Eating disorders are serious, complex illnesses that often strike during adolescence or young adulthood. Approximately 10 percent of individuals with anorexia or bulimia, and an estimated 40 percent of those with binge eating disorder, are male—and some mental health professionals believe these percentages are increasing. In addition, excessive muscle building, purging, steroid misuse, and other behaviors that are unhealthy but do not reach the level of “disorder” may be on the rise among males.

Due to a lack of data, it has not been feasible to track the frequency of male eating disorders over the past few decades. One factor that impacts prevalence studies is social stigma. Stigma has severely limited the amount of federal research in the area of male eating disorders (no one seems to want to spend a lot of money on it); stigma has also discouraged male sufferers from seeking treatment and participating in the promising studies that do finally get off the ground. Many men and boys feel ashamed of the behaviors that accompany their eating disorders—they often perceive eating disorders as “female illnesses”—and so they frequently choose to struggle with their condition alone rather than risk being judged or ridiculed.

Images of super-skinny female models are believed to contribute to body dissatisfaction and unhealthy weight loss practices in girls and women. Men may also be affected by models with unrealistic measurements. It’s rumored that former American Apparel CEO Dov Charney’s complaint that male mannequins were too big helped spur the creation of male mannequins with 27-inch waists (the average waist size of an American male is closer to 39 inches); now there are concerns that the ultra-thin mannequins encourage the development or exacerbation of eating disorders in men and boys. Waists this narrow—while appropriate for 13-year-old boys—are unrealistic, unhealthy, and, for the most part, unattainable for adult men.

The good news is that public awareness campaigns are moving forward, and although there remains a great deal of work to be done to educate the public about the symptoms and treatment of male eating disorders, there are signs of progress. Books such as The Adonis Complex and Making Weight have been instrumental in starting public conversations about male eating disorders, and it is no longer unusual for newspapers or magazines to publish articles about the trials and tribulations of male eating disorder sufferers. Billy Bob Thornton, along with other high-profile men who’ve had eating disorders, have also come forward to tell their stories.

People need to know, though, that while clinicians are seeing more males with eating disorders than they did 15 years ago, this doesn’t necessarily indicate a rise in the number of men and boys affected by eating disorders; what it may actually mean is that eating disorders are increasingly on the radar screens of educators, health professionals, athletic coaches, and parents. Continued attention to early detection and treatment holds the promise of improved health for the many boys and men who suffer from these painful illnesses every year.

Related: How to Help Kids Develop a Healthy Body Image

What is an Eating Disorder and When to Worry?

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