Ask the Expert: What Is Bigorexia?
By Toby Amidor, MS, RD, CDN, FAND
Today’s Dietitian
Vol. 25 No. 5 P. 6

Q: Can you explain what bigorexia is and what the best practices are for dietitians who counsel clients and patients with this condition?

A: Developing a healthy body by following an exercise routine can be part of a healthful lifestyle, but when individuals are focused solely on body image, they may crave an unattainable body size and shape at the cost of personal health. Bigorexia is a condition that’s emerging especially in male body builders, so becoming familiar with it can better aid RDs in counseling clients. Below is an explanation of this condition, its negative health consequences, and counseling recommendations.

Understanding Bigorexia
Also known as muscle dysmorphia, bigorexia has elements of obsessive-compulsive disorder and is characterized by a negative perception of one’s body, fear of being inadequately muscular, and the urgent desire for excessive physical exercise.1 The condition often is associated with dependence on anabolic steroids or other addictive substances.1 According to Leslie J. Bonci, MPH, RD, CSSD, LDN, owner of Active Eating Advice (www.activeeatingadvice.com), bigorexia has been around for a long time. When Bonci, “worked with the Pittsburgh Steelers, the weight room had mirrors and there was a lot of body checking going on.” However, she says that during the pandemic, many athletes were isolated and inundated with unrealistic body expectations and images online, making the problem much worse.2 “Young men, some are athletes in team sports, some are embarking on their own fitness journey,” are the most vulnerable, Bonci says. There also are “young women who are overly focused on being lean, toned, [with] flat abs, in part due to the #sinfluencers and #thinfluencers and the nonstop stream of body ideals and descriptions flooding social media feeds,” Bonci adds.

There are numerous health and social risks associated with individuals with bigorexia due to strict diet regimens, excessive exercise, and potential substance abuse. When people with bigorexia use anabolic steroids, they inject large muscle groups (eg, thighs, buttocks), and this can increase their risk of coronary heart disease and kidney and liver damage.1 If they share needles, they can contract HIV and hepatitis. Anabolic steroid use also is associated with aggression, paranoia, anxiety, depression, reduced sexual libido, erectile dysfunction, and severe acne. Plus, there are increased risks of orthopedic injuries if individuals exercise while in severe pain or when they have acute injuries.1

In addition, individuals with bigorexia tend to follow strict diets that aren’t nutritionally balanced, as they’re often too high in protein, which can lead to kidney damage.1 Psychologically, people with bigorexia can show signs of suicide risk, such as suicide ideation.3

Participating in social activities also may become an issue for these individuals. They may choose to work out vs attend social activities or avoid places where they need to show their bodies—such as at pools, beaches, and locker rooms—as bigorexia tends to increase anxiety and lead to social isolation.4

Red Flags
According to Bonci, there are several signs that can alert RDs to the possibility that a client may have bigorexia, such as the following:

• Devoting many hours daily or weekly to workouts far more than is necessary for fitness. For athletes, this includes increased hours above and beyond necessary workouts, practices, and conditioning for sports.

• Continuing to exercise while having an increased risk of injury, as the fear of stopping outweighs the potential for injury.

• Prioritizing workouts over school, work, family, and social activities.

• Staying covered up—choosing baggy clothes rather than those that are more revealing.

• Rigidity of meal timing, limiting food choices, food elimination, and a reliance on supplements designed to increase muscle mass and decrease body fat.

• Increased emotional and psychological symptoms, including irritability, mood swings, greater anxiety, and social isolation.

Recommendations for RDs
RDs should take a multidisciplinary approach to working with clients diagnosed with bigorexia. They should coordinate care with social workers or psychologists, and physicians (or other health care practitioners deemed necessary). “I always talk to my clients and tell them to imagine what you could accomplish when you take care and repair your body,” Bonci says, adding that she emphasizes striking a balance between exercise and food intake to optimize goals. RDs also should educate clients on how to nourish and nurture their bodies instead of torturing or harming them. Finally, dietitians should encourage clients with bigorexia to eliminate certain social media accounts that may feed into their obsession and slow recovery efforts.

— Toby Amidor, MS, RD, CDN, FAND, is founder of Toby Amidor Nutrition (tobyamidornutrition.com) and a Wall Street Journal bestselling author. She’s written nine cookbooks, including Diabetes Create Your Plate Meal Prep Cookbook: 100 Delicious Plate Method Recipes and The Family Immunity Cookbook: 101 Easy Recipes to Boost Health. She’s also a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Run and other national outlets.

Send your questions to Ask the Expert at TDeditor@gvpub.com or send a tweet to @tobyamidor.

References
1. Tovt S, Kajanová A. Introduction to bigorexia. Kontakt. 2021;23(2):133-137.

2. Imperatori C, Panno, A, Carbone, GA, et al. The association between social media addiction and eating disturbances is mediated by muscle dysmorphia-related symptoms: a cross-sectional study in a sample of young adults. Eat Weight Disord. 2022;27(3):1131-1140.

3. Ortiz SN, Forrest LN, Smith AR. Correlates of suicidal thoughts and attempts in males engaging in muscle dysmorphia or eating disorder symptoms. J Clin Psychol. 2021;77(4):1106-1115.

4. Olivardia R. Mirror, mirror on the wall, who’s the largest of them all? The features and phenomenology of muscle dysmorphia. Harv Rev Psychiatry. 2001;9(5):254-259.