Eating Disorders in Men and Boys

Eating Disorders Not Just a Girl Problem

Although fewer men than women suffer from eating disorders, a new study indicates that the number of men with anorexia or bulimia is much higher than previously believed. Despite this, men, whose treatment needs are the same as those of women, do not seek help and, therefore, do not get adequate treatment.

"[Eating disorders] have been seen largely as an issue affecting women, and because of that, I think men have been far less likely to identify themselves as affected by it or to seek out treatment -- much in the same way as men with breast cancer tend to show up in breast cancer clinics much, much later," says the study's author, D. Blake Woodside, MD.

Because there are few large studies of men with anorexia and bulimia, Woodside, who is with the department of psychiatry at the University of Toronto, evaluated and compared 62 men and 212 women with eating disorders with a group of almost 3,800 men with no eating disorders.

Although more than twice as many women as men had eating disorders, there were more men affected than would be expected, suggesting that the occurrence of eating disorders may be higher among men than the current National Association of Anorexia Nervosa and Associated Disorders estimates. According to the group, men are thought to make up about 1 million of the 8 million Americans with eating disorders.

In terms of symptoms and unhappiness with their lives, there was little difference between men and women with eating disorders. Both sexes suffered similar rates of anxiety, depression, phobias, panic disorder, and dependence on alcohol. Both groups also were much more unhappy with how things were going in their lives than men with no eating disorders.

Woodside says his study supports the assumption that anorexia and bulimia are virtually identical diseases in men and women.

A number of reports in the medical literature suggest that gay men account for a significant percentage of male anorexia. Woodside's study did not look at this issue, but he says it should be studied further to rule out whether gay men may simply be more likely to seek treatment for anorexia, though not necessarily more likely to suffer from the disorder than heterosexual men.

"Perhaps it may have a bit of a 'snowball effect,' because men may feel if they come forward they will be thought of as homosexual, even if they are not," Woodside says.

Another expert who treats eating disorders says society has a tendency to glamorize eating disorders while at the same time making fun of the people who have them.

"The media and society believe it's all about these beautiful models trying to lose weight, when that's really not what eating disorders are about," says Mae Sokol, MD. "They're less about food and eating and much more about people's sense of self-esteem and identity and who they are."

Sokol says anorexia may be less noticeable in men than women because men can still have muscle mass even though they are thin.

"In fact, it's more dangerous for men to develop anorexia nervosa than for females ... because when males get down to the lowest weight ranges, they've lost more muscle and tissue, whereas [fat] is something you can lose for a period of time without repercussions," says Sokol, a child and adolescent psychologist at Menninger, a psychiatric hospital in Topeka, Kan.

Despite the media's focus on anorexia, bulimia, and other eating disorders, Sokol says that men are still brought up to believe it's not something that's supposed to happen to them.

"The public thinks of it as a 'girl disease,' and these guys don't want to have to come out and say, 'I have a girl disease.' Plus, to have to come to a [treatment facility] where most of the patients are women -- they don't feel good about that at all," she says.

Woodside agrees that feeling uncomfortable may be a big part of why men are less likely to go for help for an eating disorder.

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"I think, for a lot of them, it's definitely a case of 'Do I fit in here?' when men come in [to a treatment center]," he says.

In an editorial accompanying Woodside's study, Arnold Anderson, MD, writes that men seeking treatment "are often excluded from programs by gender alone or are treated indistinguishably from teenage girls."

Anderson, of the department of psychiatry at University of Iowa Hospitals and Clinic in Iowa City, says more research comparing men and women with eating disorders is welcomed because it will help identify factors that may lead to different treatment approaches.

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