What causes eating disorders?

Genetics and the environment both influence the development of eating disorders. Research is showing that, like other medical and mental health illnesses, there is a genetic link to eating disorders. Genes set the stage. The environment puts the ball in motion. And the environmental triggers can come from peers, family dynamics or our larger culture that is obsessed with looks and perfection.

What is the prevalence of eating disorders in males?

According to a 2007 Harvard University study, 25 percent of those who struggle with anorexia or bulimia and 40 percent of those who struggle with binge eating are male. Some researchers in the field estimate that the number of males struggling with anorexia and bulimia may be closer to 30 percent.

Why do you think we are seeing an increase in the number of boys and men developing these disorders?

I think that our culture’s emphasis on having the so-called “perfect” male body is helping drive this increase – think chiseled torso and “six-pack abs.” Research shows that when men are shown slides of a male model, they experience an increase in body dissatisfaction. And body image disturbance is a key element in the development of an eating disorder. Men are now under the same pressure as women to achieve the unachievable: physical perfection.

Are there any differences between male and female eating disorders? If so, what are they?

Once an eating disorder has developed, it looks very similar clinically in both sexes. However, males and females take different paths in developing eating disorders. For women, dieting is the central gateway into an eating disorder. For men, excessive exercise and fasting tend to be the gateway. The sexes also differ on what they focus on; eating disordered women obsess about their body weight, whereas eating disordered men obsess more about their body shape, particularly from the waist up. Studies also show that 50 percent of men who develop an eating disorder were overweight when they were children or adolescents, and were teased by their peers because of their bodies. So, where women who develop an eating disorder may feel overweight, half of eating disordered men actually were overweight. Also, men are more likely than women to develop an eating disorder in an attempt to avoid health issues their fathers experienced. For instance, if a man’s father suffered from a heart attack, the young man may go into overdrive with his exercise and calorie counting and diet to avoid a similar fate. Also, something unique to men is “reverse anorexia,” where guys may use steroids or exercise relentlessly to achieve a larger, more muscular body because they constantly feel too small.

Are some men at a greater risk of developing eating disorders?

Yes. Males who participate in sports that have weight classes or necessitate weight restriction (e.g., wrestling, gymnastics, swimming, track, rowing) are at a higher risk. Guys who were overweight and teased by their peers are at a high risk, too. Certain professions like models and jockeys are also vulnerable. One of the highest-risk groups [is] gay and bisexual men. According to the Academy for Eating Disorders, at any given time, 10 percent of late adolescent and adult females struggle with some sort of disordered eating symptoms. A study conducted in 2007 revealed that over 15 percent of gay and bisexual males have struggled or struggle with some form of disordered eating.  

Do males usually seek treatment for their eating disorder?

Unfortunately, many do not. Many eating disordered males go undiagnosed because these disorders are still seen as a “female problem.” Eating disorders are not part of the traditional male health paradigm. Because many in our society, including health care providers, consider this disorder a “female issue,” there is a great deal of shame attached to male eating disorders, which keeps many men from admitting to themselves, much less their loved ones or doctors, that they have a problem with food, their body image or excessive exercise.

What are some signs that someone you know may be battling an eating disorder?

For males, excessive exercise can be a red flag, especially if he is exercising when he is ill, injured or exhausted. Also, skipping meals or fasting can be a clue that something is going on. Excessive body checking in the mirror or weighing himself many times a day can also signal a potential problem. If he is constantly making comments about being too fat or not being muscular enough, that could be a sign, too.

What kind of physical side effects can an eating disorder have on a male if left untreated?

Eating disorders can do tremendous damage to the human body regardless of the patient’s gender. The digestive system and the cardiovascular system can be severely compromised. Also, like women, men can develop osteoporosis. The main difference with men, of course, is the level of testosterone, which can be greatly reduced in an anorectic male. It is crucial to get treatment. If left untreated, eating disorders can kill. They are the most lethal of all psychiatric disorders.

What would you say to a male who you think may have an eating disorder?  

I would acknowledge the courage it took to voice his concerns. It takes a lot for guys to step forward and admit that they have issues with food and body image. Most importantly, I would encourage him to seek help from a team of professionals (physician, therapist, dietitian) who understand male eating disorders. The sooner treatment begins, the better the prognosis for recovery.   

Brad Kennington, LMFT, LPC, is the executive director of Cedar Springs Austin Eating Disorder Center. For more information, please visit www.cedarspringsaustin.com.