If you have wondered why a disease like anorexia seems to impact primarily middle class white girls, a new paper in JAMA Pediatrics will shed some new light on the issue.

A new paper analyzed survey responses of 5,527 teenage males from across the U.S.and found that 17.9% of these young men are suffering under the yoke of female body expectations and are extremely concerned about their weight and physique. These boys were found to be more likely to start engaging in risky behaviors, including drug use and frequent binge drinking.

Evaluations for eating disorders have been developed to reflect girls' concerns with thinness but not boys' concerns, so the authors reviewed responses to questionnaires completed as part of the Growing Up Today Study. Teens responded to surveys every 12 to 36 months from 1999 through 2010.

Boys tended to be more interested in muscularity than thinness, with 9.2 percent of males reporting high concerns with muscularity, compared with 2.5 percent concerned about thinness and 6.3 percent concerned with both aspects of appearance.

Males concerned about muscularity and who used potentially unhealthy supplements, growth hormone and steroids to enhance their physique were approximately twice as likely to start binge drinking frequently and much more likely than their peers to start using drugs. Boys concerned with thinness were more likely to develop depressive symptoms.

A total of 2.9 percent of all respondents had full or partial criteria binge-eating disorder, and nearly one-third reported infrequent binge eating, purging or overeating.

Anorexia nervosa and bulimia nervosa are characterized by an excessive influence of weight and physique on self-evaluation, with patients focused on being thin or wanting to losing weight.

Most eating disorder assessments reflect this desire for thinness and may overlook boys concerned about their weight and shape but who want to be more muscular. The authors say this may be the male equivalent of girls who are very concerned with their weight and who use vomiting or laxatives for weight control.

"Clinicians may not be aware that some of their male patients are so preoccupied with their weight and shape that they are using unhealthy methods to achieve the physique they desire, and parents are not aware that they should be as concerned about eating disorders and an excessive focus on weight and shape in their sons as in their daughters," says the paper's lead author, epidemiologist Prof. Alison Field from Boston Children's Hospital Adolescent Medicine Division.

Citation: Alison E. Field, ScD, Kendrin R. Sonneville, RD, ScD, Ross D. Crosby, PhD, Sonja A. Swanson, ScM, Kamryn T. Eddy, PhD, Carlos A. Camargo Jr, MD, DrPH, Nicholas J. Horton, ScD, Nadia Micali, MD, PhD, 'Prospective Associations of Concerns About Physique and the Development of Obesity, Binge Drinking, and Drug Use Among Adolescent Boys and Young Adult Men', JAMA Pediatrics November 04, 2013 doi:10.1001/jamapediatrics.2013.2915