Eating disorders have the second-highest mortality rate of any mental illness. And yet, they’re often misdiagnosed or underdiagnosed because of stereotypes and stigmas encountered by patients. However, recent research shows a rise in pediatric eating disorder hospitalizations between April 2002 and March 2020, with one of the largest relative changes in rates being among males — a population significantly overlooked. The takeaway of the study was that “existing eating disorder programs must adapt to accommodate changing patient presentations.”
It sounds simpler than it is, as diagnosing eating disorders has long relied on the stereotypes that often define them. Today, people still believe that those with eating disorders are white, thin, affluent women and girls. Research shows that that isn’t always the case.
So why is it so difficult to recognize and diagnose eating disorders in young men and boys? Yahoo Life spoke to multiple experts in the field to explore the reasons behind why this specific underrepresented group has been left out of the conversation and how the industry is working to fix the problem.
What to know about boys, men and eating disorders
They’re not as uncommon as you might think. Research shows that males represent up to 25% of those struggling with eating disorders. While extensive research is lacking, the former medical director of Toronto General Hospital’s eating disorders program, Dr. Blake Woodside, tells Yahoo Life that there have been a number of community epidemiological studies that suggest rates as high as “one male case of anorexia for every four female cases, and for bulimia, one in three.”
The Canadian Medical Association Journal reported the life-threatening nature of male cases, stating that “affected males have a 6-times higher mortality rate than those in the general population.” Woodside notes that the severity of cases between men and women is important. “Men and boys usually present looking sicker than the women do, on average,” he says. Findings published by the International Journal of Eating Disorders align with that, stating that atypical anorexia nervosa in men leads to “significant medical comorbidity” and “longer hospital stays” compared to females with the same diagnosis.
This is likely a result of poor screening for eating disorders in boys and men that allow for longer periods of illness before getting diagnosed or treated, despite the fact that the illness is “identical” in men and women otherwise. “Once a boy or a man gets anorexia, bulimia, it looks exactly the same,” says Woodside. “The only thing that’s different are the stories of the way in.”
Sports, for example, can be a protective factor for adolescent males who participate in them at higher rates than females, as muscularity is often emphasized more than thinness in athletic performance. However, this can contribute to an unhealthy obsession with nutrition and exercise as a means of building muscle for football or making a certain weight class in wrestling.
It may look different than young girls dieting for weight loss, but it’s an issue of restriction and overexercise nonetheless. “We’re so much quicker to call a woman a compulsive exerciser than a man because it fits more the masculine stereotype to be bulking up or even running and so forth,” Ruth Striegel Weissman, a clinical psychologist and editor in chief of the International Journal of Eating Disorders, tells Yahoo Life.
Conforming to beauty ideals is another thing that’s long been seen as a female problem, but has recently had a significant impact on males because of social media. “Boys and men have been catching up a little bit with women because of those pressures,” says Weissman. “It does push eating disorders all across the board.”
Why are men and boys often overlooked?
Some place blame on diagnostic criteria, which has historically been gendered towards women. Until 2013, the Diagnostic and Statistical Manual of Mental Disorders, used to diagnose mental disorders, listed the loss of menstruation as a requirement for a diagnosis of anorexia nervosa. But even as that has been omitted from the DSM-5, its most recent iteration, the stereotype that eating disorders are a woman’s disease remains.
“As a consequence, we’re not screening for them in male populations, and providers don’t have their radar out for boys or men presenting with a problem,” says Weissman. “If you’re not sensitized and you’re not asking the right questions, you are going to miss it.”
The stereotyping also affects the awareness, or lack thereof, that male patients have of their own behaviors. “Guys may feel it’s not a problem they should have, so they’re more reluctant to acknowledge it, or they may describe their behavior a little differently,” she says, recalling an interview with a young man whom she asked if he felt a loss of control when eating. He responded no, until further probing. “Well, if I was a girl, I’d say yes,” Weissman recalls him saying. “So even acknowledging losing control over something is against masculine stereotypes,” she says.
Reggie Ash, director of therapy at Equip Health, an eating disorder treatment program focused on virtual and individualized care, tells Yahoo Life that not having the language to express mental health issues or body dissatisfaction is keeping boys from getting help.
“The football team isn’t talking about their struggles. The football team is saying, ‘Who can do the most push-ups? Who can lift the most weights?’ The wrestling teams are doing the same type of things and they’re not having space even among themselves to have some of those conversations,” Ash says. “Society has to be able to create this equal playing field for anyone, regardless of gender, to be able to be vulnerable and say, ‘I’m struggling right now.'”
Experts say that treatment centers need to be more inclusive. “There are high levels of care where you have mostly females and then put one male in there,” says Ash. “That’s a struggle for them — it’s very resistant. We have to be very cognizant of that and make male groups.”
Since doing so at Equip, the program has received a 139% increase in male inquiries from 2022 to 2023, signaling the higher rates of patients looking for treatment. The program also accepted 95% more males to ensure that they’re going through the process. Even so, males just make up 14% of patients they see.
Ash says that boys and men do well in their recovery once they’re no longer resistant to it. Woodside even says that they have “higher rates of recovery” than women when they get the help that they need. But as males face more pressure when it comes to their bodies, it’s important to meet that with a community encouraging them to get to a place where recovery is possible. More body positive imagery and messaging, including the empowering stories of men who have overcome their struggles, can help.
What are the early signs of an eating disorder?
Early intervention is important when it comes to the likelihood of recovering from an eating disorder. Here, Woodside lays out what to look for when it comes to eating disorders in young boys in particular.
• Pay attention to your child’s weight curve: “If a kid falls off their weight line, say they were at the 60th percentile and now they’re at the 40th percentile, that’s trouble,” says Woodside. “Even if they don’t look a lot underweight, it means they stopped growing. And that’s a really important warning sign for parents.”
• Take note of strange eating habits: Picky eating is common in children, says Woodside. “A normal picky eater has foods that they generally don’t eat, but it’s a stable range,” he says, noting that reasons for it don’t have to do with nutritional value. “A kid who’s getting into trouble usually starts to extend the range of things they don’t want to eat. And they talk about it a little bit differently. They start to say that they’re ‘bad.’ And that’s troublesome.”
• Be aware of social life and activities: “Altering the way they live to narrow the focus of their life from a normal range of things they do to just stuff that’s focused on weight loss” is a red flag, says Woodside. For example: “They stop hanging out with their friends and all they do is watch TikTok videos and people who are dieting or exercising,” he says. “That’s a bad sign.”
