Scott Webb (Host): When it comes to body image and young boys, they likely have the same struggles that girls do, but they're less likely to talk about their feelings and their coping strategies may differ greatly from that of girls. And my guest today is here to help us to understand what young boys may be experiencing and how we can help them.

And I'm joined today by Dr. Sherry Sakowitz-Sukkar. She's the Director of Pediatric Wellness and Weight Management at Valley Health.

 Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb.

Doctor, it's nice to have you here today. This is an interesting take on things. As I mentioned to you, I've done podcasts about young girls and body image, but focusing specifically today on young boys and their body image and what contributes to all of that. So, let's just start here. Like, what are the biggest differences in body image struggles between boys and girls?

Sherry Sakowitz-Sukkar, MD: They both struggle, but in different ways. There's a lot of pressure on girls to be smaller and thinner and really just to shrink down. While boys, the pressure is to be bigger and stronger and there's actually this double demand for them to be muscular and have low body fat.

They both are really struggling. But like I said, in different ways and they talk about their bodies in different ways and they both have their own fitness language. So girls are usually talk about a body part, like I hate my thighs or my butt and boys are constantly talking about their body, like, I need to bulk up or I need to cut.

So they're both struggling but in different ways.

Host: Yeah, yeah, so true. I was telling you that I have a boy and a girl, they're a few years apart. They both played sports. My son was small, my daughter wasn't small. And so I'm just sort of smiling, listening to you like, yes, my children speak about their bodies very different ways, even though in some cases, you know, they had the same end goals.

 So I'm so glad to have this conversation today, and as I was mentioning to you, you know, I've done these before, but usually focused on girls. So why do you think historically we only really focus on girls when we have these conversations, and maybe what's the cost of that silence for boys?

Sherry Sakowitz-Sukkar, MD: So I think previously a lot of the data and studies were really focused on eating disorders and thin ideals in the media, and really boys were left out and their struggles really went unnoticed. And to be honest with you, Scott, this was a big missed opportunity for support. And boys have learned that it's just not masculine to talk about insecurity.

So instead of talking about it, they developed unsafe habits such as things like extreme workouts, over-training, taking supplements and the problem is they just don't feel that they can talk about things. So their silence really turns into shame and anxiety and depression. And it's really a shame and I, I'm happy now that it's kind of coming out now and, being more talked about.

So I think when it's more talked about, there's going to be more available help for young boys today.

Host: Yeah, I, and I don't know whether it's a stigma or what it is exactly, but like, you know, I was a little boy once myself and I played sports, and I don't recall anyone ever encouraging me to speak about how I felt about myself or my body image or my muscles, or any of that. And of course I've tried to encourage my kids to talk to us and talk to others.

But it's great to have the advice of an expert, and as you say, like, we can help them now because we can talk about it and we know what they're going through. And I guess it makes me wonder, like, what are some of the most maybe common misconceptions, boys and parents, you know, is it weight, fitness, masculinity, kind of all the above.

Sherry Sakowitz-Sukkar, MD: So I think one of the biggest misconceptions is that bigger is better, and parents look at their child if they're working out and they're getting stronger, not realizing that it could mean misusing supplements or over-training. Another thing today I see a lot of boys, is they're really talking about protein.

They think if they eat protein and they lift weights, then they're going to be healthy. And people aren't realizing that boys aren't eating healthy, they're not eating all the different macronutrients. They're cutting carbs, they're loading up on powders. And you know, some kids are having three, four shakes a day and health doesn't come from a blender.

This other misconception is that this like toughness kind of a myth that men and like tough men, they should ignore their hunger. They should overtrain, ignore pain, emotions, and really like masculinity should be based on self-respect and not based on self-neglect. They should care about themselves.

They should take care of themselves. And I think a lot of times parents really sort of miss the boat. They're, they're not realizing that their kid is heading towards a problem. They look to see how they look and if they look good, they think that they're fine.

Host: Right. Yeah. As you say about the protein, like my son, he evaluates everything he eats because he works out a lot, you know? And so he evaluates everything he eats based on how much protein is in it. Right. And as, yeah. And the shakes are good, but maybe not four shakes per day, like somewhere in there. Yeah. Right. Somewhere in there, there, there's a middle ground. And, and I know that you work with kids medically, but it makes me wonder like how much of your work ends up being more psychological weight, you know, about psychological weight than the physical part of the weight, if that makes sense?

Sherry Sakowitz-Sukkar, MD: To be honest with you, the medical stuff is easy. I could order labs, I could take their blood pressure, I could prescribe medications, but truly the hardest part here is dealing with the psychological stuff. Kids today, they really don't, they don't care if they have high blood pressure.

They don't care if they have pre-diabetes. But what they do care about is the social stuff, the pressure to look a certain way, to fit in, to be invited to parties, to feel confident and belong. And these things are really what's driving their choices. And of course social media is, you know, fueling the fire.

They see perfectly filtered bodies. And it's really giving them unrealistic goals. So, you know, kids are seeing all this stuff and they want to look like these people, and they feel like if they don't look like these people, then they're not good enough. And I really have to go in and change the way they think about these things.

I do a lot of like cognitive behavioral therapy and try to explain to them that appearance doesn't equal health. And we go into talk about, you know, like there's no good or bad foods and you don't commit a crime by eating a brownie or skipping a workout and really to stop bullying themselves.

That's what most of my work is about. It's mostly psychological. The medical stuff is a few minutes. It's the psychological burden of that they should look a certain way that really affects these kids and is really driving what they're doing. So yeah, the medical stuff is easy. The psychological stuff, that's the tough part.

Host: Yeah, for sure. And as you say, you know, when it comes to social media and Instagram, everybody looks beautiful and thin and tan and amazing on Insta. But in real life, you know, we all are who we are. We look the way we look, and we're just trying to do the best by ourselves, for our kids. And, and I know what my answer would be to this Doctor, because as I mentioned, you know, I was young and I played sports and I know how coaches spoke to us, the horrible things they said to us, but I'm wondering in today's day and age, you know, the role that sports coaches and the sort of gym culture play, help or harm, do you think?

Sherry Sakowitz-Sukkar, MD: Both really. I think that the words that the coaches use really matter and really make a difference. When we're talking about how do, how can they help them? They can really build up their players, make them feel capable. Really, they can change the way how the kids feel about their bodies and build confidence.

And, you know, if the coaches focus on effort and you know, responsibility and are they on time and, are they being a good player? Are they treating other players nicely? Like that's really important. But you know, I've seen a lot of harm and I've seen it recently and a lot of it, I see like wrestlers and football players come in that they need to be a certain weight to be eligible to play, and I think that like this could be very dangerous because kids end up cutting carbs, skipping meals, eating very low calorie diets, and sometimes not even drinking water all day. So this is really developing into disordered eating and a lot of stress.

So, I wish that eligibility was based on other things may, maybe more performance. And the other thing is they do these weigh-ins in public. So the coaches humiliate the kids. If they are a pound over, they start yelling at the kids and making them feel like they've committed a terrible crime.

This is frustrating for me as a obesity medicine specialist because the number on the scale does not mean health. I could have a kid who's getting fit, who's getting stronger, who actually is the same weight as they were before, but they've built a lot of muscle and lost a lot of fat.

So I don't think this is a good way of doing things. And unfortunately, this is the way it's done. It's been done for years, and I don't see any change coming in the future. But you know, these coaches need to understand that they have a lot of power and this could affect these kids for life.

Host: So I'm wondering, from your perspective, how do you approach weight management with boys, you know, without reinforcing shame or these unrealistic standards?

Sherry Sakowitz-Sukkar, MD: I always start by telling them that this is not their fault. It's not their fault, it's not their parents' fault. And that obesity is a complex chronic disease and it is not a lack of willpower. And I go on to explain to them, this is shaped by genetics, environment, behavior, hormones, stress.

Things that are much bigger than their choice alone. So we also talk about what is meant by a healthy weight. And I try to explain to them that the number on the scale doesn't define health. And if we look a little bit deeper, and I usually do a body composition analysis, and I can tell they're percent body fat and muscle mass.

And that's how we define healthiness. Like how do they feel from day to day, and how much muscle and fat do they have on their body? And really the goal isn't chasing a number. It's improving health and energy and mood and confidence. And the last thing we usually focus on is just on small, realistic habits.

I try to get them to eat real food, avoid processed food, make sure they eat a protein with every meal, make sure they eat fresh fruits and vegetables every day. They stay active every day, drink water, make sure they get enough sleep every night and cut back on screen time. So we really just focus on, you know lifestyle and healthy habits. And I constantly tell them, this is not a quick fix and they just need to be consistent. They have to sustain these different changes. And, you know, if they do that, then that's the best way to get these kids to feel good and not to feel shameful about that they're here, that they come to see me.

I make it very comfortable for them. And, yeah, that's what I do.

Host: Yeah. And sometimes along the lines of us parents and dealing with our kiddos, like what can or should we say or not say to support a healthy body image?

Sherry Sakowitz-Sukkar, MD: Okay, so first off, the way parents talk to their children really, really matters and their, the parents' voices becomes the child's inner voice. So parents need to understand that what they're saying is really going to affect their child. So let's just start with what should you say to your kid? So always offer support to your child.

Of course. Make sure your child knows that you love them at any size. They can tell their child that their body is still growing and the goal is fueling their body. They can try to build healthy habits together as a family unit. They can say, I'm here to support you. I'm not trying to judge you.

They can give advice that they should be moving their body because they love their body, not because they hate it. Now things they shouldn't say. So anything that is going to make your child feel like whatever choice they're making, whether it be a food choice or a lack of activity choice, is disappointing to you because kids don't like to disappoint their parents and that leads to guilt.

And, just disordered thinking. So some specific things that I recommend I, that parents don't say are things like, how can you still be hungry? Or you don't need seconds or you need to earn your dessert, or are you sure you want to eat this? And the other thing that parents shouldn't talk about are comments about bodies.

Either comments about the parents' bodies, like, I feel fat today. Or comments about their child's body. You look like you gained weight or your stomach looks big. Any sort of body comments because then the kids are going to feel that their bodies aren't good enough. They're going to feel like people are judging them all the time.

The last thing I would tell parents not to say is not to praise weight loss. That instead they should praise the behaviors. So you want to get your kid to do the things like, like go to the gym every day, so like you're doing so great. I'm so proud of you're going to the gym every day.

You don't want to say to your kid you're looking really thin today because that means like if you don't say it another day, they're going to think that, you know, maybe they don't look thin. So you want to praise the behaviors instead. And those are some things I would say and not say.

Host: Yeah. I've learned over the years, Doctor, especially with my daughter, even though we're focusing on boys today, that every time I think I'm saying the right thing, I'm usually saying the wrong thing. What's one thing, Doctor, yeah you wish every pediatrician or teacher or parent knew about helping boys with body image?

Sherry Sakowitz-Sukkar, MD: Okay, so first off, boys care how they look. They just can't always articulate it. And about 30 to 35% of adolescent boys today report some sort of dissatisfaction. And there are certain warning signs that parents or teachers or pediatricians can pick up and things like sudden rigid clean eating or maybe skipping family meals.

Secret supplement use, or excessive workouts, or if you see your child panicking, if they miss a workout. Maybe some mood changes or even if you can see like rapid, weight swings. You, you can tell when your kid is eating a lot or trying to cut. So that's, they, they call that bulking or cutting.

Any of these things are warning signs and you should be opening up a conversation and normalizing this and talking about it with your child or with their healthcare provider. The key here is that body image issues really don't discriminate, and they just look a little different in boys than they do in girls. So you have to know what to look for and you have to look for it.

Host: And it makes me think, Doctor, that, you know, probably fairly often when a boy walks into the clinic, you know, to see you, that maybe weight is the issue, but I feel like maybe sometimes that's a symptom of something deeper. Does that check out?

Sherry Sakowitz-Sukkar, MD: Definitely, definitely. So weight is definitely usually a reflection of something else going on. So when I start diving a little deeper and getting better history, things like poor sleep or having a lot of stress or even ADHD, anxiety, depression, all these things, really can cause, overeating, looking for food as comfort, looking for food as a, a means to control something.

When kids' lives start feeling out of control, they look for something that they can control easily. So when you treat, like what's underneath, like if I treat the poor sleep or the ADHD, or like the lack of structure or sometimes the self-criticism, then the physical health becomes, you know, much easier to treat.

 I usually say that you can't fix someone's body without really understanding the whole story behind it.

Host: Right? Do you think, Doctor, that boys, I'm putting in quotes, but essentially hiding generally more dangerous behaviors than even we think? We suspect, even as their loving parents, like are there some subtle warning signs that we should all be on the lookout for?

Sherry Sakowitz-Sukkar, MD: I definitely think that they are. Many boys hide disordered behaviors under the word discipline. So you really want to watch for things like skipping meals or rigid eating rules, panic if they miss a workout, supplement stashes, or constantly checking themselves out in the mirror.

This rise in muscle dysmorphia, and there are reports that maybe even like a third of boys have this, and that is boys who feel that they're too small, even when they're muscular. And, really that's not vanity. They're in distress. They're needing help.

Just like any other mental health concern. So, you know, if you see some of these things, you, you talk to them about it.

Scott Webb: Yeah. I wondering, Doctor, like take me through a healthy conversation about weight. Like what does that sound like? Especially for a boy who's struggling with weight, but also more importantly, maybe self-worth?

Sherry Sakowitz-Sukkar, MD: Okay, so the first thing I like to talk about with my patients is we try to change their mindset. So I always tell them on, on their first visit that they need to stop bullying themselves and they need to speak to themselves with kindness because you can't hate your body into becoming healthy.

That's the first thing we talk about. We like replace their negative self-talk. So instead of saying, I'll, I'm never going to change, or I hate how I look, I want them to have this like inner, like the way that they speak to themselves as like, I'm going to learn how to do this. I can do this.

You know, really speak to themselves, with kindness. And we talk about progress and they don't have to be perfect. There are really no rules. And I always say just try to be better than the day before. I also remind them not to compare themselves to people on social media, that that's not real.

These photos are edited and filtered. Everyone's body is different and I even tell them not even to go on social media because I think it's, it's not good. Sometimes I ask them things like, what is it that you appreciate about your body? Just to make them feel good.

They don't hate everything about their body. And at the end of the day, like a, a healthy conversation about weight isn't about judgment or numbers. It's about learning how to treat your body with respect. So, that's really where we start. The most important thing is, changing the way they think about these things.

And to feel that they can do it and, and that, you know, just because they have a big butt or a big thighs or something like that, it doesn't mean that they're going to be remembered for this. That people remember people for other things. And your appearance doesn't affect other things.

Host: Is there a phrase you wish every parent would just stop using when they're talking about weight? Like, what's that one thing?

Sherry Sakowitz-Sukkar, MD: Yes.

Host: Like, stop saying this.

Sherry Sakowitz-Sukkar, MD: Then stop saying to your children that they need to lose weight, because you are, you know, the parent says, you look like you need to lose weight, but what the kids hear is you are not good enough the way you are and your worth depends on how you look and I know that the parents mean well, but the comments are really doing the opposite, and they're creating shame and self-doubt.

And to be honest with you, Scott, I had this firsthand. When I was growing up, my mom used to say that to me and she loved me deeply. I heard this message over and over again. She would say, oh, Sherry, you're so pretty, but you just need to lose five or 10 pounds. And that stayed with me forever, and I really wasn't overweight.

But by her saying that to me, it made me feel terrible. It made me feel that she was disappointed in me and I love her dearly. But parents don't realize the power that they have. And so I usually tell parents instead of focusing on their appearance, you know, focus on how they're feeling.

Maybe like, how's your energy lately? What helps you feel strong and confident? You're not really basing it on losing weight, but you know, you're getting to that. Like maybe if the child says they're really tired lately, they, they want to take naps, you know, you're kind of getting the idea like, you know, maybe you're eating foods that make you tired, you know, talk about stuff like that.

Eating a lot of carbs at the end of the day and that makes you feel sleepy, so you know that it's better to talk about that than it is to actually talk about that you need to lose the weight.

Host: Absolutely. It's been a great conversation today. We had some fun, had some laughs and got to, you know, some really important things. I want to finish up on the most positive note possible here, Doctor, like what's the most powerful body image message you've heard a boy say or wish more boys would hear, or, or, could hear.

Sherry Sakowitz-Sukkar, MD: One that's really stayed with me came from a boy who I treated, who struggled with severe obesity and very low self-esteem, and he spent lot of years feeling very ashamed about his body and, you know, tried every diet, punishing himself with, you know, very low calorie diets, working out as a form of self punishment.

But through working with me and through a lot of behavioral, cognitive behavioral therapy, he really started to change his mindset. And we taught him to listen to his body, to try to eat when he's hungry, to move because he felt like he wanted to move and really to stop weighing himself. And, after losing about a hundred pounds, he came to me one day and he said.

"But when he stopped worrying about what other people thought of me and just focused on taking care of myself, day by day, that's when everything started to come together." And he also said to me, "when I stopped punishing my body and started appreciating what it could do, that's when I finally felt free." So I actually use those quotes and talk to other patients of mine and tell them this story because I think that if everyone could do that, then it would really change things and it would help people get on a good journey and know, if you do these things, it really does help you.

Scott Webb: Yeah. And, and it's so easy to say and it's hard to convince children, but that's, we're all fighting the good fight, right? Parents, providers, you know, we're all in this together trying to help our kids, boys, girls, body image, weight, all of this. I really appreciate this conversation and your time today. Thanks so much. Thank you.

Sherry Sakowitz-Sukkar, MD: Thanks, Scott. Take care.

Host: And for more information about pediatric wellness and weight management at Valley, please visit valleyhealth.com/pediatricwellness or call 201-316-8438.

 And if you found this podcast helpful, please share on your socials and check out our entire podcast library for topics of interest to you. And thanks for listening to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Scott Webb. Stay well.