Eating Disorders in Boys and Men
Search “eating disorders” on Google, and you’ll find a wealth of images of young women. Despite this harmful stereotype, eating, weight and body image issues affect people of all ages and are becoming increasingly prevalent among boys and men. Indeed, approximately 1 in 4 eating disorder sufferers are male , and the long-term survival rate for males with eating disorders is lower than for females . Research suggests that men and boys of racial/ethnic, gender and sexual minority groups are particularly susceptible to developing eating disorders of all types, including Binge Eating Disorder (BED), Bulimia Nervosa (BN), Anorexia Nervosa (AN), and Avoidant/Restrictive Food Intake Disorder (ARFID) .
The presentation of eating disorders among males may, or may not, vary greatly from female populations. For some, concerns about muscularity, leanness and body size are central to the development of disordered eating behaviours, which may lead to the development of muscle dysmorphia (MD). Studies suggest that around 22% of boys engage in activities driven by a desire to build muscle , including dietary adjustments to support muscle growth, weight training regimes, supplementation, and steroid use. Prepubescent boys as young as 6 have been found to prefer a lean, muscular physique, despite lacking the hormonal profile necessary to build muscle effectively . Being of a higher weight also increases the likelihood of young men engaging in disordered eating behaviours such as restricting, fasting, missing meals, vomiting, binge eating and taking laxatives or diuretics, as seen in BED, BN, and AN . Individuals who take part in aesthetic or weight-based sports such as boxing, dance, horse racing, bodybuilding and gymnastics are also at particular risk due to pressure to ‘make weight’ or meet sport-specific aesthetic ideals, meaning they engage in disordered behaviours to achieve these highly pressurised standards .
Whilst more emphasis, and certainly more research, has focused on the pressure girls and women are placed under to conform to unrealistic body ideals, there is undoubtedly also pressure on men and boys. Idealised traits typically associated with masculinity such as height, size, strength, muscularity and even aggression have contributed to widespread body dissatisfaction. Statistics from the Mental Health Foundation suggest that millions of UK men are affected by body image issues.
Despite the rise in eating disorders within the male population, many go undiagnosed and untreated. Doctors can be inclined to misdiagnose due to the assumption that eating disorders mainly affect women coupled with outdated eating disorder assessment tools which have historically been developed based primarily on female aetiology and symptomology. Additionally, male sufferers are less likely to seek support due to the double stigma they may face, with both eating disorders and psychological therapy characterised as “feminine” or “gay”. In order to tackle this, improved training for doctors, the use of assessment tools specifically for men based on user feedback and lived experience, more male-only treatment services and a more open conversation around the topic are called for.
More recently, and encouragingly, diagnostic tools such as the Eating Disorder Assessment for Men (EDAM), and measures of muscularity-oriented eating attitudes and behaviours such as the Eating for Muscularity Scale (EMS) have contributed to the improved clinical understanding, support, and treatment outcomes for boys and men  and campaigns such as those spearheaded by BEAT and Time To Change are tackling the unhelpful gender bias surrounding eating disorders and mental health more broadly.
If you are a male and are concerned you may be suffering from an eating disorder, or if you are concerned about a loved one, there is a lot of help available. Your GP will be able to support you in understanding more about assessment and treatment options and how to access these, and eating disorder charity organisations such as BEAT, the National Centre for Eating Disorders, Anorexia and Bulimia Care and TalkED offer free, helplines and support.
Above all remember that full recovery is possible. Early intervention has been shown to improve treatment outcomes  so it is important not to delay accessing support. Services can facilitate early intervention by removing arbitrary access criteria such as body mass index (BMI) and comorbidities  and friends and family can support boys and men in seeking help by creating a wider dialogue around eating disorders in males and normalising accessing treatment.
Having an eating disorder can be an incredibly isolating and engulfing experience. But there is hope. Reach out.
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