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When you think of eating disorders, who comes to mind? Probably not the guy lifting weights in the gym for two hours a day, or your buddy who won’t touch hamburgers or sweets. Many of us don’t expect to see eating disorders in men, and don’t recognize the signs. But these conditions are more prevalent in men than many of us realize, and most of those men are struggling alone, research suggests. It’s time to change that.
“I was a freshman at Penn State University. I had never heard the word ‘bulimia.’ I had never heard the term ‘eating disorder.’ I would hide my binging and purging by turning on the shower and faucets. I felt completely alone, like no one could understand. The shame was overwhelming. At the time, I felt that men didn’t throw up their meals, men weren’t ashamed of their reflection in the mirror, and men didn’t talk about their bodies.”
—Brian Cuban, lawyer and author of Shattered Image: My Triumph Over Body Dysmorphic Disorder (Net Minds Corporation, 2013)
Batman used to be one of us
He was the only superhero without super powers, but now he looks more like the Hulk. “Batman used to be portrayed realistically and with a very functional body,” says Dr. E. Paul Zehr, author of Becoming Batman: The Possibility of a Superhero (Johns Hopkins University Press, 2008) and professor of neuroscience and kinesiology at the University of Victoria. “The later images of huge, steroid-monster Batman are not only inaccurate but nonfunctional for most of the things Batman would need to do,” he says. This unrealistic body type is the male equivalent of the Barbie doll.
- 185 lbs.
- 20% body fat
- 225 lbs. (40 extra pounds of muscle)
- 10% body fat
(Batman body estimates by Dr. Zehr)
Men get eating disorders, too
A national survey suggests that men account for 25 percent of anorexia and bulimia cases (Biological Psychiatry, 2007). In a 2011 study involving 2,800 students at a large university, for every four women who appeared to have an eating disorder, so did one man, according to the Journal of American College Health.
“It’s so important to recognize that many men and boys do struggle with food, weight, and shape. Recognition is the first step in overcoming the stigma,” says Dr. Tom Wooldridge, co-executive director of the National Association for Males with Eating Disorders, and assistant professor of psychology at Golden Gate University, California.
Increasingly, researchers are exploring the extent and causes of disordered eating among men. “[A person] does not choose to have an eating disorder. Eating becomes disordered by expecting one’s body to be what it is not,” says Dr. Ray Lemberg, a clinical psychologist in Arizona.
“Now I schedule my meals a week in advance, and don’t go out to eat, so I have my diet in perfect check.” —Luc
Luc’s full story
“From age 9 to 15 I was the ‘fat kid.’ The taunting still haunts me. I used to be in the gym for two hours a day and it took preference over school and friends. I spent $100 a month on anabolic supplements. A doctor warned me of the dangers of ‘bigorexia’ [an unofficial term for muscle dysmorphia, a body image condition]. Now I schedule my meals a week in advance, and don’t go out to eat, so I have my diet in perfect check. On days when I know I will be drinking later, I cut carbs and add extra cardio. There is always a drive to break the memory of being the fat kid growing up. I have bettered myself a little, but it’s still hard.” —Undergraduate, Pennsylvania
“I lifted weights so often that I was too tired to play my sport.” —Isaac
Isaac’s full story
“It started with basketball. I lifted weights so often that I wore myself out to the point where I was too tired to play the game. People commended me for how I ate, but I was very restrictive. I didn’t have dessert or any sweets for two years, and I didn’t go out to eat very often with friends or family. I was never diagnosed with an eating disorder, although I have always had an obsessive-compulsive personality. What helped me was when I realized that my family and friends came first and I didn’t want to ruin my relationships. I can’t urge enough that seeking help from close family members and friends is vital. Support is everything.” —Second-year student, Wyoming
Guys are under-diagnosed
Men are less likely than women are to get help for eating and body image issues, partly because seeking psychological support is considered “unmanly,” according to a 2005 study in Psychology of Men & Masculinity.
In addition, men with eating disorders may present differently than women and go undetected. “Men are more likely to emphasize lean muscularity instead of weight loss,” says Dr. Wooldridge. “This means that treatment providers need to look for different signs.”
Men and women have similar rates of binge eating (which is associated with depression), but far fewer men than women receive treatment, the International Journal of Eating Disorders reported in 2011. “I work with many males who binge eat but are of normal weight. They may not get identified [by a health care provider] because their weight, blood pressure, and heart rate are normal, yet they are suffering with a food problem,” says Dr. Roberto Olivardia, a clinical instructor in psychiatry at Harvard Medical School, Massachusetts.
Men who are suffering alone can reach out to a counselor, friend, or family member, survivors say. “I finally took that first step. I got honest with everyone I had been lying to about my eating disorder, most importantly my family and the treatment providers who were trying to help me,” says Brian Cuban, the author and lawyer. “What I feared most didn’t happen: I was not rejected. There was only love and support.”
Possible warning signs:
- Compulsive exercising, especially strength training
- Anxiety or stress about missing workouts
- Rigid rituals involving food or eating
- Rigidity around eating only “healthy” foods (“orthorexia”)
- Restricting food or over-exercising to compensate for alcohol calories (“drunkorexia”)
- Binge eating (episodes of consuming unusually large amounts of food)
- Substance abuse
- Use of steroids and other performance-enhancing or muscle-enhancing supplements
How the media messes with men’s body image
Unrealistic representations of the male body are all around us, in actors and athletes, superheroes, even toy soldiers. The media message that attractiveness is associated with a specific look and body type has been found to affect men’s self-image, as it has long been known to influence women’s. In a 2006 study involving undergraduates, media images that sexually objectified the male body seemed to make men more self-critical of their own bodies (Journal of Communication). This media exposure and self-scrutiny is associated with men’s drive to build muscle, according to the journal Psychology of Men & Masculinity (2003).
In a recent survey by Student Health 101, close to 70 percent of respondents said there’s pressure on guys to have a certain body type. “Males are under siege more than ever to live up to unrealistic media images portraying [them] as either unnaturally muscular or thin,” says Dr. Ray Lemberg, a clinical psychologist in Arizona. Forty-three percent of men express dissatisfaction with their body; three decades ago, that figure was 15 percent, according to the National Eating Disorders Association (NEDA).
Other environmental factors that may contribute to eating disorders include peer pressure, bullying, sexual abuse, and other types of trauma. Biological and genetic factors are also involved. Eating disorders among men appear to be more common in the gay and transgender community but also affect heterosexual men, according to the National Eating Disorders Association.
Muscle dysmorphia, "orthorexia," and "drunkorexia"
This diagnostic term refers to a type of body dysmorphic disorder. People with this condition perceive themselves as not sufficiently muscular. They may work out obsessively, overspend on dietary supplements associated with building muscle, and have abnormal eating patterns. In a recent Student Health 101 survey, 60 percent of respondents said they have male friends who seemed overly concerned about looking muscular.
This unofficial diagnostic term refers to restricting the type or categories of food (but not the amount) to the point that it negatively affects quality of life. This is an extreme version of “healthy eating.” “Orthorexia” may be related to obsessive-compulsive disorder and may be more prevalent in men than in women, according to a 2012 study in the Archives of Psychiatry and Psychotherapy.
This unofficial term refers to restricting food or exercising obsessively to compensate for calories from alcohol. Research involving college students shows a strong association between heavy drinking, high levels of physical activity, and disordered eating, according to a 2012 study in the Journal of American College Health.