What image springs to mind when you consider the words eating disorder? A stay-at-home dad, a male CEO, a teenage boy hanging out with his friends, or a young man on the university rugby team?
It is more likely you thought of a teenage girl or young woman who appears significantly underweight. Leigh Cohn, author of Making weight: Men’s conflicts with food, weight, shape & appearance, [1] states that “A young adolescent girl from a relatively privileged background was the image because that was the type of person showing up for treatment. All the emphasis was on women.”
For decades it has been considered a female illness that rarely affects men. However, a growing body of research is turning this widespread public perception on its head. Studies demonstrate that disordered eating practices in men may be increasing at a faster rate than in females. [2]
Approximately 1.25 million people in the UK have an eating disorder. The National Association for Males with Eating Disorders estimates that 25 to 40% of sufferers are males.
This misperception around the gender of eating disorders means that many male sufferers go undiagnosed and do not receive the treatment they so desperately need.
Breaking the Stigma of Male Eating Disorder
Chris Ecclestone, who played Doctor Who, made the headlines in 2019 when he admitted that he had suffered from anorexia for most of his adult life. In his book I Love Your Bones, he described himself as a “life-long body hater” and had suffered in silence due to the shame and stigma around the condition until his marriage breakdown in 2016. [3]
“I’m male and northern and from a working-class background, so you were not supposed to speak about your feelings (…) I still carry all the baggage about masculinity and toughness, and I was ashamed about my depression and eating disorder.”
Chris was hospitalised for the condition and contemplated suicide due to intrusive thoughts. This might seem a shocking tale, indeed it is, but it is not as rare as we think. Growing numbers of men are suffering in silence with a variety of disordered eating issues.
Eating disorders have the highest mortality rates of any psychiatric disorder. Of those surviving an eating disorder, 50% fully recover, 30% improve significantly, and 20% remain chronically ill. [4]
We must break the stigma associated with male eating disorders and ensure that these men get the help and support they need to recover.
Understanding the Differences
Eating disorders have been reviewed through a female lens to such an extent that up until the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), amenorrhea (loss of menstrual period) needed to be present for a diagnosis of anorexia nervosa. This meant that men were physiologically incapable of qualifying for a diagnosis regardless of their presence of other symptoms!
Until recently, men were excluded from research studies as the cases were deemed too rare to consider. By marginalising male disordered eating in this way, we lost valuable insight into the key differences in the presentation of eating disorders between the two genders and varying treatment models.
Thankfully the growing body of research in recent years is making up for the lost time, and the differences are becoming more understood. Treatment models can then adapt accordingly.
Eating disorders most commonly arise during adolescence, where one of the key differences can be seen. Teenage boys are often skinny due to their growth spurt and lack of muscle at that age. Therefore, a physical disparity or appearance of low weight or malnourishment can be hard to spot, unlike underweight teenage girls who would typically be filling out and displaying a fuller figure.
Binge eating disorder has been found to be equally as common among men as women. However, the stereotypes and stigma around food consumption between the sexes cloud diagnosis. Binge eating can be deemed more acceptable for males, especially among teenage boys. A boy eating several burgers in one sitting, or a pile of sandwiches, may be considered ‘funny’ or ‘cool’ by his friends or thought acceptable by parents as he is ‘growing’. And, of course, that may be the case, which is why disordered eating can be challenging to spot in men.
Excessive exercise is also considered more socially acceptable for men than for women. If a man goes to the gym every day, even twice a day, this can give him kudos amongst his peers. However, men are more likely to suffer from disordered eating linked to muscle gain and obtaining a particular physique. This condition is known as musclephoria, similar to anorexia but focusing on ‘bulking up’. A renowned study also evidenced that 30% of regular gym-goers and athletes in a range of sports suffer from orthorexia nervosa. [5] Orthorexia, like anorexia, focuses on the restriction of food, whether it be the amount, type, or frequency of intake, with a focus on healthy/clean eating.
Underlying Causes
The underlying causes of eating disorders are thought to be the same across the genders. These include genetic disposition, conditioning, environment, projecting emotional issues onto the body and societal messages that reward the perfect body.
In recent years the male physique has been under as much critique and objectification in popular media as the female body. As a result, there has been an escalating trend of the diet and exercise industry targeting men promoting the ideal lean and muscular body image.
A negative body image is a known trigger for disordered eating behaviours. A negative body image has been found to affect 50% of girls, 30% of boys, 80% of women and 40% of men. [6] A negative body image can result in numerous psychological and physiological disorders, including depression, anxiety, eating disorders, body dysmorphic disorder and obsessive-compulsive disorder, to name but a few.
Route to Recovery
Despite the scale of eating disorders in the UK, resources to treat them are relatively scarce. GPs are often under-experienced in this area, especially with male patients, and there are very few specialised treatment centres. People affected by eating disorders are often vulnerable due to their age and mental health – they often avoid detection and evade treatment.
However, early treatment is critical for a full recovery from an eating disorder. Successful treatments include cognitive behavioural therapy, family therapy, journaling, gratitude interventions and self-esteem interventions.
Males suffering from disordered eating have a powerful stigma to overcome and, as a result, can be significantly neglected in both diagnosis and treatment. Education and awareness are essential to break this stigma and ensure that men with eating disorders are given the treatment they deserve.
If you would like to seek help or learn more about disordered eating issues, please get in touch with me, Dr Bunmi Aboaba, The Food Addiction Coach, by following this link.
Sources
[1] Holbrook, T. M., A. E. Andersen, and L. Cohn. “Making weight: Men’s conflicts with food, weight, shape, & appearance.” (2000)
[2] Mitchison, Deborah, and Phillipa J. Hay. “The epidemiology of eating disorders: genetic, environmental, and societal factors.” Clinical epidemiology 6 (2014): 89.
[3] Bloomer, Alison. “Tackling The Stigma Of Eating Disorders In Men And Boys”. BJFM, 2019, https://www.bjfm.co.uk/blog/tackling-the-stigma-of-eating-disorders-in-men.
[4] Steinhausen, H.C. (2002). “The Outcome of Anorexia Nervosa in the 20th Century.” American Journal of Psychiatry, 159, 1284-1293
[5] Sheil, Bláithín. “Orthorexia And Athletes: An Area For Concern – Trinity News”. Trinity News, 2015, http://trinitynews.ie/2015/12/orthorexia-and-athletes-an-area-for-concern/.
[6] Kearney‐Cooke, A., & Tieger, D. (2015). Body image disturbance and the development of eating disorders. In L. Smolak & M. D. Levine (Eds.), The Wiley Handbook of Eating Disorders (pp. 283-296). West Sussex, UK: Wiley
