When we think of eating disorders, we rarely picture a man working out obsessively, starving himself to look lean or wanting to emulate celebrities on magazine covers.

For years, eating disorders have been viewed as a “white woman’s disease.” And estimates of male eating disorders told a similar story: while the majority of women suffered from eating disorders, only about 10 percent of men did.

Recent research, however, paints a different, bigger picture: more men are suffering from eating disorders than previously thought. Out of 3,000 people with anorexia and bulimia, 25 percent were men (and 40 percent had binge eating disorder), according to a Harvard study.

What distinguishes men with eating disorders from their female counterparts?

• Symptoms: The diagnostic criteria for anorexia, for instance, focus on women, which is evident in its hallmark symptoms of amenorrhea (the absence of menstruation) and fear of fatness. Though some men do exhibit a fear of fat, others typically want to be muscular (particularly their chest and arms), obsess over attaining a low body fat percentage and focus their efforts on excelling at a sport (which prompts some to abuse steroids and exercise excessively).

Instead of engaging in traditional compensatory behaviors like vomiting or abusing laxatives, men instead are more likely to exercise compulsively (as cited in Weltzin, Weisensel, Franczyk, Burnett, Klitz & Bean, 2005).

• Images and ideals: For decades, women have been inundated with unrealistic, thin images in magazines, movies, ads and other media outlets. And now, men are also feeling the pressure for physical perfection, surrounded by unattainable images of muscular physiques, six-pack abs, bulging biceps and lean bodies.

But, in contrast to women, where the images are one size fits all (thin is always in), men have a variety of images to emulate, psychiatrist Arnold Andersen, M.D., told The Wall Street Journal:

“Some want to be wiry like Mick Jagger; some want to be lean like David Beckham, and some want to be really buff and bulked, like Arnold Schwarzenegger.”

Interestingly, reports that wiry images are contributing to eating disorders have prompted one fashion show to ban thin male models with a BMI below 19 or 26 and 28 inch waists, UK’s Telegraph reported this Monday.

• Dieting: Men might diet for different reasons than women, including (as cited in Greenberg & Schoen, 2008):

– to prevent weight gain (many eating disordered men were overweight as kids).

– excel in sports. According to an article on CBS News:

Athletes whose weight is crucial to their performance – jockeys, wrestlers, distance runners and gymnasts – have a higher incidence of eating disorders. [Co-author of Making Weight] Cohn said they can develop bad habits when weight loss is seen as a requirement of the sport.

– avoid health complications.

– improve appearance after childhood teasing.

– for their jobs. Dr. Andersen told The Washington Post:

Other patients include men who began dieting to meet job requirements — and couldn’t stop. “We’ve had a number of military people like colonels,” said Andersen, who was formerly on the staffs of Johns Hopkins Hospital and the National Institutes of Health. “The military is very strict, and they’re afraid they’re going to get chucked out” or fail to win a promotion if they don’t lose weight to meet certain requirements.

Not surprisingly, these differences make it harder for professionals to diagnose eating disorders in men. And, oftentimes men are unaware that they’re suffering from an eating disorder in the first place.

In homosexual men

Eating disorders are more prevalent in gay and bisexual men than in heterosexual men (Feldman & Meyer, 2007), though one expert attributes the higher prevalence to a greater likelihood to seek treatment.

Either way, some have pointed to the increased emphasis on physical attractiveness in gay communities as a contributing factor, whereas others view participation in these communities as protection against eating disorders (as cited in Feldman et. al, 2007).

Why now?

Unfortunately, we can’t confirm the reasons behind this increase in male eating disorders. It’s uncertain whether more men are actually developing eating disorders today or if more men are coming forward.

Barriers to treatment

• Stigma: Since eating disorders are known as a woman’s disease, men might be embarrassed to seek treatment, worried that they’d be seen as less of a man.

• Services: Because male eating disorders have only recently received attention, many treatment centers don’t have separate services that treat men.

Resources

• List of centers: Fortunately, treatment facilities that focus on men do exist. These centers include:

– Rogers Memorial Hospital, Oconomowoc, WI

– River Oaks Hospital, New Orleans, LA

– The Eating Disorder Program at University of Iowa in Iowa City, IA

– Center for Eating Disorders at Sheppard Pratt, Baltimore, MA

– Remuda Ranch

• For more information, you can find resources here.

References

Feldman, M.B. & Meyer, I.A. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40 (3), 218–226.

Greenberg, S.T. & Schoen, E.G. (2008). Males and eating disorders: Gender-based therapy for eating disorder recovery. Professional Psychology: Research and Practice, 39 (4), 464–471.

Weltzin, T.E., Weisensel, N., Franczyk, D., Burnett, K., Klitz, C. & Bean P. (2005). Eating disorders in men: Update. Journal of Men’s Health & Gender, 2 (2), 186-191.

Eating Disorders in Men