There is a word many parents have never heard, but many children and teenagers already know: looksmaxxing.
At first glance, it can sound almost harmless. Skincare. Haircuts. Fitness. Better posture. Dressing well. Learning how to feel more confident. Those things, on their own, are not the problem. Wanting to care about appearance is not new, and it is not inherently unhealthy.
But looksmaxxing is different.
Looksmaxxing is an online culture built around the idea that a person should “optimize” their appearance as much as possible, often in pursuit of a very narrow, idealized version of beauty or masculinity. For boys and young men, this may center on a sharper jawline, lower body fat, more muscle, clearer skin, greater height, or a face and body that look closer to a filtered, curated, algorithm-approved ideal. At its most benign, looksmaxxing may appear to involve grooming, skincare, fitness, or style. But in more troubling corners of this culture, the pursuit of optimization can move far beyond ordinary self-care. In clinical practice, and in the online content many adolescents are consuming, this pursuit of optimization can move far beyond skincare, grooming, or fitness. It can include cosmetic procedures, steroid use, dangerous stimulant use, and even self-injury aimed at changing facial structure.
Perhaps the most disturbing part is the way pain and harm can be reframed as discipline, commitment, or self-improvement. In these spaces, vulnerable adolescents may encounter the idea that damaging their own bodies is a reasonable price to pay for a sharper jawline, a leaner face, or features that better match an online ideal. Some young people are even being exposed to content that presents methamphetamine as a tool for becoming thinner or more facially “defined,” turning a highly addictive and medically dangerous stimulant into something falsely packaged as appearance optimization. That is not self-improvement. That is a dangerous distortion of what it means to care for oneself.
That is where this becomes frightening.
Because this is no longer just a teenager comparing themselves to a celebrity in a magazine, which was bad enough! This is a child with a developing brain being shown endless images, videos, rankings, routines, before and after transformations, and commentary about what is “wrong” with their face or body. The feedback loop is immediate, the content is tailored with unsettling precision, and the standards are unrealistic, creating a pressure that can feel constant and inescapable.
We are entering uncharted territory.
For too long, eating disorders in boys and young men were underrecognized, misunderstood, or missed entirely. Much of the conversation around body image focused on girls, thinness, dieting, and weight loss, and while those concerns still matter deeply, they were never the whole story. We are now seeing a growing number of males struggling with eating disorders, including many who do desire weight loss or thinness. But looksmaxxing adds another layer. For many boys, the pressure is no longer only about being thin. It is about being lean, muscular, angular, disciplined, and visibly “optimized.” The focus may be on body fat, muscle definition, facial structure, supplements, exercise, or constant body checking. And because these behaviors can be framed as fitness, confidence, or self-improvement, the distress underneath can be easily missed or considered a “fad”.
As a physician who cares for children and adolescents with eating disorders, this worries me tremendously.
It worries me because teenagers often do not describe this as distress. They describe it as self-improvement, saying they are simply trying to become healthier, stronger, more attractive, or more confident. But over time, what begins as an interest in appearance can become consuming. A teenager may spend hours researching skincare, jaw exercises, body fat percentages, protein goals, supplements, or workout plans, while gradually becoming more rigid with food, more compulsive with exercise, more preoccupied with mirrors and photos, and more withdrawn from normal life. What looks like discipline on the surface may, underneath, be a child who feels they are not good enough yet.
And because the language sounds like discipline, parents may miss the suffering underneath.
There is a meaningful difference between healthy self-care and a child becoming consumed by the belief that their body or face must be fixed. Healthy self-care usually makes a child’s life bigger. It supports confidence, connection, flexibility, and wellbeing. Looksmaxxing, when it becomes obsessive, often makes a child’s life smaller. It can narrow their food choices, their social life, their sense of worth, and their ability to feel comfortable in their own skin. The medical risks can be very real. Extreme restriction, rapid weight change, over-exercise, dehydration, stimulant or supplement use, purging behaviors, and unmonitored attempts to alter body composition can affect the heart, blood pressure, hormones, growth, puberty, sleep, mood, concentration, and bone health. Steroids and other appearance-enhancing substances can carry serious risks as well, especially when used by adolescents without medical supervision. These concerns are not theoretical. They are increasingly part of the world our children are navigating.
The U.S. Surgeon General has warned that social media is not proven to be sufficiently safe for children and adolescents, and that social media use is nearly universal among teens. The advisory also notes evidence connecting social media use with body image concerns, disordered eating, social comparison, and low self-esteem. That matters because looksmaxxing does not exist in isolation. It exists inside a digital environment that can repeatedly tell a child: your jaw is not sharp enough, your skin is not clear enough, your body is not lean enough, your muscles are not big enough, your face is not symmetrical enough, your height is not enough, you are not enough. No child should have to grow up under that kind of microscope.
Parents do not need to panic every time a teenager becomes interested in grooming, fitness, or appearance. But we do need to pay attention when that interest becomes rigid, consuming, or distressing. Warning signs may include sudden preoccupation with appearance, frequent mirror checking or body comparison, distress about specific facial or body features, avoidance of photos or social events, rigid eating, compulsive exercise, interest in supplements or steroids, secrecy around online content, or noticeable changes in mood, sleep, school performance, confidence, or social connections.
The most important question is not simply, “Is my child trying to look better?” The better question is, “Is this starting to cost them their health, their joy, their flexibility, or their sense of self?”
Looksmaxxing is scary because it takes normal adolescent insecurity and feeds it through an endless machine of comparison. It gives children a vocabulary for self-criticism before they have the maturity to understand what they are consuming. It can make dangerous behaviors look aspirational. It can make obsession look like discipline. And it can make a struggling child feel as though the problem is their body, when often the problem is the pressure being placed on that body. They need parents, clinicians, therapists, dietitians, coaches, and schools to understand that body image distress in boys is real, eating disorders in boys are real, and online appearance culture can be deeply harmful even when it is packaged as motivation.
Our children deserve better than this!
We are still learning what this new appearance culture will mean for children and teenagers, but we do not need to wait until a child is medically unstable or deeply entrenched in disordered behaviors before we take it seriously. Early recognition and compassionate attention can make an enormous difference, especially in a landscape where the message children receive online is often that they are a project to be perfected. They need to hear something steadier from us: that they are not a face to perfect, a body to optimize, or a collection of features to correct, but a whole person deserving of care, protection, and belonging.
U.S. Surgeon General. Social Media and Youth Mental Health Advisory.
American Academy of Pediatrics. Social Media and Adolescent Mental Health.
Nagata JM et al. Research and clinical commentary on boys, young men, digital media, eating disorders, and muscle dysmorphia.
Recent reporting on looksmaxxing and adolescent risk.
When most people think of anorexia nervosa, they picture someone who appears visibly undernourished. But this image does NOT reflect the full reality of eating disorders. One of the most important and often misunderstood presentations of this disease is atypical anorexia, a condition that can be just as medically serious, yet far less likely to be recognized early.
Atypical anorexia is classified within Other Specified Feeding or Eating Disorders (OSFED). It describes individuals who meet all of the psychological and behavioral criteria of anorexia nervosa with restrictive eating, an intense fear of weight gain, and significant distress related to body shape or weight but whose weight remains above the weight threshold specified for a diagnosis of anorexia nervosa. In many cases, these are children and adolescents who have experienced substantial or rapid weight loss, yet still appear outwardly “well.”
This distinction, however, is misleading. What matters medically is not simply where a child’s weight falls at a single point in time, but how their body has changed and how that change is affecting their physiology. Research consistently shows that the degree and velocity of weight loss are closely tied to medical risk. Even relatively modest weight loss when paired with the cognitive features of an eating disorder can be associated with significant psychological distress and clinically meaningful illness.
Because these patients may not “look sick”, atypical anorexia is frequently overlooked. Many families are reassured, and even medical providers may underestimate the seriousness of the illness. As a result, young people with atypical anorexia often come to medical attention later in the course of their illness, after the body has already begun to show signs of strain.
And those signs can be profound. Some of the sickest patients I have treated have been patients with atypical anorexia.
Children and adolescents with atypical anorexia can develop many of the same medical complications seen in "classic" anorexia nervosa. The body, faced with inadequate energy intake, begins to adapt in ways that prioritize survival. Heart rates may slow significantly, a physiologic response sometimes described as a “hibernation” state. Blood pressure may drop, particularly when standing. Electrolyte disturbances can emerge, especially in those who are purging. In some studies, nearly a quarter of adolescents hospitalized with atypical anorexia had bradycardia, and almost half showed orthostatic changes on presentation. Importantly, these complications are not determined by appearance. A child may seem outwardly stable while experiencing meaningful physiologic compromise. In fact, some research suggests that the amount of weight lost may be a more reliable predictor of medical instability than current weight alone.
There are also important nuances within this diagnosis. Not all individuals with atypical anorexia arrive there in the same way. Some have bodies that resist weight loss despite significant restriction. Others may have lived in larger bodies and lost a substantial amount of weight without ever reaching a threshold traditionally labeled as “low.” Still others may have experienced repeated cycles of weight loss and regain over time. What unites these presentations is a pattern of ongoing restriction and the substantial psychological burden it creates, reflecting both the severity of the illness and the degree to which these behaviors can become entrenched.
Recovery requires thoughtful, coordinated care. A multidisciplinary team, typically including a medical provider, therapist, and registered dietitian with expertise in eating disorders, will help guide both the medical and emotional aspects of healing. Atypical anorexia challenges the assumptions many of us have about what illness looks like. It asks us to look beyond appearance, to listen carefully, and to take early concerns seriously. Because when it comes to eating disorders, the absence of obvious signs does not mean the absence of risk and timely, informed care can make all the difference. This is something I care deeply about. I have seen how often people are overlooked because they do not fit a narrow definition of illness and I am committed to making sure that children and adolescents are recognized based on what their bodies and behaviors are telling us, not just where their weight falls, and that they receive the careful, comprehensive medical care their presentation truly requires.
Many children go through periods of picky eating.
They may prefer familiar foods, dislike certain textures, or take longer than parents would like to warm up to something new. That alone does not mean a child has an eating disorder. But sometimes what looks like picky eating is actually something more significant: avoidant/restrictive food intake disorder, or ARFID. What makes ARFID different is that the restriction goes beyond ordinary food preferences and becomes serious enough to affect nutrition, growth, physical health, or day-to-day functioning, without being driven by a fear of weight gain or a desire to be thinner.
ARFID does not look the same in every child. Some children are highly sensitive to the taste, smell, texture, temperature, or appearance of food. Some have a strong fear of an aversive event like choking, vomiting, or abdominal pain. Others seem to have very little interest in food at all and may rarely feel hungry. In many cases, the list of accepted foods becomes narrower over time rather than gradually broadening as a child gets older.
What I watch especially closely is the trajectory: whether things are gradually broadening and settling, or becoming narrower, more distressing, and more disruptive over time. Typical picky eating is frustrating, but many children still take in enough nutrition, continue to grow, and maintain their day-to-day functioning while slowly expanding their diet over time. With ARFID, the eating pattern becomes more impaired. Meals may create intense distress. Family life may start to revolve around avoiding certain foods or situations. School, travel, restaurants, sleepovers, and social events may become much harder. Weight loss may occur, but even when it does not, a child can still have significant nutritional deficiencies or psychosocial impairment.
Parents often ask, “What are the red flags that tell me this is no longer just picky eating?” I worry more when a child is losing weight, falling off their growth curve, relying heavily on supplements, eliminating more and more foods, avoiding entire textures or food groups, showing intense fear around eating, or having nutrition-related symptoms such as fatigue, dizziness, abdominal pain, constipation, poor concentration, or feeling cold all the time. I also worry when eating has started to interfere with school, relationships, and normal family life.
For many parents, one of the hardest parts is recognizing that ARFID can be present even when a child does not appear obviously unwell. Some children with ARFID are underweight, but not all are. A recent systematic review found that children and young people with ARFID can present across the weight spectrum, although low weight, nutritional deficiencies, and low bone mineral density are common concerns. Most studies found heart rates and blood pressures in the normal range, but some children with ARFID do experience bradycardia (low heart rate) or hypotension (low blood pressure). ARFID can carry meaningful medical risk, even when a child does not “look sick” or is mistakenly dismissed as simply being a picky eater.
ARFID often overlaps with other developmental, behavioral, or mental health concerns rather than occurring on its own. Higher rates of anxiety, autism spectrum disorder, ADHD, obsessive-compulsive features, and other emotional challenges have been described in children and adolescents with ARFID. These co-occurring conditions can influence how a child experiences food, eating, sensory discomfort, fear, and distress. Still, these associations do not mean that every child with one of these conditions has ARFID, or that every child with ARFID will have the same clinical picture. It does mean that restrictive eating in these children deserves thoughtful assessment rather than dismissal.
The good news is that help exists. Treatment for ARFID is often most effective when it is approached collaboratively, with medical care, nutrition support, and therapy aligned around the child’s needs. Current guidance and recent reviews support outpatient treatment whenever it is safe, often using family-supported approaches and cognitive-behavioral strategies tailored to the reason the child is restricting. The goal is not to shame a child into eating. It is to understand what is driving the restriction and help the child gradually return to a safer, more flexible relationship with food.
For families, the most important message is this: you do not have to carry the burden of deciding alone whether it is “serious enough.” If your child’s eating is becoming more limited, more distressing, or more disruptive to growth, health, or daily life, it is worth taking seriously and worth seeking support. Picky eating deserves thoughtful attention. ARFID deserves recognition and treatment. And families deserve clarity, thoughtful guidance, and a clearer sense of what comes next.
For many families, one of the hardest parts is knowing when a change deserves closer attention.
Eating disorders do not always begin with one dramatic moment. More often, they begin quietly. A child starts skipping snacks. A teen becomes more rigid about food. Exercise becomes less about joy and more about compulsion. A once easygoing eater becomes increasingly anxious around meals. These changes can be easy to miss at first, especially when they are explained away as “healthy eating,” stress, sports training, or a phase. Eating disorders can affect children and teens at any body size, and early recognition matters.
In my work with families, the earliest signs are often not dramatic weight loss. They are changes in behavior, tone, and flexibility. A child may begin cutting out entire food groups, making excuses to avoid meals, eating in increasingly rigid or ritualized ways, or becoming unusually preoccupied with food, calories, exercise, or body size. Some children become more withdrawn, irritable, or guarded. Others begin pulling back from activities they once enjoyed.
Sometimes the first signs parents notice are physical. This may look like weight loss, but it can also show up as unexpected changes in weight, a child falling away from their usual growth curve, dizziness, feeling cold much of the time, constipation (especially without a history of it), abdominal discomfort, fatigue, difficulty concentrating, fainting, menstrual changes, or slowed growth and pubertal development. In children and adolescents, those changes in growth and development are especially important. A child does not need to appear severely underweight to be medically unwell.
That last point is especially important. Restrictive eating disorders can occur in children and teens at higher weights too. Recent pediatric guidance emphasizes that eating disorders are often missed in youth who do not fit the stereotype families, schools, or even medical systems expect. A child can be in a larger body and still be engaging in dangerous restriction, purging, bingeing, or other eating-disorder behaviors that deserve prompt attention.
Parents also often ask me what is “too much” exercise, “too much” concern about food, or “too much” dieting. The answer is usually this: when eating, movement, or body concerns begin to narrow a child’s life, it is worth paying attention. If food rules are getting stricter, meals are becoming more emotionally charged, social eating is being avoided, or your child seems increasingly distressed around food or their body, I would much rather families ask early than wait for things to become unmistakable. Early help improves the chances of recovery.
It is also okay to trust your instincts. Families are often told to wait, watch, or not overreact. But if your child’s relationship with food, exercise, or body image feels different in a way that worries you, that concern is worth listening to. You do not need to have a diagnosis in hand before asking for help. You do not need to wait for severe weight loss. And you do not need to wait until your child is in crisis. Recent pediatric literature continues to emphasize earlier detection, closer monitoring of growth and vital signs, and prompt intervention when concerns appear.
What should you do next? Start with a calm, direct conversation. Lead with concern, not accusation. Try to notice patterns without turning meals into a battle. Then seek an evaluation from a clinician experienced in pediatric eating disorders. Medical assessment matters because eating disorders affect far more than eating alone. They can affect heart rate, blood pressure, hydration, electrolytes, growth, bone health, mood, and day-to-day functioning.
Most of all, I want families to know this: you do not have to wait until things look extreme for your concern to be valid. When a child is beginning to struggle with an eating disorder, early recognition, steady guidance, and compassionate care can make all the difference for both the child and the family. And having the right support around your child and your family can make all the difference.
