Eating disorders don’t discriminate, so why do we?

Eating disorders have the highest mortality rate of all mental health disorders. They affect our bodies, our brains and are strongly linked with death by suicide, particularly in young people. Despite this, disordered-eating assessments, diagnosis and treatment programs are still not fit for purpose. Especially if you identify as male.

How did we get here?

Beat, the UK’s leading eating disorder charity, suggest males make up around 25% of people with eating disorders, although it predicts the actual number is much higher. Yet, decades of bias, exclusionary research has driven misconceptions about the femininity of disordered eating. In fact, many professional experts, from scientists to medics, background researchers to those working on the front line, still believe the condition only affects females. And who can blame them when they’re influenced by reams of substantial medical evidence. The only problem? Nearly all of this research was conducted on women and young girls, exclusively.

Specific measurement tools and treatment approaches are used by professionals in the UK to assess and treat young people with disordered eating behaviours. The same tools and criteria are used, regardless of gender. This means no adjustment is made for the incomparable weight and muscle differences, or disordered-eating motivation, experienced by males. In fact, for many years, diagnosis required missing a menstrual period for more than six months. No prizes for guessing why this condition couldn’t be met by someone without a womb.

Although male representation in eating disorder research has improved in the last five years, assessment, diagnosis and treatment has not changed. Diagnosis of male patients can be delayed, or missed completely, because they physically cannot meet the requirements of BMI, muscle mass or other arbitrary numbers, or because their motivations do not match those on the checklists. By the time they’re diagnosed and start treatment, their disordered eating has often escalated, with significant complications requiring more intense intervention and prolonged recovery time.?

What else is happening?

Eating disorder stigma isn’t just taking place in research labs and doctor’s surgeries. Young men are consistently not seeing themselves represented in conversations about disordered eating. This is especially concerning because identity confusion and an ‘unstable sense of self’ are both major factors in developing an eating disorder.

Arguably, the average male teen won’t be trawling through journals and research papers. However, the media they are looking at may still be misrepresenting eating disorders as ‘female’ problems, because that's what the research says.

For example, a recent study reviewed twenty years of characters in US tv and films, shown as experiencing an eating disorder; nearly 90% were female. With this message out there, how can young men find the courage to speak to a professional about their symptoms? More importantly, how are they supposed to understand that they’re experiencing symptoms in the first place?

"It's really difficult when you don't see yourself reflected in the services around you, or you're told by this lack of visibility, that your experiences aren't real." James Downs, living with disordered eating. Interviewed by the BBC, 2020.

What does the future look like?

When it comes to mental illness and reducing stigma, representation matters. This is especially true when it comes to tackling gender stereotypes or preconceptions. Male celebrities including cricketer Freddie Flintoff and actor Christopher Eccleston have spoken about their own experiences with disordered eating. Both acknowledging how shame prevented them from speaking out, or recognising that they needed help:

“I realised the shame was more debilitating [than the disorder], especially being male.” Eccleston’s interview with The Guardian, 2023.

Hearing these personal stories may encourage young men to recognise their symptoms and seek support; but there is still a real risk that the help they receive might not be suitable. ?

Gender-specific treatment and prevention programs are proving more effective for treating numerous mental health disorders, especially when working with young people. However, if the misconception that males don’t experience eating disorders continues in the medical world, they will continue to be excluded from research and gender-specific treatment will remain out of reach.

Ultimately, there remains a genuine risk that stigmatic research will continue to prevent effective treatment for the most destructive mental illness of all.

Everyone experiencing disordered eating deserves better, personalised support, regardless of gender identity. If you are experiencing disordered-eating, help is available today.