Male Eating Disorders — Gender Differences and Similarities

By Lindsey Getz

It’s well known that eating disorders traditionally are associated with females. Unfortunately that association may be causing fewer men to be diagnosed and ultimately get the treatment they need. In fact, the National Eating Disorders Association has dubbed male eating disorders a silent epidemic because it estimates that as many as 10 million U.S. males will have a clinically significant eating disorder at some time in their life.

However, issues such as gender role conflict and traditional masculine ideals mean that many males will never seek help for an eating disorder. Though the treatment for men and women is very much the same, many males never get the same chance for recovery.

“Eating disorders do not discriminate, and that’s true of age, race, class, and of course gender,” says Megan Garrett, LCSW, day treatment program team leader at The Renfrew Center of Northern New Jersey. “But eating disorders have developed a stereotype that says it’s a woman’s disease. As a result, there may be a bit of a shame aspect of men coming forward, making them less likely to get help.”

“There is definitely a stigma attached to male eating disorders and this association of it being a ‘female issue,’” adds Jim Gerber, PhD, clinical director at Castlewood Treatment Center in St. Louis. “That stigma is even stronger among the younger males we treat as well as among athletes. It might be even harder for these individuals to come forward because of the negative associations.”

Emerging Symptoms
Society and the media’s portrayal of what it means to be a man is a large part of the problem. Athletes often have added pressure of meeting a certain weight class or looking a certain way for their sport. Those pressures can lead to problematic eating behaviors such as binging and purging or restrictive diets. Like females, some males go the other direction and begin a pattern of overeating and binging.

Once people fall into these patterns, the behaviors are similar whether a person is male or female. But how the disorder actually looks on the person may be different, Gerber says. In fact, it may be less recognizable on men. “Men naturally have more muscle mass than women, so it may not look as bad as it actually is,” he says. “That can also be very dangerous if the male has a restrictive eating disorder. If the person gets to a low enough weight, their muscle mass will actually be destroyed earlier than it would be in a woman.”

Tracey Lee Cornella-Carlson, MD, CEDS, DFAACAP, medical director for child and adolescent eating disorder services at the Eating Disorder Center of Rogers Memorial Hospital in Wisconsin, agrees that the exhibited symptoms are similar among men and women, and both are secretive in their behaviors. Other symptoms include anxiety surrounding food, an inability to focus, a dramatic change in appearance, and isolation.

But Cornella-Carlson says while the behaviors to reach a perceived goal may be similar, the ultimate goal itself may be a bit different for males. “Females want an ideal thin body type, but often men want a muscular physique,” she says. “As a result, one difference is that with men, you might see a lot more trips to health food stores for supplements and other related products.”

Cornella-Carlson adds that supplements can start out as a healthy pursuit but, like anything else, take a wrong turn when they become an obsession. The disorder linked to an obsession with health foods and supplements has its own name—orthorexia—and males, just like females, can experience it. “It may start out with eating a lot of fruits and vegetables, but that obsession may ultimately lead to the individual just not taking in enough nutrients and food at all,” Cornella-Carlson says.

Silent Epidemic
The warning signs of an eating disorder tend to be more recognizable among females. In fact, Garrett says males may already be exhibiting plenty of warning signs but those around them may fail to pick up on them. “A lot of times people just aren’t even aware that the signs a male is showing are signs of a problem,” she says. “And yet, if a female had those symptoms, such as talking obsessively about dieting, people would begin to pick up on the fact that there might be a problem.”

Cornella-Carlson agrees, adding that doctors and clinicians on the front lines of care, such as primary care physicians, need to be better educated about the fact that males can also experience eating disorders since even they may miss the warning signs. “Eating disorders can affect every system of the body, so a primary care physician may be the first to pick up on the fact that something is wrong,” Cornella-Carlson says. “Unfortunately, they might not recognize the root cause of the problem.”

For example, if physicians don’t consider the possibility of eating disorders when treating male patients, they may not think to or actually ask about eating habits and behaviors. They may pursue a solution to the problem at hand, such as a thyroid condition, but miss what was causing it in the first place, leaving the eating disorder undiagnosed. “If more primary care doctors could be aware that men are also affected by eating disorders, they could talk to their patients about it and be ready to refer them to help,” Cornella-Carlson says.

Even more alarming is the concern that, in some cases, those in leadership roles, such as coaches or teachers, may turn a blind eye to symptoms. “Eating disorders among men are simply not given the attention they deserve and may even be dismissed as just part of their life or as part of being an athlete,” Gerber says. “Eating disorders among men are often not recognized as a problem in the same way they would have been for a female. Social workers, physicians, coaches, and other professionals need to be better educated that this is not just a disorder that affects women, and it’s not just another part of being an athlete either.”

Treatment Options
When it comes to treating eating disorders among males, the experts say the approach doesn’t really differ from what works with females. “In both males and females, we see the eating disorder as having evolved to deal with other issues, so we stabilize the behavior and then move toward abstinence while also addressing those underlying issues,” Gerber explains. “Those underlying issues largely evolve around symptoms such as depression, anxiety, grief, or loss and often lead to the secondary issues related to self-esteem or body image.”

Garrett says the professionals at The Renfrew Center believe in using a treatment team, which may include several different professionals, such as a registered dietitian, a therapist, and maybe even a psychiatrist. She says both males and females benefit from a team-approach that takes a look at the entire person.

While the treatment approaches don’t differ based on gender, Cornella-Carlson says one factor that can be quite beneficial in recovery is whether males can connect with other males. It’s important for them to see they’re not alone in what often feels like an isolating disorder, particularly because of the stigma attached to it for men.

“The males that come to us often provide a lot of support for one another and that helps them make incredible strides,” Cornella-Carlson says. “We often hear them say they are relieved, and they appreciate that they are not the only male struggling with this. They really bond and often keep in touch following treatment. There certainly are stressors that are unique to being male—just as there are those unique to being female—so males can benefit from connecting with others like them and working out those issues.”

Cornella-Carlson says a recent National Eating Disorder Association ad she saw sums up the bottom line. “The ad basically said that it’s just as difficult to be Ken as it is to be Barbie,” she says. “That’s very true. Males do have the same body image pressures as females, and it’s important that this message gets out there. Men need to realize it’s OK for them to come forward and get help. As with any medical condition, the earlier we can start treatment, the better.”

— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.