It's a well-worn movie storyline - a scrawny, picked-on anti-hero is transformed into a muscle-bound champion, often through some fantastical gift like a secret serum. It is hard to imagine a better advertisement for using dangerous steroids to build up muscles.

But how much should we worry about the messages being sent to boys by the skinny-kid-cum-super-heroes of this world? After all, boys don't care much about how their bodies look. Or do they?

A new Australian study published in the Journal of Adolescent Health, has for the first time shown that body dissatisfaction isn't just dangerous for girls. When young and teenage boys start worrying too much about how they look it is just as damaging to their quality of life.

And while girls report significantly higher rates of body dissatisfaction, just over half boys in the study of 1,666 school children reported some body dissatisfaction.

"When boys are unhappy with their bodies it impairs their quality of life to an equal degree as it does for girls," says lead researcher on the study, University of Melbourne psychologist Dr Scott Griffiths.

The finding comes at a time of emerging evidence that men are increasingly suffering from body dissatisfaction, as highlighted by the alarming growth in steroid use in Australia. It suggests that boys could also be increasingly at risk and Dr Griffiths says the research should be a wake up call for parents and health services.

"There is this inaccurate perception that boys just don't care about their body image, and it is a common perception especially among older health professionals and among fathers who grew up in a different time when perhaps body image was less important for men."

"While the burden of body dissatisfaction clearly falls disproportionately on women, research shows that it is increasingly becoming a problem for men. And while we don't have data on whether it is an increasing problem or not among for boys, we can say that when body image is a problem for boys they are no less affected than girls."

He says that given the potential dangers, both psychological and physical, we urgently need to develop interventions aimed at boys in the same way we tailor interventions to build self esteem among girls.

The research was based on data from 1,666 school children aged between 12-18 from the Australian Capital Territory who filled out surveys in supervised school environments. Of these 531 were boys and 1,135 were girls. The surveys used established psychological tests for body image, eating disorders and quality of life.

Girls reported higher levels of body dissatisfaction and diminished quality of life with 81.6 per cent of girls reporting some dissatisfaction. But the number of boys reporting some dissatisfaction was also significant at 55.7 per cent. And once the effect of eating disorders is stripped out, those boys who were suffering from body dissatisfaction reported diminished quality of life equivalent with that reported by girls.

Dr Griffiths says it was important to strip out eating disorders because body dissatisfaction among boys will often centre on wanting to be more muscled, rather than, as it is for girls, being thin.

Dr Griffiths says the results suggest that body dissatisfaction is a health problem in its own right rather than simply a risk factor for eating disorders.

"Health professionals should explore and potentially treat body dissatisfaction even when there is no associated or underlying medical condition," he says.

Rising steroid use a warning

The research on adolescents follows research published last year by Dr Griffiths and colleagues on comparing body dissatisfaction and quality of life across men and women. The research covered over 2,000 people, almost half of which were men, and the results were the similar to that found in the later adolescent survey.

There is also evidence that body dissatisfaction is becoming more widespread among men. The use of muscle-building steroids for example has grown rapidly. In 2010 steroids accounted for just 2 per cent of all injection users, but by 2014 had grown to 7 per cent nationally, and over 10 per cent in New South Wales and Queensland. Since 2011, steroids have been the number one most commonly injected drug amongst new injection drug users.

Such increasing steroid use is evidence of potentially rising rates of muscle dysmorphia. This is where someone becomes obsessed with becoming more muscled because they see themselves as puny. It is the opposite of anorexia where people become obsessed with losing weight because they fear they are too fat.

"We have a steroid epidemic," says Dr Griffiths. "It is the canary in the coal mine telling us that we are missing the fact that body dissatisfaction is a significant problem among men."

And men are also increasingly suffering eating disorders. Between 1998 and 2008 extreme dieting and purging grew more rapidly among males than it did among females.

"Australia is the first country where we find this happening and it would suggest that in the future, unless trends change, men and women will reach parity," he says.

What is driving this change? Dr Griffiths says it is hard to be definitive but the increasing glorification of muscled men in the media is at least partly to blame. But he speculates that it may be a consequence of a crisis in what it means to be masculine given improving gender equality.

"In the past men had different pathways for projecting their masculinity. They could establish themselves as the breadwinner or as the protector. But that is no longer so much the case because there is increasing parity between the genders. Women are increasingly seen as breadwinners and protectors too.

"So if you are a man and want to project your masculinity in a way that is socially acceptable and doesn't stigmatise genders, then you can put on big muscles."

Whether female or male, Dr Griffiths says the problem is that people and society tend to focus on how people look, and the reality is that this is unlikely to change.

"People will always worry about how they look, the key is to not worry too much. One way to do that is encourage people and society to focus more on what someone can do - their skills and capacities - rather than what they look like. We need to be careful that we stress the importance of function over form, not the other way around."

Dr Griffith's co-authors on the study are Dr Stuart B. Murray of University of California, San Francisco; Caroline Bentley, Kassandra Gratwick-Sarll and Dr Carmel Harrison all at Australian National University, and Dr Jonathan M. Mond at Macquarie University and Western Sydney University.

Dr Griffiths is giving a public lecture on eating disorders on 17 May, 2017.

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