The pressures girls and women face to achieve unrealistic body ideals have long been a subject of discussion, with many speculating the rising rates of eating disorders have a direct correlation to social media. Recently, a survey conducted by Facebook has shown that social media  negatively impacts body image in teen girls.

But despite the focus on females, males also experience negative body image. Body dysmorphia, an obsessive focus on perceived defects in one’s body, impacts women and men at equal rates, according to the  Anxiety & Depression Association of America. And according to the  National Eating Disorders Association (NEDA), approximately 1 in 3 people experiencing an eating disorder is male.

In fact, the prevalence of eating disorders in men is on the rise, according to a recent study in the  American Journal of Men’s Health. An estimated 10 million boys and men in the U.S. will experience an eating disorder in their lifetime. But boys and men are much less likely to seek treatment for their eating disorder, says Dustin Webb, a licensed clinical social worker and administrator of  behavioral health for Texas Health Dallas.

“Stigma is very real with men and eating disorders,” he says. “One primary driver involves societal gender role expectations. We still live in a world where women feel pressure to be thin and men to be big and strong, but both men and women can feel the same pressure to achieve that body type and to develop an eating disorder as a coping mechanism for how to get there.  The difference is that we tend to accept this struggle more easily for women than we do men.”

Signs of an Eating Disorder in Males

There are several forms of eating disorders, with the three most common being anorexia nervosa, bulimia nervosa and binge eating disorder.

Anorexia is primarily characterized by weight loss or maintenance by extreme dieting, starvation, or too much exercise. Anorexia is the most deadly behavioral health disorder.

Binge eating disorder involves eating unusually large amounts of food in relatively short periods of time.

Bulimia is primarily characterized by binging and purging of food.

While Webb notes that there are many contributing factors when it comes to developing an eating disorder, including a genetic predisposition, he often learns from patients that their eating disorder developed over time as a reaction to coping with stress. That stress can come from anywhere — school, home, extracurriculars, peer relations, social media, etc.

Non Wels, a mental health blogger and host of the  “You, Me, Empathy” podcast, has written and spoken about his own eating disorder, hoping to increase awareness of the issue.

When Wels was 18, he stopped eating while dealing with severe family stress. He lost a life-threatening amount of weight, his hair fell out, he was always cold, and exhausted all the time but couldn’t sleep. At his lowest point, he had suicidal thoughts. But he says realizing he had an eating disorder, then asking for help took a long time.

“Talking openly about these things would have gotten me ridiculed by my father,” Wels says. “I recognized in strangers and people I met that they were looking at me and seeing that I was struggling, but I don’t think anyone knew what to say.”

However, when a desire to be lean coincides with a desire to also be muscular, it is referred to as muscle dysmorphia, a subtype of body dysmorphic disorder. Research has found that masculine body ideals are influencing men’s behavior toward diet and exercise, with many men trying to bulk up and achieve a certain level of muscularity. According to research, 25% of normal-weight males perceive themselves to be underweight and 90% of teenage boys exercised with the goal of bulking up.

Additionally, a recent study found that nearly a third of teen boys in the United States report they want to gain weight. Nearly a quarter of young men also report taking supplements, steroids, or eating more to bulk up.

Associated symptomatic behaviors often include compulsive exercise, disordered eating characterized by protein supplementation and dietary restriction, and the use of supplements and performance-enhancing drugs or steroids.

But Webb notes you can’t always tell just by looking at someone whether they’re struggling with an eating disorder, especially because many aspects, particularly when it comes to a muscular-focused disorder, can seem healthy and normal, such as exercising, consuming healthy foods and taking nutritional supplements.

Eating disorders are unique in that they have both mental health and physical health consequences. The following behaviors can be indicative of an eating disorder:

Emotional/Behavioral

• Weight loss, dieting, and control of food are primary concerns
• Food rituals
• Social withdrawal
• Frequent dieting, body checking
• Extreme mood swings

Physical

• Noticeable weight fluctuations
• Gastrointestinal complaints
• Dizziness upon standing
• Difficulty concentrating, sleeping
• Issues with dental, skin, hair, and nail health

Who is at Risk of Developing an Eating Disorder?

Any person, at any stage of their life, is at risk of developing an eating disorder. However, there are some groups of individuals who are at an increased risk of developing an eating disorder. Athletes, people of color, and those belonging to LGBTQIA+ communities are at an increased risk.

Athletes in some types of sports could result in the development of anorexia. These types of athletes could be at risk because these sports require some element of weight restriction, according to NEDA:

• Gymnasts
• Bodybuilders
• Dancers
• Swimmers
• Wrestlers
• Runners

Olympic diver Tom Daley recently reported the extreme pressure he felt to lose weight, stating his body image issues came from within the sport.

“It was hammered into me that I was overweight and needed to lose weight in order to perform,” he says.

As for those in the LGBTQIA+ community, a recent research review found that sexual minority adults are up to four times as likely to experience anorexia, bulimia, or binge eating compared to cisgender heterosexual adults.

In addition to distinct body image pressures, other minority stressors like discrimination, or psychological comorbidities like depression, may contribute to the prevalence of eating disorders among queer men.

Broader cultural and societal conceptions of how men are supposed to act also play a role, not only in the development of an eating disorder but seeking help. A sense of shame along with that stigma is one reason men may be less likely to seek treatment or recognize their obsession with diet and fitness as an issue.

How Treatment and Recovery Can Work for Men

Addressing eating disorders in their early stages increases the likelihood of achieving full physical and emotional recovery, according to NEDA. But men have an increased risk of dying from an eating disorder because they are typically diagnosed much later than women.

men are not welcome in eating disorder programs since most are made for women.

Just as men may not seek out treatment for themselves, family members and friends may not recognize their struggle. Even some clinicians may overlook signs of eating disorders in men because of the longstanding misconception that eating disorders were a female-focused issue.

But Webb notes a lot of that is changing, starting with changing screening measures to be more inclusive.

“For many years it was widely thought in the medical and behavioral health communities that men only made up a very small percentage of eating disorders. Now we have data that negates that,” he says.

If you notice that a man in your life appears to be struggling with an eating disorder, Webb adds it is important to remain calm and express your concern with “I” statements. Do not shame, place blame or make assumptions, then give them open space to be heard.

“Early conversations aren’t about advice or judgment — they are about giving him the opportunity to talk about his struggles and to realize that his world didn’t collapse after doing so,” Webb explains.

You can suggest resources for help, but Webb adds that men are typically slower and less likely to seek out therapy on their own, but they may be more willing to visit with a primary care provider or other medical provider first.

If you receive resistance or pushback, look for a middle ground between forcing the issue and ignoring it. You can also ask if they want help making the first call or appointment.

“But be prepared – often the eating disorder is a trusted and reliable coping mechanism that isn’t easy to dump,” Webb cautions. “Not all change happens the first go-round. Show patience, genuine interest and above all else, compassion.”

Resources for Support

For those who are struggling and don’t feel like they have someone they can confide in, Webb recommends finding a support group. There are both in-person and online options available, and Texas Health Behavioral Health also offers guidance and support for adolescents and young adults.

Additional resources include:

• Call the National Eating Disorders Association helpline at 1-800-931-2237 or text “NEDA” to 741741 if you are in a crisis and need help immediately.
• Take this gender-neutral screening quiz from NEDA to find out if you do have an eating disorder and could benefit from seeking help.

Texas Health Resources’ Behavioral Health offers a complimentary assessment offered to help you identify what level of care is best, and to provide referrals, as needed. Texas Health Behavioral Resources are offered at 18 locations throughout North Texas. You can schedule an appointment online or by calling (682) 626-8719.