What’s the most serious eating disorder?

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Eating Disorder:  The pressures girls and women face to achieve unrealistic body ideals have been of public concern for some time. A survey by Facebook showing that social media has a negative impact on the body image of adolescent girls, for example, may even lead to congressional regulation.

But girls and women aren’t the only ones who experience negative body image. About 1 in 3 people who experience an eating disorder is male, according to the National Eating Disorders Association (NEDA).

Behaviors often associated with eating disorders, such as bingeing, purging, and fasting to lose weight, are almost as common among men as they are among women.

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 HealthTrusted Source. An estimated 10 million boys and men in the United States will experience an eating disorder in their lifetime.

The assumption among men, and even many physicians, that eating disorders primarily affect women can lead to misdiagnoses.

Due to stigma and feelings of shame, men may deny their symptoms and hesitate to seek treatment.

To address the problem in a meaningful way, it is important to recognize the particular impacts that eating disorders can have on men, identify who is at high risk, and find treatment options.

What do eating disorders look like in men?

Eating disorders in women are commonly associated with the desire to lose weight and lose weight. But the same does not happen as often with men.

“The symptoms you think of for a classic eating disorder are extreme or unhealthy weight loss behaviors, such as vomiting or fasting, but idealized male body image doesn’t really point to that same ideal,” says Dr. Jason Nagata, an assistant professor of pediatrics at the University of California, San Francisco, where he studies eating disorders in adolescents.

“A lot of men are trying to gain muscle and bulk up, so a lot of those weight loss behaviors don’t really apply to them,” Nagata explains.

In fact, Nagata’s research has found that male body ideals are influencing men’s behavior toward diet and exercise in distinctly different ways.

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

What's the most serious eating disorder


But the pursuit of extreme weight loss can also be a problem for men, particularly in certain high-risk groups.

Steve Walk, 71, collapsed on the gym floor when he was a college wrestler in high school, enduring anorexia and bulimia to compete in a lower weight class.

Walk, a retired engineer and educator living in Fredericksburg, Virginia, finally made a full recovery. He has spent years volunteering with organizations like NEDA to help people with eating disorders.

Male body image has evolved dramatically since Walk’s school days in the 1960s, with narrowing ideals increasingly focused on appearance.

But you can’t always tell just by looking at someone if they are struggling with an eating disorder. While there may be apparent signs, “eating disorders are unique in that they have consequences for both mental and physical health,” says Nagata.

Eating disorders can potentially affect every organ system in the body. An obsessive focus on diet and exercise can lead to serious and even deadly physical health impacts that require urgent treatment. But that is not always the case.

Nagata points out that it’s also possible to be physically healthy while experiencing extreme mental anguish from diet, exercise, and body dissatisfaction.

Identifying eating disorders among men as a mental health problem is crucial to advancing our understanding of them, as has been the case with anxiety and depression in recent years.

Who is at high risk for developing an eating disorder?

Athletes, people of color, and LGBTQ + people may be at increased risk for eating disorders and their associated behaviors.

Body dysmorphia, an obsessive focus on perceived flaws in the body, affects women and men equally, according to the American Anxiety and Depression Association.

Transgender people may experience body dysmorphia in relation to gender dysphoria, the term for distress over discrepancies between one’s body and gender identity.

“Transgender people, and people with gender diversity in general, have a lot of concerns about body image, because part of gender dysphoria has to do with appearance,” says Nagata.

What's the most serious eating disorder

Growing up, Henry Giardina, a Los Angeles-based editor, thought he was ignoring messages directed at girls about their bodies, valuing extreme thinness and whiteness, because he is trans and does not identify as a girl.

But those family pressures ended up resurfacing in a modified form as she transitioned.

“He wasn’t really ignoring them,” says Giardina, 33, in retrospect of the messages directed at girls. “I was welcoming them in and waiting for the moment when they could apply for me.”

After undergoing superior surgery in 2012, Giardina recalls moving from one place of bodily concern to another.

“My body problem was over,” he says of her transition. “Then it became something like, the more weight you lose, the more masculine you will be.”

Giardina found that he viewed neglected male musicians, such as Morrissey and Michael Stipe, as a personal ideal of masculinity.

With the continued help of his therapist, Giardina now works to actively fight the critical voice in her head and listen to her body. “I’m trying to get back to a natural place of recognition, ‘Oh, your body knows what it wants.’

“Due to the possible combination of messages about male and female bodies, queer men may be at increased risk of eating disorders, due to” both the pressures of thinness and the pressures of muscularity or a combination of both, “says Nagata. .

A recent research review, a trusted source, found that sexual minority adults are two to four times more likely to experience anorexia, bulimia, or binge eating compared to heterosexual cisgender adults.

In addition to different body image pressures, other minority stressors, such as discrimination, or psychological comorbidities such as depression, can contribute to the prevalence of eating disorders among queer men.

Why Are Body Concerns Increasing Among Men?

Images of immensely muscular men have become ubiquitous, circulating apps like Instagram, and taking on outsized proportions in the Marvel Cinematic Universe and on billboards and magazines.

Recent admissions from the likes of Olympic diver Tom Daley and “Eternals” star Kumail Nanjiani have pointed to the dangers of striving for an extremely muscular physique reflected so widely in pop culture.

But social media algorithms and Hollywood norms continue to propagate bodily ideals that can be dangerously unattainable.

What's the most serious eating disorder

“Social media was a very, very big factor in my eating disorder,” says 21-year-old Joseph Goldberg, who experienced anorexia, bulimia, binge eating, excess exercise, and more, before recovering and volunteering to help others. .

“I saw all these fitness people [talking about] staying slim,” says Goldberg, who is an Orthodox Jew and lives in Boca Raton, Florida.

That fueled an obsession to avoid certain foods that are not considered “clean,” like sugar and saturated fat. “It got to the point where it would take me two hours to do the shopping,” says Goldberg, because he would thoroughly study the ingredients on each label.

The broader cultural conceptions of how men are supposed to act also influence the way men relate to fighting.

“Toxic masculinity and the belief that a man should keep his upper lip stiff at all times is one of the main causes of the stigma that men cannot have eating disorders,” says Goldberg.

That sense of shame and stigma is one reason men are less likely to seek treatment or recognize their obsession with diet and fitness as a problem.

Addressing eating disorders in their early stages increases the likelihood of achieving a full physical and emotional recovery, according to NEDA.

That is why developing specific screening measures for men and fostering a culture of openness around the issue is so important in combating disorders.

The importance of inclusive language in diagnosis and treatment

While eating disorders can manifest very differently in men, the language surrounding their diagnosis remained strictly female-centered until recently.

A number of terms related to body image issues have emerged specifically in their application to men.

Nagata describes muscle dysmorphia (sometimes known as “bigorexia”) as a preoccupation or obsession with not having enough muscle, which can lead to steroid use and excessive concentration on exercise. But even that is not technically considered an eating disorder.

“Even in the term eating disorders, the focus is on diet,” while one’s relationship with food may be only part of the problem.

Ideally, Nagata favors an interdisciplinary approach to treatment, including physical monitoring, a mental health assessment, along with therapy and consultation with a nutritionist, to address any impacts a patient may be experiencing.

How Treatment and Recovery Can Work for Men

Naming the particular body problems men face and raising awareness among those who may be suffering and their medical providers is critical to developing successful treatment.

Not only that, but knowing that many other men are having similar experiences can be a significant part of recovery.

“Understanding that you are not alone is very powerful,” says Goldberg of his time participating and facilitating support groups with ANAD (National Association for Anorexia Nervosa and Associated Disorders). Especially since struggling mentally with an eating disorder can be very isolated.

During his 50 years of recovery and mentoring others, Walk, the former college wrestler, has discovered the importance of ultimately normalizing eating disorders and learning to coexist.

“Radical acceptance is a huge piece,” says Walk. “Eating disorders are part of the world, like oaks and bluebirds. Okay, “he says.” But let’s do something about it. “

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