Eating disorders in men
Eating disorders are often discussed as a problem primarily affecting adolescents and girls. However, the reality is that mental health professionals are seeing an increasing number of cases that begin before puberty and also involve boys.
Being a boy with an eating disorder presents its own unique challenges. The severity in a man can be as great as, or even greater than, in women , but with a key difference: both boys and their families tend to view anorexia, bulimia, and binge eating as a "girl's disease." This often leads them to take longer to recognize they have the problem or to be more reluctant to seek professional help. At the same time, society has historically focused more on the female body than the male body, and affected boys themselves explain that being overweight is more normalized in men than in women. Added to this is the fact that adolescence is typically a more intense and volatile period, both in terms of lifestyle and emotional well-being, and is associated with more disordered eating than other stages of life.
Jordi Figuerola Pérez
In fact, it is believed that the diagnosis of male eating disorder cases is often underestimated, and that they could collectively reach up to 25%, i.e., 1 in 4 community cases (as the NICE reference guide to good clinical practice warns).
Thus, it is not uncommon for children to arrive at the clinic with fully established symptoms. In one study, up to 50% of children with eating disorders who requested treatment required immediate hospitalization (Griffiths, 2014), with all the potential consequences, since delayed diagnosis and treatment, and a longer duration of the disorder, are poor prognostic factors.
The fact that eating disorders are less common in men simply means that they occur less frequently in them.
The most frequent specific eating disorder in men is binge eating disorder, followed by bulimia nervosa (30% of cases in men) and anorexia (10-15%) (Gorrell & Murray, 2020). Avoidant-restrictive food intake disorder ( ARFID ), on the other hand, occurs primarily in boys (2/3), mostly in childhood. Among cases of anorexia that begin before puberty, the proportion of boys is increasing.
The fact that in men the physical repercussions do not include amenorrhea (which has been removed from modern diagnostic criteria in favor of significant weight loss) means that the physical impact can go more unnoticed or be concealed for longer. And when weight gain has occurred, it is usually better tolerated socially and does not prompt consultation, as the physical problems it creates take longer to manifest. When a man gains weight, it is sometimes said that he is "stronger." This is rarely applied to a woman. Furthermore, in girls, puberty and the physical (and psychological) changes it entails generally occur earlier than in boys.
Is eating disorder different in boys than in girls?
Different, no. With peculiarities, yes. Let's see them.
The triggers we can find if we explore what happened are not very different between the two sexes. Boys with eating disorders have been found to have a higher baseline weight compared to girls; a history of bullying and doubts about sexual orientation are also especially common. Therefore, all of these can be precipitating factors for an eating problem in males.
Beyond this, the underlying conflicts and fears are similar in both sexes and common to adolescence in a broader sense.
The physical manifestations are also similar, but in boys, if they lose weight, the hormonal imbalance manifests differently. In girls, female hormones (estrogens) decrease, with the effect of male hormones (androgens) predominating: hair appears in typically male areas, acne develops, and menstruation ceases. In boys, androgens decrease, which is why genital and body hair is reduced, approaching the female pattern, and at the same time, sex drive decreases. Weight gain, for its part, causes medium- and long-term problems that are no less significant; these include obesity, joint strain, diabetes, and cardiovascular problems. Binge eating and vomiting themselves also contribute to acid reflux, indigestion, and bowel irregularities, including both diarrhea and constipation.
The ideal body that men aspire to also differs from that of women, which can add to any pre-existing insecurities and concerns about sexuality. These aspects will need to be addressed in therapy.
What motivates boys to alter their eating behavior?
Various reasons. Some engage in excess to release impulsiveness or manage anxiety and frustration , as many teenagers do, for example, by drinking heavily; others aim to reshape their bodies by building muscle rather than losing weight, sometimes opting for high-protein diets that eliminate sugars and fats, followed by periods of restriction (a type of behavior that encourages binge eating and bulimia). In other cases, weight loss is indeed the goal. In any case, the aim is to be liked and to feel more integrated into their peer group or sexual orientation in a society where the ideal of adolescent beauty has become increasingly androgynous and sexually ambivalent.
And a note to draw attention to the influence of digital media and social networks, where young people look for role models. Among those who primarily use apps that emphasize physical appearance, such as Instagram or TikTok, a greater preoccupation with body image has been detected, which is linked to eating disorders.
So it's important to broaden our perspective and not assume that all boys and men with an eating disorder want to build muscle, just as not all girls who cut down on their food intake exercise compulsively or induce vomiting in an attempt to become ethereal.
Regarding other additional mental health problems, eating disorders in males are more often associated with substance abuse (alcohol, drugs, anabolic hormones), and also with depression, compared to females.
Improve care for men with eating disorders
Given that most clinical scales and diagnostic tests for eating disorders were created primarily with women in mind, creating one specific to sex (for example, regarding body ideal) is an outstanding issue.
Treatment in specialized units typically offers a comprehensive approach to the various aspects of eating disorders: nutritional, psychological, and relational. It is designed to include both group sessions and individual sessions to address each person's specific difficulties. Few centers offer specific therapies for men, primarily due to the limited number of cases .
Under ideal circumstances, highly specialized treatments for eating disorders could be offered based on gender or sociocultural factors. For example, a therapy group for those who have been adopted, for those who have suffered bullying , a group exclusively for boys, or for transgender individuals, or for pre-pubescent children, or for parents who themselves suffered from an eating disorder. Currently, this is possible in very few facilities in our area, and it could be an interesting challenge for the future. On the other hand, doing so would create division and could lead to stigma. It is better to listen and act according to the needs expressed by those directly affected. What we do try to do is group individuals by age or by level of mental development (there are many different 15-year-olds, for example). What we can and must offer them is a space where they feel comfortable sharing their concerns, and thus work together to find ways to resolve them, dissociating them from food or any other behavior that becomes addictive and harmful.
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