,” Wiss said. “The fitness industry can play a large role in projecting images supporting the cycle of body dissatisfaction. The idea is that males should only have one body type.”
And indeed the marketing of many (if not most) protein and pre-workout products features images of professional body builders. These strength athletes are paid to work out multiple hours a week without for the most part having to balance the demands of full-time non-sports lives. They support extreme muscle growth through active steroid use, and are usually photographed in their competition phase, in which they have stripped as much subcutaneous fat and excess water out of their systems as humanly possible. Trying to look like them is as realistic for the average gym rat as it is for the average cycling enthusiast to be as lean as Tour de France riders who ride 20,000 miles a year and are pictured in the middle of one of the world’s most demanding endurance athletic events.
But that doesn't stop body dysmorphia sufferers from trying, Wiss said. In his view, the marketers of many sports nutrition products are feeding on this affliction.
“It’s a huge industry and the goal is to make money. The fitness industry relies on unrealistic images to engender insecurity in its customer base,” he said.
The risk doesn't extend to merely ending up with a gym rat who has no close relationships. Without treatment many body dysmorphia sufferers progress from injecting steroids to injecting other things.
“35% of male steroid abusers meet lifetime criteria for substance abuse disorder,” Wiss said. “You’ve already got a population that’s needle-friendly. They’ve gone from steroids to heroin.”
Wiss said counseling these clients involves trying to reorder their thinking about exercise and the goals of exercise. The mindset promulgated by the marketers of ‘extreme’ products doesn’t help.
“I try to get people excited about a new way of life, to shift their focus from extreme muscle mass toward sustainable fitness. I increase the levels of plant-based antioxidants in their diet, I decrease proteins and reintroduce fiber-rich foods. It’s not education, it’s re-education,” he said.