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Eating Disorders in Men and Boys: How Stigma Impacts Care

Eating Disorders

September 19, 2022

As most of us know, the world can be highly stigmatizing - especially when it comes to mental health. Eating disorders have the highest mortality rate of all mental health diagnoses. At the same time, there continues to be a significant, harmful stereotype that in order to “deserve” eating disorder treatment, a patient must look a specific way. The idea that it is only thin, white, women who suffer from eating disorders prevents many people from seeking the care they deserve. A very prevalent example of this is seen with boys and men in our society. 

There are many factors that contribute the under-diagnosis of eating disorders in men, including the stigma of males seeking psychological help and the societal assumption that eating disorders are feminine. However, studies have shown that 10 million boys and men will experience an eating disorder in their lifetime. These numbers, unfortunately, are also on the rise (1). 

It is imperative that we correct these false assumptions surrounding gender and eating disorders. By working towards the stigmatization of eating disorders, we will improve accessibility to diagnosis and treatment. Let’s start by diving into some of the facts about eating disorders in males: 

 

The Facts About Eating Disorders in Males:

  • From 1999 to 2009, hospitalizations involving eating disorders for male patients have increased by 53%. 
  • While men struggle with all forms of eating disorders, anorexia nervosa (AN), binge eating disorder (BED) and bulimia nervosa (BN), the proportion of males reporting a lifetime prevalence of BED was greater than for AN or BN. 26% report BED vs 25% with AN and BN. 
  • Eating disorders have the highest mortality rate of any mental health diagnosis. Studies suggest that men with eating disorders have a higher mortality risk than females (2). 
  • Men with eating disorders typically suffer from co-morbid conditions such as: anxiety, excessive exercise, depression and substance disorder (3). 
  • Subclinical eating disorder behaviors (which is just a fancy way of saying the behavior type or frequency does not meet criteria for clinical status) are nearly as common among males as females (4). Subclinical behaviors include: binge eating, purging, fasting, taking laxatives. 
    • Quick side note: just because a behavior is subclinical does not mean it is not deserving of treatment. Any and all eating disorder behaviors are harmful to overall health and wellbeing. 
  • Body image concerns are very much so present in males. Per the National Eating Disorder Association, findings show (5): 
    • Most males would like to be lean and muscular, which typically represents the “ideal” male body type. Exposure to unattainable images in the media leads to male body dissatisfaction.
    • The sexual objectification of men and internalization of media images predicts drive for muscularity.
    • The desire for increased musculature is not uncommon, and it crosses age groups. 25% of normal weight males perceive themselves to be underweight and 90% of teenage boys exercised with the goal of bulking up.

These statistics about males with eating disorders highlights something big: there is a significant gap in treatment and research for a population in need. Let’s talk about how to move forward with treatment and some considerations if you or a loved one is struggling with eating disorder behaviors. 

 

Treatment Considerations for Males: 

Pay attention to red flags


We’ve established that eating disorders go mis- or undiagnosed in males largely due to a stereotype about what an eating disorder “should look like”. Let’s work to push back against that belief and start to understand that eating disorders do not have a look. Anyone regardless of age, gender, size or race can suffer with an eating disorder. Check in on yourself and your people. 

If you want some guidelines or parameters take a look at this handout Identifying Eating Concerns.pdf or blog.

Seek support


This could mean reaching out to a loved one who can help you navigate finding a specialist or going right to your primary care. Remember, studies suggest that males with eating disorders have higher mortality rates versus females, so early intervention is critical. Make sure that the people you are talking to are eating disorder informed, some reliable sources to search on include: 

  • Multi-service Eating Disorder Association (MEDA): (www.medainc.org)
  • The International Association of Eating Disorder Professionals (IAEDP): (http://www.iaedp.com/
  • ED Referral: (https://www.edreferral.com/
  • Look for eating disorder credentials in providers such as CEDRD (for registered dietitians) or CED-S (therapists and other medical providers). 

Research also indicates that being in a more male-surrounded environment with treatment can be beneficial. This could be an interesting consideration when thinking about team members that you feel safe and comfortable with. 

Review resources to feel less alone in your journey: 


Websites, research, books, can all do a fantastic job at reminding you that you are not alone. Eating disorders thrive in isolation and the more we retreat, the further the eating disorder sinks its teeth in. Seeking support is hard and you can do hard things. This resource from Kelty Mental Health provides a list of resources specific for males with eating disorders, linked
here

It’s time to end the stigma that eating disorders are a one size fits all diagnosis. If you or a loved one is struggling, please do not sit in this space. Call us today for a free, 30-minute clarity call  to help you assess the best next steps for your individual treatment needs. We are here for you!

 

References: 

  1. Sangha S, Oliffe JL, Kelly MT, McCuaig F. Eating Disorders in Males: How Primary Care Providers Can Improve Recognition, Diagnosis, and Treatment. Am J Mens Health. 2019 May-Jun;13(3):1557988319857424. doi: 10.1177/1557988319857424. PMID: 31184292; PMCID: PMC6560809.
  2. Raevuoni, A., Keski-Rahkonen, Hoek, H. (2014) “A review of eating disorders in males.” Current Opinions on Psychiatry, 27-6, 426-430. Sabel, A., Rosen, E., & Mehler, P. (2014) “Severe anorexia nervosa in males: clinical presentations and medical treatment.” Eating Disorders: The Journal of Treatment and Prevention, 22-3, 209-220.
  3. Weltzin, T. Carlson, T., et al. (2014) “Treatment Issues and Outcomes for Males with Eating Disorders” in Cohn, Lemberg. 
  4. Mitchison, D., Hay, P., Slewa-Younan, S., & Mond, J. (2014). The changing demographic profile of eating disorder behaviors in the community. BMC Public Health, 14(1). doi:10.1186/1471-2458-14-943
  5. NEDA Website: linked here 

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CATEGORIES

eating disorders

intuitive eating

diet talk

meal planning

movement

parent support

work with us!

tell me more!

I'm Ryann. Founder of NourishRX, mom of three and a certified eating disorders registered dietitian. To us, you're a unique individual with a story that led you to where you are today - not a stereotype or just a name on a chart.

Hello!

take the quiz

Which NourishRX PATH is right
for you?

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