While doing research for my book “Being You: The Body Image Book for Boys,” I spoke with many boys and young men about their body image, physical activity and eating behaviors. These conversations were notably different than the conversations I’ve had with girls and women across my career.
For one thing, it was immediately obvious that boys and men were not practiced at discussing these issues in the ways that girls and women are, and they don’t necessarily see these issues as particularly relevant to them. In fact, those who had been diagnosed with eating disorders all seemed to say the same thing: They didn’t know that boys and men suffered from eating disorders until they were the ones suffering.
Adam Fare, an advocate for eating disorders awareness in the U.K., told me that it was difficult for him to find his way to an eating disorder diagnosis. This was “mostly due to stigma around male eating disorders and a lack of awareness even within the medical profession.”
Jason Wood, the author of “Starving for Survival,” a memoir of his journey with orthorexia, described the relief he felt when he first came to understand that he had an eating disorder. Although it consumed his life, he had never heard of orthorexia. Even as he was coming to accept that he needed help, he wasn’t sure how to describe or label what was wrong with him. Although orthorexia is an unofficial diagnosis (not formally recognized in the diagnostics and statistics manual used by psychologists), this unhealthy obsession with eating healthily can quickly erode a person’s well-being.
Before the pandemic began, there was evidence that eating disorders were on the rise. You don’t need to be a psychologist to appreciate that two years of navigating COVID-19 has negatively impacted many people’s mental health. Further, research indicates that the pandemic has created a context of isolation, anxiety and decreased access to social support and psychological support services; eating disorder symptoms have increased.
How Eating Disorders in Boys and Men Differ
Boys and men often don’t conform to popular stereotypes of eating disorders; they may not be underweight, and although they may restrict what they eat, they may also be very active. In fact, body image concerns among men often focus on muscularity and gaining weight and muscle. This poses a challenge for medical professionals. A severely underweight patient who is afraid of gaining weight can more easily be identified as struggling with an eating disorder than a patient committed to “clean” eating and daily gym workouts.
And yet, research indicates that 1/4 to 1/3 of eating disorder patients are boys and men. The most common eating disorder is binge eating disorder, which is characterized by binge episodes that are not followed by compensatory behaviors (e.g., purging). The majority of these boys and men are unlikely to seek treatment for their eating disorder, and the fatality rate – already among the highest fatality rate for any mental health condition – is higher among men with eating disorders than women.
Even in less extreme cases, eating disorders can lead to damage in all organ systems and low levels of testosterone among boys and men. Decades of research indicates that these disorders are resistant to treatment, chronic and have direct and indirect health consequences. For example, one in five patients with anorexia die by suicide.
Treatment for Eating Disorders
Recognizing the seriousness of eating disorders and the vulnerability of all genders to experience eating disorders (studies indicate that non-binary and trans individuals appear to be at heightened risk) has improved, yet there’s a long way to go to achieve widespread appreciation of the devastating consequences of these illnesses. Statistics about eating disorder risks make it clear that treatment for these disorders is essential.
Although there is less stigma surrounding mental illness than their once was, plenty of stigma still lingers. Add to this the persistent feminization of eating disorders, and it’s no wonder that boys and men are left out when it comes to support and treatment.
This is why Jason Wood tells me that his advocacy work is so important to him. “I will not stop until everyone out there knows they are enough, and it’s okay to ask for help,” he says.
I’ll also humbly suggest that education that includes all genders needs to start younger. It turns out, there are good books that can help with this.
My two books, “Being You: The Body Image Book for Boys” and “The Body Image Book for Girls: Love Yourself and Grow Up Fearless,” are intended for tweens and teens and take a broad view of body image and physical and mental health more generally. With health misinformation ubiquitous on TikTok and other media that kids are tuned into, offering evidence-based information about antecedents and consequences of body image (e.g., basic nutrition, depression) is essential if the direst of consequences – eating disorders – are to be reduced. Further, normalizing conversation about these topics will make help-seeking more likely when disorders develop.
As Adam Fare says, “I think by raising awareness and talking about our experiences, we can help change things for the better.”