Eating Disorders. Yeah, Sometimes It’s a Guy Thing.

Dear Healthy Men: Settle a bet. My buddy says men and boys sometimes get eating disorders. I say only females can. Who’s right?

A: Sadly, your buddy is, but you’re far from alone. In fact, I think most believe that women and girls are the only ones affected by eating disorders. But here are the facts: In the U.S., at least a third of the 30 million people suffering from eating disorders are boys or men, according to the National Eating Disorders Association (NEDA). That’s 10 million people, most of whom won’t ever get the help they desperately need because they have a Y chromosome. That, folks, is a real—and sometimes quite deadly—tragedy.

So why do we ignore men and boys with eating disorders? I’ve come up with at least three reasons:

• Even though a lot of those 10 million boys and young men know they’ve got a problem, they don’t ask for help because they’re afraid that people will make fun of them. After all, real men don’t have eating problems right? Guys who do acknowledge that they have a problem and ask for help often find that eating disorder treatment programs accept only females.
• Too many medical professionals don’t consider that boys could have an eating disorder. So even when the symptoms are staring them in the face, pediatricians and primary care docs too often ignore them. Mental health professionals—people who really ought to know better—also turn a blind eye to boys. One of the big industry groups, the American Psychiatric Association, has a very informative section on its website devoted to eating disorders. But the first symptom on the list is “menstrual periods cease.” Most boys will stop reading right there.
• Studies generally exclude boys and young men from relevant research. And if they’re left out of research, they’re also left out of clinical trials for drugs and other potential therapies.

The Media: Feeding Us Eating Disorder-Triggering Myths

Eating disorders are often related to body image. People suffering from anorexia, for example, look in the mirror and, no matter how skinny they are, they see an obese person. Generally speaking, girls and women worry more than boys and men do about being overweight, and some of those worries are driven by the media, with its constant fawning over female celebrities’ makeup tips or another’s bikini pictures.

That’s the bad news. The worse news is that the media does something equally damaging to boys. Men’s magazines, movies, and TV shows feature guys with impossibly large biceps, too many abs to count, and the kind of physique none of us will ever achieve. Those same idealized (and objectifying) images also show up in girls’ and women’s magazines, where they influence the expectations their readers have for men and boys. As a result, males who are overweight may feel even more pressure to lose weight—which could contribute to eating disorders. And those whose weight is perfectly fine may develop another type of disorder: “muscle dysmorphia,” also known as “bigorexia” or “manorexia.” Bigorexics (who are almost always male) look in the mirror and, no matter how ripped they are, see a 96-pound wimp.

While bigorexia isn’t as deadly as anorexia and other “traditional” eating disorders, it can still lead to a number of very serious problems. Boys and men who feel pressured to have the perfect body often become anxious and depressed (which can lead to suicide). They diet and work out obsessively, may start taking steroids and other “supplements,” and can do permanent joint- and muscle damage. Those obsessions can become so consuming that schoolwork and career may suffer, and they may stop spending time with friends and family because they don’t want to interrupt their workouts, or they feel embarrassed about how skinny they are.

If you or someone you know has an eating disorder, including bigorexia, get some help. Now. If the person is under 18, start with his pediatrician. If he or she laughs it off or refuses to consider an eating disorder, find another doctor. If he’s over 18, set up a visit with the primary care doc or a mental health professional who has experience treating people with eating disorders. You’ll also find a ton of great resources, information, guidance, and support at the NEDA website, https://www.nationaleatingdisorders.org/