About 10 percent of individuals with an eating disorder who have come to a health professional’s attention are male. But there is a growing consensus that that number vastly under-represents men and boys who are suffering.
Having a “girl’s disease” might make males even less likely than their female counterparts to seek help. But self-reporting in eating disorders is rare for both genders, especially with children and adolescents.
The biggest problem remains that for parents and even health professionals, an eating disorder might not be “part of the script,” said Jocelyn Lebow, an assistant professor in clinical psychology who specializes in adolescent eating disorders at the University of Miami Miller School of Medicine.
The Diagnostic and Statistical Manual of Mental Disorders — or DSM, as it is commonly known — saw major updates in 2013 that helped pick up on disordered eating in males. Binge eating, which occurs roughly equally in males and females, is now a recognized category of eating disorder, along with bulimia nervosa and anorexia. Another important update: skipping three menstrual cycles has been eliminated as a requirement to diagnose anorexia.
“[But we] still have a ways to go to capture all of the disordered eating practices that are out there,” Lebow said. “And as they’re set up right now, the measures and criteria are still more skewed to picking up on things that you would see more with females.”
Once diagnosed, males with eating disorders face difficulties linked to their disease’s gendered stigma. Many face parents who resist the diagnosis, or who speculate about their child’s sexuality. And intensive care at a specialized center can be hard to find, with many places treating women exclusively.
“And then when they are in a treatment facility, often times they will be the only one. And that can be hard, if you’re already feeling different or shame,” said Gayle Brooks, vice president of the Renfrew Center. “To be in an environment where you are the only male can be very isolating and difficult.”
The Renfrew Center, a residential facility in Pompano Beach that treats eating disorders for girls and women, does not treat males.
As in females, male eating disorders often run concurrent to anxiety, depression, obsessive compulsive disorder and are a common result of abuse. And while it’s true that social stigma around weight is predominantly directed at and internalized by women, men are in no way immune.
One 2005 survey of high school students saw 55 percent of female respondents admit to having tried one or more eating disordered behaviors to control weight. But 30 percent of male respondents did, too.
“In this day and age, most people know not to call a teenage girl fat, unless you’re being an actual bully. But I think more people assume that a boy should be able to take that joke. But in our culture, weight stigma is a huge issue,” Lebow said. “With the obesity epidemic … people are taught that it is the worse thing in the world to be overweight, both socially and medically. And they’re really given props when they do things to lose weight even if what they’re doing is not healthy.”
Weight-restrictive sports like wrestling, swimming, gymnastics, body building, and running are often the triggers for males with eating disorders.
According to Maria Cabral, a fellow in adolescent medicine at Miami Children’s Hospital, athletes can be particularly hard to treat.
Either because the sport is too strong a trigger, or because treatment often requires taking them out of the sport at least temporarily.
“They can develop a severe depression, even become suicidal,” she said.
Gay men are also disproportionately represented in eating disorder diagnoses, something which many health professionals say is a good indication of how traumatically stressful it can be to be gay today.
“We find that it’s not the fact that one is of a particular race or sexual orientation that is the issue, but it is the stress of discrimination, the stress of rejection, of bullying, these are the sorts of things that make someone more susceptible to an eating disorder,” Brooks said.
And although research on the subject is thin, transgender persons, including transgender males, may also be more likely to face eating disorders. While some point to gender dysphoria and the desire for transgender persons to suppress their condition via undernourishment, others argue this approach neglects to take into account the social and economic marginalization of trans persons.
And because starvation by itself alters the brain to trigger disordered eating behaviors, Lebow says that with enough weight loss, “anybody can accidentally back into an eating disorder.”
Many of her patients developed their eating disorder, she said, after a chronic illness or a medication’s side effects caused them to lose a significant amount of weight.
“And I think that with those kids, people don’t see it for a really long time, because there’s a reason for their weight loss,” she said.
For parents, Lebow recommends paying attention to weight loss, to children or teens falling off their growth curve for height or weight. Behavioral changes — especially becoming more withdrawn socially — could be a red flag, even if the child or teen is maintaining their grades and participation in sports, she said. Skipping meals and large amounts of food suddenly going missing are also potential warning signs, as is a preoccupation with body and weight.
“Any behavior changes around eating, I think you should talk to your child,” she said. “Becoming a vegetarian is not a sign of an eating disorder — but it can start there with some kids. If your kid tells you they want to become vegan one day, talk to them about why. Talk to them about how they’re going to get their calories and their nutrients. Really just stay on top of those changes.”
For both male and female adolescents and adults, the University of Miami Eating Disorders Treatment Program offers treatment and therapy. Call 305-243-2301 for information.
For teens and children, both male and female, Miami Children's Hospital department of Adolescent Medicine also offers treatment and therapy. Call 305 668 5525 for more information.