June 4, 2019
While girls and women make up the majority of individuals affected with eating disorders—such as anorexia, bulimia, and binge eating—as many as one-quarter to one-third of patients who manifest these symptoms are boys and men.
What’s more, according to a recent study conducted at the University of California-San Diego and discussed by the New York City-based nonprofit, Child Mind Institute, disordered eating behaviors are increasing at a faster rate in males than females.
However, the researchers say, because eating disorders often manifest themselves differently in boys, they are harder to detect by parents as well as healthcare providers. Stigma is another issue. Men may not want to be associated with a problem that primarily affects women, and men are less likely to admit weakness and seek help.
Girls with eating disorders are typically obsessed with being thin. Conversely, boys with anorexia tend to be more focused on achieving a muscular physique.
This manifestation is sometimes known as “reverse anorexia” or “bigorexia,” explains Douglas Bunnell, a clinical psychologist and expert on eating disorders who practices in Westport, Connecticut. “These boys have all the psychological features of anorexia, except they’re pushing it in the opposite direction.”
Speaking to Christina Frank of the Child Mind Institute in an interview, Dr. Bunnell explained that, to achieve what they perceive to be the “ideal” physique, boys may work out excessively, or use steroids or over-the-counter supplements to minimize body fat and increase muscle mass and definition. An obsession with “clean eating”—cutting out carbs, increasing protein, or adhering to restrictive fad diets —is another common feature.
And the problem may develop earlier than eating disorders do in girls, notes Dr. Bunnell. “We think boys may have onset earlier—sometimes during early and mid-adolescence — but there are all sorts of nuances.”
Of course not all boys who express dissatisfaction with their bodies will develop an eating disorder. Here’s what to look for if you’re trying to determine whether a boy’s habits are within the normal range of eating behavior— or have crossed over into a problem that needs attention:
- Excessive focus on and time spent exercising
- Rigidity around eating rituals
- Eating large of amounts of food
- Going to the bathroom in the middle of meals or right after
- Refusing to eat certain food groups
- Having unusual behaviors around food (cutting food into small pieces, pushing food around the plate)
- Obsessively reading nutrition information or counting calories
- Constantly getting on a scale or looking in the mirror
- Avoiding or withdrawing from social gatherings involving food
Unlike with girls, who often become alarmingly skinny and visibly unhealthy, eating disorders in boys are harder to recognize because often nothing looks “wrong” on the outside. Eating disorders in boys are also easier to hide under the guise of what is considered acceptable, even laudable, male behavior.
“Exercising, even excessively, is socially valued in men,” says Dr. Bunnell, who adds that overeating is also more socially condoned in men than in women. “A group of 17-year-old boys eating multiple Big Macs, for example, might be considered amusing or even cool,” he says. “In fact, these behaviors may be masking an eating disorder.”
However, like girls and women, boys and men with disorders such as anorexia nervosa suffer from physical problems. In particular, they usually exhibit low levels of testosterone and vitamin D; in some cases, testosterone supplementation is recommended. Other health consequences of eating disorders in men include damage to muscles, joints and tendons from over-exercising. Using steroids to bulk up can result in acne, testicular atrophy, decreased sperm count, high blood pressure, high cholesterol, abnormal liver function, constipation and bursts of anger (known as “’roid rage”).
People with eating disorders are also more likely to struggle with depression, anxiety disorders, substance abuse, and personality disorders.
Research shows that boys and men respond well to the same eating disorder treatments that have been successful for females. Whether in an in-patient or out-patient setting, the focus is on restoring health and addressing the psychological and emotional components with psychotherapy. Parents are engaged to help establish an environment that supports healthy eating habits and body image.
The challenge is getting males to seek help. Most eating disorder programs are centered on girls, which can make boys feel out-of-place. There are some male-only programs, and the hope is that, as awareness grows and stigma decreases, there will be more.
“We know a lot more about boys and eating disorders compared to, say, two or three years ago,” says Dr. Bunnell. “We just think there are a lot more boys and men out there who feel inhibited or ashamed about coming forward. It’s critical for parents, pediatricians, and school counselors to develop awareness of eating disorders being as much of as a potential issue for boys as for girls. We have treatments and we want boys to be sure they know they can have access to them.”
Research contact: @ChildMindInst