Men and Eating Disorders

You may be wondering why, as I mostly work with women, I’ve decided to tackle the topic of men with eating disorders. Here are a couple of reasons: 1) I am working with more men with this problem than ever before and have noticed a huge rise in this phenomenon and 2) I feel that we don’t discuss how boys and men are vulnerable to eating disorders enough and how to help them avoid the eating disorder trap.

I am working with some men who engage in all kinds of disordered eating practices and who suffer from low self-esteem and poor body image. Their stories have deeply touched me and forced me to re-examine my beliefs around eating disorders being mostly a female phenomenon.

Research backs me up on my sense that more men than ever before are struggling with eating disorders. Dr. Mark Warren, clinical psychiatrist and medical director of the Cleveland Center for Eating Disorders explains that eating disorder prevalence rates have grown substantially in recent years: “In the ’60s and ’70s, eating disorders in men were thought to be almost nonexistent, in the ’80s and ’90s about 10% and now 25-30%. So, all we know is that it is more prevalent than was previously thought.”

This is a staggering statistic! In less than a twenty-year period, eating disorder rates have more than doubled for boys and men.

A study from the University of Toronto estimates that one in every six people diagnosed with anorexia nervosa is male.

Interestingly, the increasingly high rate of eating disorders among males is also a Western phenomenon. A recent Harvard study found that Asian men show less dissatisfaction with their bodies than males in the United States and Europe. The researchers found that this is because Western males are far more preoccupied with being muscular than Asian males.

Gay males are at particularly high risk for developing eating disorders for many reasons. Here is a great resource on this topic and suggest you read this fascinating article.

Secondly, a wonderful documentary on this subject, Do I Look Fat? was made by the filmmaker, Travis Mathews. Here is an excerpt from the NEDA website in the filmmaker’s own words:

Coming out of the closet isn’t usually someone’s idea of a good time. There’s always the perceived risk that the receiver of the news is going to drop you into a box labeled discard. 

What’s helped me during those more difficult disclosures was the idea, the hope, the promise of a community that would support me if any worst-case scenarios materialized. The resources for men coming to terms with their sexuality are plenty and help to soften feelings of isolation and shame. I knew this, and I knew that I wasn’t alone, even if I sometimes felt that way.

So, it was difficult to grasp why my struggle to come forward, to come out, about an eating disorder fell on deaf ears, cowering under the shame of a having a woman’s illness. I knew that eating disorders affected women disproportionately but I also knew from the most cursory scan of the gay community that we were a body-obsessed bunch. 

In time, I began meeting men who candidly spoke of their struggle with body image and food and I heard some constants that helped in explaining the lack of support. For instance, many men felt emasculated or bullied for some part of their lives and were reluctant to align with something that would further feminize them. “I might be gay, but I’m not that gay,” was the message. In short, I uncovered internalized homophobia within a community rampantly silenced behind rainbow pride stickers. 

As a filmmaker, I began sleuthing about the community to not only understand the many facets of eating disorders amongst gay men, but also to create a resource that was absent. Over the course of two years I focused on seven gay men who had or were struggling with body obsession and eating disordered behavior to get a personal understanding of the larger community’s silence. I also traveled to Rogers Memorial Hospital – at the time, the only residential center in the country that had a separate treatment program for men – to get a clinical understanding of the issues. These accounts are the crux of what became the documentary, Do I Look Fat? 

As I’ve traveled with the film, people continue to ask me how prevalent this is. My answer remains the same: it’s difficult to know with real certainty. Men, both gay and straight, are generally reluctant to seek medical attention for any health-related issue, eating disorders being no exception. Our culture feeds this reluctance by its steady framing of eating disorders as a woman’s issue. 

Numbers may be hard to nail down, but studies consistently show gay men disproportionately represented among men with eating disorders. Considering that gay men are thought to represent about 5% of the male population, it’s alarming that they represent up to 42% of the male eating disordered population, according to research conducted by Dr. William Howard at the John Hopkins University School.

Why are males in Western society at such high risk?

The following information is adapted from a presentation from a NEDA conference entitled “Why do Males have Eating Disorders and How do They Get Better?” by Theodore E. Weltzin, MD and Melissa Schneider, MA, as well as from the NEDA website.

A few of the risk factors for males include:

Attempts at Weight Loss

Males are more likely to be overweight than females and often resort to diets in order to lose weight. And we know that dieting is the first step to the development of serious eating disorders.

Exercise

The current body ideal in our culture for men is to be fit and have obvious muscle definition (a good example are the Calvin Klein underwear ads for men-what an impossible ideal to live up to!)

High Risk Sports/Activities

Boys and men are expected to engage in dangerous “masculine” sports like football, rock-climbing, and rugby. These activities call for a fit, bulky body, which increases pressure on them to live up to the body ideal called for.

Societal influences include unrealistic body ideals. For example, most men perceive the ideal body image to be 13 kg more muscular than they actually are. Most heterosexual men also believe that women prefer men who are much bigger than they are.

The NEDA website points out that the “ideal” male body type is muscularity:

Findings include:

Most males would like to be lean and muscular, which typically represents the “ideal” male body type. Exposure to unattainable images in the media leads to male body dissatisfaction.

The sexual objectification of men and internalization of media images predicts drive for muscularity.

The desire for increased musculature is not uncommon, and it crosses age groups. 25% of normal weight males perceive themselves to be underweight and 90% of teenage boys exercised with the goal of bulking up.

Muscle dysmorphia, a subtype of body dysmorphic disorder, is an emerging condition that primarily affects male bodybuilders. Such individuals obsess about being adequately muscular. Compulsions include spending many hours in the gym, squandering excessive amounts of money on supplements, abnormal eating patterns, or use of steroids.

And sadly, Yang, Gray, and Pope (2005) point out that: “In most western societies the man’s traditional roles have declined leading some to suggest that young men may have increasing focus on their bodies as one the few remaining sources of masculine self-esteem.”

Lastly, research findings in males with eating disorders show that sufferers:

• Were more likely to be obese/teased when young
• Diet to achieve a muscular body
• Often have gender identity issues
• Are often survivors of sexual abuse
• Are often involved in weight related sports
• Have experienced separation or the loss of a father while growing up