Men with eating disorders are misunderstood

Despite years of scientific research showing that eating disorders affect men and not just women, many people still associate eating disorders with women. The problem isn’t just in popular media; even academics continue to publish research studies in which they include only women in their analysis. A new academic paper released online this week describes how eating disorders in men are misunderstood by both the public and treatment providers.

Binge eating is almost equally common between men and women, depending on how researchers define it (2012 source, 2007 source). About 25% of Americans suffering from bulimia were men according to a large 2007 study. Given those prevalence rates, it’s surprising that more research on binge eating and bulimia doesn't include men. 

As part of a special journal issue devoted to men and eating disorders, clinicians at a US men's treatment center review several overlooked issues faced by men with eating disorders.  For example, bulimia may go unrecognized in men who, rather than vomiting, rely on exercise to compensate for their binge eating and try to maintain a seemingly healthier weight.  Steroid use, more common among young males than females, is another behavior that's often related to disordered eating in men. A man may be trying to gain weight rather than lose weight and still be suffering from an eating disorder that's causing serious harm to his body.

Similarly, men abusing drugs might be diagnosed with substance abuse while an underlying eating disorder could be missed entirely. The use of stimulants can be a means to manage weight. While it’s of course important for men to get help for substance abuse, focusing on treating possible eating disorder symptoms afterwards should be a priority. 

Men and women with eating disorders also differ in terms of their weight in childhood or early adulthood. Men with an eating disorder often suffered from obesity before developing an eating disorder. In contrast, many women were of a normal weight before developing an eating disorder, but they but felt fat.

The review paper goes on to describe how men may not even recognize an eating disorder in themselves, much less seek out treatment. Even when aware of problematic eating/weight issues, men may feel ashamed and uncomfortable reaching out to discuss these issues. If they do take steps to see a doctor or therapist, the clinicians may miss signs of an eating disorder. This could be because of a bias in associating eating disorders with women, but also with problems in how clinicians assess for eating disorders (which is the topic of another paper in the same journal).

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Dr. Gupta is a professor at Barnard College of Columbia University and provides individual therapy at Tribeca Psychology

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