Research indicates that over one third of people experiencing an eating disorder are men (Paxton et.al.,2021). Many experts believe that this number could be even higher, as the stigma surrounding eating disorders in men prevent many from seeking help.

Studies suggest that up to a quarter of people suffering from anorexia nervosa and bulimia nervosa are men and an equal number of men and woman have binge eating disorder. Unfortunately, many men go undiagnosed as having an eating disorder, either due to their own reluctance to seek help, stigma and a lack of awareness in the community, or because of a lack of understanding from health practitioners.

Eating disorders and disordered eating behaviours in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating (Nagata, Gansen & Murray, 2020). For men, body dissatisfaction is more commonly manifested as the pursuit of a muscular, lean physique rather than a lower body weight (NEDC, 2018). While eating disorders in females often starts in adolescent years, men tend to develop eating disorders at an older age. The average age of onset in men is 17–26 compared to 15–18 in women (Columbia University).

Some of the warning signs of an eating disorder in men include:

• Excessive or compulsive exercise patterns (e.g. Exercising when injured/unwell, exhibiting distress if unable to exercise.
• Preoccupation with fitness and/or muscle toning, body shape, weight and appearance.
• Constant or repetitive dieting
• Restrictive eating behaviour (e.g. Avoidance of certain food groups, counting calories/macros, fasting, replacing meals with fluids).
• Behaviours focussed around food preparation and planning (e.g. Obsessive meal planning and preparing, reading nutritional guides).
• Bingeing and/or purging.
• Fear of gaining weight.
• Social withdrawal or isolation.
• Heightened sensitively to comments or criticism about body shape or weight, eating or exercise habits.
• Muscle enhancing drug use.

The general risk factors for eating disorders are the same for men and women. Low self-esteem, perfectionism, weight or body-related teasing or bullying are all known risk factors.

However, there are certain factors that present more or less of a risk to men and boys when it comes to eating disorders:

• Weight-loss dieting is a less common risk factor for men than it is for women.
• Men whose job requires a particular body ‘look’ such as models, actors or entertainers may have a higher risk of developing an eating disorder than the general population.
• Male athletes are at a higher risk of developing an eating disorder with estimates that up to 19% of male athletes experience disordered eating and/or an eating disorder (Reardon et.al., 2019). At a higher risk are those in sports that require a particular physique, such as gymnasts, swimmers, jockeys, weightlifters, wrestlers and body builders.
• Studies suggest that 15% of gay or bisexual men have struggled with eating disorders, and around 42% of men with an eating disorder identify as gay or bisexual (Columbia University. 2007).

Cultural messaging around the ‘ideal’ masculine body shape often leads to the desire to pursue a muscular and lean physique. This can heighten body image concerns in males and may be a contributing factor to the development of an eating disorder.

Nearly one third of Australian men are dissatisfied with their body (NEDC, 2017).  Research has shown that the number of men experiencing body image dissatisfaction has tripled from 15% to 45% in the last 25 years (Australian Psychological Society, 2014) . Body dissatisfaction or negative body image can often result in overwhelming feelings of disappointment, shame and guilt. It can also lead to unhealthy behaviours such as fad dieting, disordered eating, eating disorders, exercise addiction and steroid abuse. A recent study in Australian secondary schools found that more than half of boys aged 14-16 were using muscle-building protein supplements (Yager & McLean, 2020).

Body Dysmorphic Disorder (BDD) is a mental health disorder where someone obsesses over one or more aspect of their appearance which they perceive to be out of proportion or unbearably unattractive. BDD goes beyond having body image issues to the point where repetitive negative behaviours such as repeatedly checking the mirror, grooming or seeking reassurance for hours on end can cause significant distress and even impact your ability to function in your daily life. Muscle dysmorphia is a type of BDD that causes a person to become obsessed with achieving desired levels of muscularity and leanness. It’s important to note that muscle/body dysmorphia are NOT eating disorders. They fall under the category of anxiety disorders however can exist alongside eating disorders.  

Many men who experience an eating disorder will have binge eating disorder. The gender distribution for binge eating disorder is roughly equal for males and females (Hay, Mond, Buttner & Darby, 2008). Binge eating disorder (BED) is a mental illness characterised by regular episodes of binge eating. Binge eating involves eating an excessive amount of food, which may take place in a rapid space of time, or may be more of an extended grazing. These episodes can feel chaotic, uncontrollable and highly distressing.

Men who participate in sport are at higher risk of disordered eating and/or eating disorders. Disordered eating can occur in any athlete, in any sport, at any time, crossing boundaries of gender, age, body size, culture, socioeconomic background, athletic calibre and ability (Wells et.al., 2020).

Research shows that people who engage in aesthetic, gravitational and weight-class sports such as weight-lifting, boxing, horse racing, rowing, gymnastics, swimming, figure skating and dance are at higher risk of disordered eating and/or an eating disorder (Wells et.al, 2020).

Athletes with eating disorders may partake in unhealthy and potentially dangerous activities such as restrictive dieting, extreme exercise regimes and/or anabolic steroid abuse.

Education surrounding body image issues need to start early for boys. As young girls are encouraged to embrace positive body image and challenge society’s appearance ideals, we also need to open the conversation to boys. Confident Body Confident Child is a great resource that can assist parents with promoting positive body image and healthy eating patterns in young children.

It is also essential to educate young boys on how to critically analyse and consume media portrayals of men so that they don’t develop an unhealthy fixation to body image, weight and food.  Advertising and people on social media utilize Photoshop and Facetune to alter their physical appearance. Advertising reinforces the ‘muscular and lean ideal’ for men by altering pictures and images to portray the ‘perfect body’ but these images are unrealistic and unattainable.

Recovery from an eating disorder is possible for everyone. Early intervention is the key to a successful recovery, so it is important to seek help as early as possible. The recovery journey is unique for everyone — for some, it can take only a few months and others may take many years.

Unfortunately many men with an eating disorder delay or avoid seeking help. This can be due to a number of reasons, for example: the stigma of having what many people regard incorrectly as a ‘female illness’, general resistance to seeking medical help, and an unwillingness to seem ‘weak’. In addition, eating disorders in men are often misdiagnosed or undiagnosed by medical practitioners.

It is important to note that the treatment services available (such as psychotherapy, nutritional advice and support groups) are effective in treating both men and women, and the prospect of recovery is equally as possible.

References

Australian Psychological Society (2014). The man behind the mask: male body image dissatisfaction. https://web.archive.org/web/20130328051857/https://www.psychology.org.au/publications/inpsych/body_image

Blinder, B.J. (2001), Anorexia in males. http://www.ltspeed.com/bjblinder/anmales.htm

Columbia University’s Mailman School of Public Health (2007). Gay Men Have Higher Prevalence Of Eating Disorders. www.sciencedaily.com/releases/2007/04/070413160923.htm

Hay, P.J., Mond, J., Buttner, P., Darby, A. (2008) Eating Disorder Behaviours Are Increasing: Findings from Two Sequential Community Surveys in South Australia. PLoS ONE 3(2): e1541.  

Paxton S.J., Hay, P., Touyz, S.W., Forbes, D.M., Sloane Girolsi, F., Doherty, A., Cook, L., & Morgan, C. (2012). Paying the price: The Economic and Social Impact of Eating Disorders in Australia, Sydney: Butterfly Foundation. 

Reardon, C.L., Hainline, B., Aron, C.M. (2019). Mental health in elite athletes: International Olympic Committee consensus statement British Journal of Sports Medicine 53(11):667-99. 

Wells, K. R., Jeacocke, N. A., Appaneal, R., Smith, H. D., Vlahovich, N., Burke, L.M, & Hughes, D. (2020). The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. British Journal of Sports Medicine, 54(21), 1247–1258.  

Yager, Z., McLean, S. (2020). Muscle building supplement use in Australian adolescent boys: relationships with body image, weight lifting, and sports engagement. https://doi.org/10.1186/s12887-020-1993-6