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The ‘Other’ 25%: Males with eating disorders

Eating disorders are complex mental disorders that negatively impact quality of life and have serious health consequences, including death. For example, anorexia, one form of eating disorder has the highest mortality of all mental illnesses. If past statistics continue to represent the future, which we hope in the case of anorexia, they do not, as recent studies demonstrate that one in five persons with anorexia will die as a result of the disorder or its complications. Certainly this number would seem far too high to ignore.

Yet, much of our society, including health professionals, fail to recognize or suspect eating disorders in females or males despite the sometimes apparent medical signs, symptoms, and the impact of eating disorders upon society. The difficulty to easily “detect” eating disorders in both males and females, the delayed supports as a result of later recognition, plus the often delayed awareness of friends and families, does not exactly help support earlier awareness of the illness – whether in a male or female.

Many readers may be surprised that the earliest medical descriptions of eating disorders, by Richard Morton, included a 16 year old boy with anorexia in 1689. Recent studies suggest that more than one in four cases of eating disorders occur in males, yet males are underrepresented in eating disorders’ treatment, eating disorders’ public information and in eating disorders’ research. Males with eating disorders’ voices are rarely heard. Males are known to have all forms of eating disorders including: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified (EDNOS).

We know that some males with eating disorders:

  • Were teased and/or bullied as a child
  • Have low self-esteem
  • Were overweight as a child
  • May have been physically and/or sexually abused
  • Have a drive for muscularity or a drive for thinness
  • Have co-morbidities such as substance use and depression
  • Over-exercise
  • Cope emotionally with their stress
  • Who are these men and boys with eating disorders? Sometimes they are a brother, a son, a husband, a boyfriend, a father, a co-worker, a student, a teammate, a boss and of course oneself.

Speaking of the thirty or so males I have worked with plus the many I have researched, in what limited research exists, there is at least one common theme. Each male with an eating disorder is an individual. An individual who seeks to be understood without judgment, and who often wants to recover, though is uncertain precisely how to begin without any consistent or easily navigable help from health care resources.

“They” cross many cultural, age and socio-economic categories. A 10 year old boy with anorexia to a 75 year old retiree with binge eating disorder, both are included in my limited understanding of the experiences of some males with eating disorders. It is also my understanding that both females and males with eating disorders are ambivalent or hesitant to seek help at various stages of their illness for many complex reasons including loss of control, trust, personal identity, and readiness to change.

Males with eating disorders may be reluctant to seek help for a variety of additional reasons compared to females with eating disorders. The reasons that men reluctantly seek treatment or help include traditionally held ideas of masculinity. Eating disorders present an additional stigma to males. Males with eating disorders may struggle with the added misperception that eating disorders are a “female only” illness.

Resources and supports that help males with eating disorders work towards recovery continue to be lacking. Often those resources that do exist are sometimes located in facilities typically identified with women or with children though indicate they are “open” to serving men as well.

In my view, we need to increasingly focus on positive body image, health promotion, self-esteem and listen for the sometimes subtle clues in the voices of males at risk of or who have an eating disorder in our circles. For example at work, during school, during fitness and in our own homes we need to listen to the cues we give each other around body shape, body size,

By building upon community based approaches that include an increased awareness and early detection of eating disorders in males and females. This includes providing adequate early education in primary schools, support to family doctors and nurse practitioners to help people who have eating disorders. Evidence supports other services in the community including comprehensive approaches to obesity that do not shame individuals or send highly critical messages to one extreme, sometimes unravelling obesity into disorder or illness against another, wellness approaches to whole self, support groups, peer-support, counseling, family therapy, and specialist services.

Many males with eating disorders who do find support, are able to recover and lead enjoyable lives.

Paul W. Gallant is an award winning BC and Canadian health care leader, with an interest in building better relationships between health providers and patients, wellness and the patient experience across sectors. In addition to multiple roles in health leadership and consulting, including Operational Leadership of the Provincial Adult Eating Disorders Program, he co-facilitates a men’s group for males with eating disorders face to face and via telehealth and has presented at numerous conferences and health forums on the topic of males and eating disorders.