Boys and Eating Disorders

When we think of those affected by eating disorders, we usually think of girls and young women. The fact is, females do make up the bulk of those who struggle with eating disorders, including anorexia, bulimia and binge eating. But disordered eating also affects boys and men.

Estimates vary, but it is believed that a quarter to a third of those struggling with an eating disorder are male. And disordered eating behaviors are increasing at a faster rate in males than females.

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. While boys with anorexia are driven by a similar motive, the majority of them tend to be more focused on achieving a muscular physique. This manifestation is sometimes known as “reverse anorexia” or “bigorexia,” explains Douglas Bunnell, PhD, a clinical psychologist and expert on eating disorders. “These boys have all the psychological features of anorexia, except they’re pushing it in the opposite direction.”

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 it may develop earlier than eating disorders 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 into something 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 weighing himself 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, but we don’t notice the psychological suffering piece.”

The underlying causes of eating disorders in boys are thought to be the same as in girls — a combination of genetic disposition, environment and societal messages that promote and reward an “ideal” body. For men, muscular physiques and “six-pack abs” might be the goal. Athletes who compete in certain sports that emphasize weight and appearance, including gymnastics, wrestling, rowing, bodybuilding, running, and dancing, are at higher risk.

Eating disorders affect people of all sexual orientations. Overall, many more straight men have eating disorders, but homosexual men seem to be at higher risk for them.

As with young women, a negative body image can trigger disordered eating, and men have been shown to react to media images of highly chiseled men the way young women react to images of very thin models. In addition to things like movies and advertising, playing a body-emphasizing video game has been shown to increase boys’ negative body-image. And one study of young men documented the negative impact of toy action figures popular with boys, noting that the extreme muscularity in action figures is as unrealistic for young men to achieve as a Barbie doll’s figure is for young women.

 All eating disorders can result in serious health problems. Menstruation is often halted in women, and both women and men can develop a loss of bone density — osteoporosis or its precursor, osteopenia — as a result of nutritional deficits.

Men and boys with anorexia nervosa, in particular, 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.

Men are more likely to die from an eating disorder than women due to the fact that they lose weight more easily, lose body fat more quickly, and tend to be diagnosed later, if at all. There is also the risk of suicide in boys who suffer from depression and other mental health problems concurrently.

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.”