Understanding eating disorders in men and boys: Overlooked and on the rise

Binging and purging. Fasting. Excessive exercise. Laxative abuse. Overly restrictive fad diets. These are common methods women and girls with eating disorders typically do to lose weight. But, females are not the only gender afflicted with these life-threatening mental illnesses. According to the National Eating Disorders Association (NEDA), approximately 1 in 3 people experiencing an eating disorder are male. 

The prevailing thought has always been that men and boys rarely develop an eating disorder. Yet, in the United States alone, eating disorders will affect 10 million males (this is likely higher) at some point in their lives. Men and boys can and do develop them and at higher rates than most of us are aware of. Unfortunately, male eating disorders are frequently undiagnosed, untreated, and on the rise. 

What are eating disorders?

Eating disorders are a predominately female illness, well-known to afflict girls and women in varying degrees from anorexia to bulimia to binge eating.  

Eating disorders rank among the most serious public health concerns in the U.S and have the highest mortality rate of any mental illness.   They are complex illnesses that can have harmful consequences for an individual’s social and emotional well-being and significantly impacts physical health.  Eating disorders can compromise every regulatory system in the body, including the immune system, digestive system, skeletal system, cardiovascular system, and reproductive system.

Males with eating disorders have similar signs and symptoms as females. They suffer comparable physical complications such as osteopenia, reduced sex drive and significant damage to the heart and other organs. 

Fast facts on males and eating disorders

• Lifetime prevalence rates for eating disorders in males are .3% for anorexia, .5% for bulimia, and 2% for binge eating disorder, but these numbers significantly underestimate the number of males with an eating disorder due to social stigma 
• Binge eating disorder is the most common eating disorder in males
• The onset of an eating disorder in males occurs later in life than females.  However, eating disorders in males can occur during childhood, adolescence, and all stages of adulthood
• Men may develop eating problems due to muscle dysmorphia, a body image disorder that compels them to pursue and muscular and lean body.  Muscle dysmorphia is sometimes called bigorexia or a man wanting to be bigger and more athletic, the traditional societal view of the ideal male body.  As a result, they often consume excessive protein, have dietary restrictions, take illicit steroids, and lift weights obsessively.   
• Certain athletic activities appear to put males at risk for eating disorders. For example, gymnasts, runners, bodybuilders, rowers, wrestlers, jockeys, dancers, and swimmers since these activities often demand weight restriction. 
• Other factors why men may develop an eating disorder include depression, anxiety, or addiction, previous weight issues over their lifetime, physical or sexual abuse or trauma, and sexual orientation issues. 
• Men with eating disorders tend to hide their illness by cutting themselves off from friends and family.
• Men are more reluctant to acknowledge they have a problem and are less likely to seek help, worrying they will appear weak and don’t want to be associated with a condition primarily thought of as a female illness.

The prevalence of male eating disorders is hard to pinpoint due to the reluctance of males to admit they have one.  However, the National Association for Males with Eating Disorders estimates that 25% to 40% of all eating disorders are males.  

Recognizing eating disorders in men and boys 

Comparing eating disorders in men and women look radically different. Usually, eating disorders in women are associated with a desire for thinness and weight loss. For men, this is not always true. 

Think of someone with an eating disorder, and our thoughts turn toward a person displaying classic signs or symptoms such as extreme or unhealthy weight-loss behaviors, such as vomiting or fasting. The focus on the ideal appearance has zeroed in looking ripped and toned. Most men would like to be lean and muscular, representing the “ideal” male body type. Men and boys, like females, are vulnerable to the unattainable images in the media leading to male body dissatisfaction. 

Many young men are more likely to take supplements, steroids, or eat more to bulk up. In these situations, it often makes it more difficult to recognize an eating disorder in a male. On the other hand, women or girls with eating disorders often exhibit extreme weight loss, lanugo (soft, feathery hair that grows all over the body to keep it warm), or periods of excessive overeating followed by purging. 

Signs or symptoms of an eating disorder in men/boys may include:

• Anxiety
• Excessive exercise
• Depression
• Substance abuse
• Low self-esteem
• Perfectionism
• Angry outbursts
• Limiting food intake
• Fear of weight gain
• Preoccupation with bodybuilding or weightlifting
• Dry skin
• Hair loss
• Low blood pressure 
• Sensitivity to cold
• Stunted growth

Male eating disorders are often overlooked

Men need help but unfortunately, eating disorders in men are often overlooked and undertreated.   Some reasons why male eating disorders have gone under the radar include:

• Scant research on males and eating disorders – less than 1% of all research on eating disorders focus specifically on males
• Men and their family members may not recognize their eating disorder
• Eating disorders are considered  a female illness
• Men may not be getting referred for treatment at eating disorder clinics
• Eating disorders in men have different symptoms than in women
• Health professionals who are biased in believing a male may have an eating disorder

One problem of an eating disorder diagnosis in males is that physicians are untrained in recognizing this illness in men and boys. Guys, including teens or younger, also want to lose weight and be fit just like women.  Females have always felt pressures to be thin.  But even males have been targeted with the message to have masculine bodies that are toned, muscular, and athletic looking.  Marketing aimed at men includes weight-loss advertisements, grooming products, cosmetic surgeries, and the fashion industry, all of which could be contributing to the rising rates of body dissatisfaction among males.

Assessment and treatment of male eating disorders

Traditional assessment tools commonly used are designed for use with females.  Therefore, they may not adequately identify an eating disorder in a male.  There is a more gender-specific eating disorder assessment tool for males that have been developed.  This tool has more questions geared towards males such as asking how frequently they check their body for signs of muscularity.  

Males seeking and receiving treatment for their eating disorder have generally been successful, primarily if cognitive behavioral therapy and family-based treatment for children and young adults are used.  Treatments often focus on limiting exercise, preventing excessive protein intake and addressing males’ stigma about their illness. Males have different and unique needs in an eating disorder recovery program than females.  

The earlier an eating disorder is identified and diagnosed in a male, the sooner he can begin treatment with an improved prognosis for recovery.  In addition, the fewer stigmas as a society we place on a male eating disorder, the better for all of us in recognizing this illness and getting males the help they desperately need.  

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.