Although eating disorders have traditionally been seen as female conditions, an increasing number of men are affected too. The precise figures for men (as for women) are unreliable, because of the stigma around these issues. It is likely that numbers are considerably higher than estimated – many individuals with disordered eating never seek medical help or are not deemed ‘ill enough’ for treatment, while others are treated privately. The official NHS statistics only record the numbers of patients treated in NHS hospitals or inpatient clinics, and as such underestimate the prevalence of disordered eating. The general consensus of organizations such as the UK National Institute of Health and Care Excellence (NICE) and Department of Health is that approximately 11 per cent of those with eating disorders are male, although B-EAT (the UK’s leading eating disorders charity) suggests that up to 25 per cent of those affected could be male.
‘. . . many individuals with disordered eating never seek medical help or are not deemed ‘ill enough’ for treatment’
There is still a stigma for men in admitting to a condition that is perceived to be effeminate or unmanly. In addition, doctors, teachers and parents may fail to identify warning signs in boys that they would immediately recognize in girls: concern over body weight and shape, distress around eating or secretive behaviours around food. Partly due to this lack of awareness by the health professions, boys and men are even more ashamed of coming forward than women and girls. Male eating disorders are most likely to begin between the ages of 14 and 25 years, but just like women, men of any age can develop them. And while society is starting to acknowledge the pressures on older women to stay thin – we rarely think about older men.
‘Male eating disorders are most likely to begin between the ages of 14 and 25 years, but just like women, men of any age can develop them.’
Comparatively little research has been carried out on male eating disorders. However, it is clear that many of the risk factors that apply to women apply to men too, in particular the use of dieting or bingeing as a coping mechanism, or an expression of underlying emotional stress. Men face a heightened risk if they have previously been overweight, or if obesity or eating disorders run in their family. Like women, men with anorexia tend to conform to a particular personality type: anxious, obsessive, persevering and perfectionist. They tend to be eager to please, and sensitive to rejection and humiliation.
‘Comparatively little research has been carried out on male eating disorders.’
Men are also more susceptible if they participate in sports that demands a particular body build, whether large or small. Runners and jockeys seem to show a higher prevalence of anorexia and bulimia, while footballers and weightlifters focus on increasing their size. Wrestlers who try to shed pounds quickly before a match in order to compete in a lower weight category can be vulnerable. Bodybuilders are at risk if they deplete body fat and fluid reserves to achieve high muscle definition, as are male models who fast or starve to hone the very ‘cut’ look seen on the covers of men’s magazines.
‘Runners and jockeys seem to show a higher prevalence of anorexia and bulimia, while footballers and weightlifters focus on increasing their size.’
Research suggests that eating disorders disproportionately affect some segments of the LGBT population, specifically gay and bisexual men. Gay men are thought to represent only a few per cent of the total male population, but among men who have eating disorders somewhere between 20 and 40 per cent identify as gay. In one study, gay males were seven times more likely to report bingeing and 12 times more likely to report purging than heterosexual males.
‘Research suggests that eating disorders disproportionately affect some segments of the LGBT population . . .’
According to the National Eating Disorder Association, ‘Eating disorders among LGBT populations should be understood within the broader cultural context of oppression.’ While one cannot generalize as to why the gay and bisexual male community is at particular risk, a number of factors appear to be relevant. The most significant is the experience of being young and gay, with intense anxiety about coming out, fear of rejection by friends and family, social isolation and discrimination within the workplace. Even in the twenty-first century, gay men still encounter prejudice and even violence: a significant proportion of male anorexics report bullying over their sexuality at school.
Body image ideals within the gay community may also contribute: it is suggested that attractiveness and appearance pressures in terms of slimness and the ‘perfect body’, similar to the pressures on women within the heterosexual community, may cause more body image disturbance and dissatisfaction among gay men.
Whatever a man’s sexuality, male eating disorders are damaging and dangerous. Disorders last on average 8 years in men, a third longer than in women. Treatment options for male eating disorders are improving, but they are still limited, with most clinics and hospital units set up for female individuals. The focus on women’s health issues, menstruation and female body image is highly alienating for young men battling the same condition, and can reinforce the message that they have a girls’ problem. In fact, men face significant health risks from restricting, bingeing and purging.
‘Treatment options for male eating disorders are improving, but they are still limited . . .’
This is an extract from The A-Z of Eating Disorders by Emma Woolf out this September