Do men have eating disorders too?
Yes they do. The most comprehensive resource on men with eating disorders is a book by Arnold Anderson, M.D. entitled, Males with Eating Disorders (1990). Some comparisons between men and women that Anderson highlights in his book are:
Historical Perspective: As much as eating disorders have been called a “women’s issue,” the first well-documented case of anorexia nervosa occurred in a 16 year old male (Morton, 1694).
Morton, R. (1694). Phthisologica: Or a Treatise of Consumptions. London:Smith and Walford.
National Center for Health Statistics (1988): 25% of Americans are overweight (e.g.., defined as 20% or more above desirable weight using insurance table charts). A larger percentage of men (25.9%) than women (22.3%) are overweight.
National Center Health Statistics, C.A. Schoenborn. (1988). Health promotion and disease prevention. United States, 1985. Vital Health and Statistics. Series 10, No. 163, DHHS Pub. No (PHS) 88-1591. Public Health Service. Washington, D.C., U.S. Government Printing Office.
Media: Men appear more comfortable with their weight and feel less pressure to be thin than women. A national survey revealed that 41% of men were dissatisfied with their weight compared to 55% of women. In fact, underweight was a much greater concern for males; only 77% of underweight men liked their appearance as opposed to 83% of underweight women (Cash, Winstead & Janda, 1986).
Cash, T.F., Winstead, B.A., & Janda, L.H. (April, 1986). The great American shape-up. Psychology Today, 30-37.
The media portrays men as concerned with physical fitness and women as concerned with their weight. Men participate in exercise at only slightly higher rates than women (43% vs. 38%) (National Center for Health Statistics, 1988). Advertisements to women focus on calories and dieting while the message to men focus on body building and toning. Magazines read by women (18-24) had 10 times more diet content than men which mirrors that 10 to 1 female to male ratio of eating disorder patients (Anderson & Mickalide, 1983).
Anderson, A.E., & Mickalide, A.D. (1983). Anorexia nervosa in the male: An underdiagnosed disorder. Psychosomatics. 24, 1067-1075.
Little boys are taught to be proud of themselves because they are strong and athletic, while girls are taught to value beauty. A Psychology Today poll confirms that men were more likely than women to claim that if they were fit and exercised regularly, they felt good about their bodies. Women respondents were more concerned with aspects of their appearance, especially weight (Cash, Winstead & Janda, 1986). Women are still judged disproportionately by their appearance and men on the basis of their wealth and power.
A distinct disadvantage of males’ obsession with physical fitness is the epidemic use of anabolic steroids to build muscle mass and boost strength. Anabolic steroids can cause psychotic reactions, such as auditory hallucinations, manic symptoms and depression Approximately 85% of all professional football players and 1 to 3% of all college seniors in the U.S. have used steroids (Slothower, 1988).
Slothower, J. (January, 1988). Mean mental muscles: The psychological price of steroids. Health. 20.
Television portrays Americans as slim and fit. Gerbner and colleagues’ (1981) analysis of a week’s sample of dramatic programs revealed that fewer than 6% of all males and 2% of all females were obese, a significant under representation of obesity in the general population. Obese men are often portrayed as powerful and authoritative; Cannon, Perry Mason, and Jake’s partner, the Fat Man, are prime examples. The majority of obese women on television are African-American (e.g., Nell Carter), perpetuating the stereotype of the black matriarch, or of low socioeconomic status (e.g., Roseanne).
Gerbner, G., Gross, L., Morgan, M., & Signorielli, N. (1981). Health and medicine on television. New England Journal of Medicine, 305, 901-904.
Dieting Patterns: According to data from the National Center for Health Statistics (1988), 56% of all overweight Americans are trying to lose weight. Approximately 48% of males are attempting to lose weight by reducing caloric intake, increasing exercise, or both, as compared with approximately 64% of females. In a sample of 1,373 high school students, females (63%) were four times more likely than males (16%) to reduce weight. Males were three times more likely to be trying to gain weight (28% vs. 9%), conforming to stereotypical ideals favoring slender women and athletic, muscular men (Rosen & Gross, 1987).
Rosen, J.C. & Gross, J. (1987). Prevalence of weight reducing and weight gaining in adolescentboys and girls. Health Psychology. 6, 131-147.
Socioeconomic Status: As socioeconomic status (typically measured by income and education) varies, so too does weight. Overweight is inversely related to education and income. The inverse relationship is more marked among women than men. The rates for overweight women are two and one-half times greater for women in the lowest education and income categories as compared with the highest categories. Rates of overweight men are fairly consistent across the education and income levels (National Center for Health Statistics, 1988).
Racial and Ethnic Influences: Obesity rates are higher among blacks (30.8%) than among whites (23.8%) according to data from the National Center for Health Statistics (1988). Although the rate for white males (26.4%) is only slightly higher than that for black males (24.8%), the rate for black females of (35.5%) is highest of all — almost 75% higher than the 20% rate for white females. For a long time eating disorders were perceived as a “young, rich, white woman’s” problem. However, more cases among minorities, older women and men are being documented. The ratio of eating disorders in white women vs. white men is 10 to 1. Male to female ratios of eating disorders in minorities have not been established to date. In one study, Gray and colleagues (1987) found low rates of bulimia among Caucasian and Black males in their college population, but found the Black males reported a higher frequency of bingeing, fasting, and dieting.
Gray, J.J., Ford, K., & Kelly, L.M. (1987). The prevalence of bulimia in a black college population. International Journal of Eating Disorders, 6, 113-124.
Occupational Hazards: Men in the following occupations are more vulnerable to eating disorders: Jockeys, dancers, swimmers, wrestlers, gymnasts, boxers, and flight attendants because these professions necessitate weight restrictions. In addition, my own experience at Notre Dame has shown some men in ROTC concerned about weigh-ins to engage in self-destructive eating habits as well.
Adolescent wrestlers who engage in repeated cycles of weight loss and regain affect their resting metabolic rates and hinder future weight control. Despite strong warnings from both the American Medical Association and the American College of Sports Medicine food and fluid deprivation practices are engaged in by wrestlers to “make weight” for matches. Forty-one percent of college wrestlers reported weight fluctuation of 5-9 lbs. every week of the season. Some can cease this behavior in the off season and some cannot (Steen & Brownell, 1988).
Steen, S.N. & Brownell, K.D. (1986). Weight loss and dietary practices in collegiate wrestlers. Presented at the annual meeting of the American Dietetic Association, Las Vegas.
Sexuality: Infertility among women due to excessive dieting and/or exercise has been well-documented by Frisch (1988). Sperm production is diminished among men weighing 25% less than ideal body weight and testosterone lowering occurs among male marathoners and top-ranked athletes yet the effect on infertility is unknown.
Frisch, R.E. (March, 1988). Fatness and fertility. Scientific American, 88-95.
Recent research highlighted in the June, 1995 ANRED (Anorexia Nervosa and Related Eating Disorders, Inc.) newsletter discussed the following:
A 1982 study of Harvard graduates found that eating disorders in women had decreased by about 50%, but the figure for men had doubled. Other researchers looked at Cornell University lightweight football players., They found that about 40% manifested “dysfunctional eating patterns” (usually binge eating or purging), and 10% fulfilled all the criteria for an eating disorder diagnosis.
Men and women with eating disorders have some similarities, but there are differences too. In both cases the person begins to starve or stuff during a major life transition: puberty, entering high school or college, leaving home, getting married or divorced, losing a loved one, losing an important relationship, getting fired, getting promoted, and so forth. In these and similar situations, the person feels overwhelmed or helpless and out of control. He or she wants very much to be back in control and tries to achieve that by controlling body shape and size.
In pubescent girls, anorexia may represent anxiety about and retreat from sexuality. Menstruation stops, or never starts, and the body looks boyish or childlike instead of lushly female. Although there are exceptions, males tend to become anorexic later, in their late teens or early 20s. For them self-starvation may symbolize confusion about sexual identity. Studies suggest that about 22% of male anorexics are homosexual. (That means that 78% are not gay, so don’t jump to hasty conclusions).
Girls and women live in a culture that unrelentingly condemns fat. Many females respond to this pressure by becoming anorexic or bulimic. Boys and men, on the other hand, generally are encouraged to bulk up, to be bigger and stronger and to occupy more space in the world. Pressures to be thin seem to affect primarily males in certain occupations and sports categories such as actors, jockeys, models, gymnasts and wrestlers. Professional athletes seem to be at risk for developing eating disorders, but even nonprofessional sports can introduce men to a food and exercise regimen that becomes compulsive.
Men who participate in long-distance running and other endurance sports can be at risk for eating disorders. In these areas the ability to live with long-term deprivation is a mark of status. Hunger and the pain of muscle and joint injuries are ignored or denied while the attainment of ever more challenging goals is glorified. Steven Zelicoff, a Pittsburgh exercise physiologist, puts it this way: “There is a certain social acceptance of (excessive) exercise. You would be frowned upon for being neurotic about the way you eat, but celebrated as a local legend for the way you exercise.”
Female compulsive athletes seem to follow a different path. Usually they become anorexic before they begin to overexercise. Their workouts become a way of achieving and maintaining weight loss.
So what kinds of help are available to men with eating disorders? The same kinds that are provided for women, but many men feel uncomfortable using them. Often they say they feel unmanly or sissy because they have a “women’s disorder.” When a man gathers the courage to enter a treatment program, he may find that he is the only male in a group of women.
Nevertheless, without treatment the future is bleak for men with eating disorders. Unless they make changes they will continue to struggle with obsessions about weight and food, compulsive dieting, binge eating and purging; damaged relationships; devastated self-esteem and medical problems ranging from minor to fatal. With treatment, including individual counseling, group therapy, family therapy, and appropriate medications, the majority of male eating disorders sufferers can recover and start building a satisfying, productive life.