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Yes, men and boys can have eating disorders, too

June 16, 2020
The Seattle Times

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On Nutrition

Here’s the thing about stereotypes — there’s usually a nugget of truth in there somewhere. But taking what’s true for a few and generalizing it to everyone is a problem no matter what we’re talking about. Right now, let’s talk about eating disorders.

Think of an individual with an eating disorder. Does a young, white, emaciated middle-to-upper-class female come to mind? Certainly, many people with eating disorders fit that image, but this stereotype excludes entire groups of people who also struggle with these dangerous health conditions, including women in midlife, people who are not white, people who don’t look “thin enough” to have an eating disorder, people with low incomes, and men.

The reality is that eating disorders know no age, gender, income, race or ethnic boundaries. When someone is struggling with an eating disorder, not fitting the stereotype is a significant barrier to seeking help. That barrier can be fatal. The risk of death from an eating disorder is higher for males than it is for females.

Stereotypes may be directly to blame for some of those deaths. Men may be ashamed to seek treatment for a “female” disorder, or their symptoms may be attributed to something else, such as a gastrointestinal disorder. Excessive or compulsive exercise, which often occurs with eating disorders — even in young boys — can easily hide under the “cover” of training hard for a sport or simply wanting to be fit, something that’s praised in our society. Because of this, males are more likely to be diagnosed later, when more damage has been done. Another contributor to deaths from eating disorders is increased suicide risk. Men and boys who struggle with an eating disorder may also be experiencing anxiety, depression or substance-use disorders.

Recent research suggests that 1 in 4 individuals with anorexia nervosa or bulimia nervosa are male, while men and boys make up one-third — and possibly more — of people with binge-eating disorder. It’s ironic that so much research on human health has traditionally focused on men, with results extrapolated to women as if they are just men with a few parts swapped out — a particular problem with research on cardiovascular disease — yet the reverse is true with eating-disorder research. Many clinical eating-disorder trials even exclude male patients because they are deemed “atypical.”

It’s true that eating disorders don’t look exactly the same in males as they do in females — perhaps one reason that it took nearly a century for clinical descriptions of anorexia nervosa to include males. Even today, many eating-disorder screening questionnaires miss men and boys because the questions look for an overvaluation of thinness. This trait is typically true in females, while males tend to overvalue a muscular body. Females with anorexia may want to be as thin as possible so they have a flat stomach, while males with anorexia may desire to be as lean as possible to highlight six-pack abs. In one study of high school students, more than 24 percent of girls overvalued thinness, but less than 5 percent of boys did.

The bottom line is that eating disorders are a mental health condition with serious medical consequences for every organ system in the body. And they can affect anyone, no matter what they look like.

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