Most people think it is women who believe their bodies must look a certain way because of the body types portrayed on TV, runway models, movie stars, magazines, coaches, parents, friends, classmates, heroes, and Barbie dolls. They think it is women who try to achieve these body types and may suffer from eating disorders such as bulimia, anorexia nervosa or binging.
And until recently, they were right. The majority of those seeking treatment for these disorders were women.
Not anymore. Boys and men have eating disorders, too. Males make up 5 to 15 percent of patients with anorexia or bulimia and 35 percent of those with binge-eating disorder.
"I have six males now that I'm working with," says Page Love, R.D., an Atlanta-based expert on sports nutrition and eating disorders.
"It's becoming more acceptable for men to seek help," Ms. Love says, "because an eating disorder is normal and not so much of a label anymore. So men are coming out and saying they have it, whereas before they hadn't been open to seeking treatment."
Institutions such as the National Eating Disorders Association have noted a rise recently in male athletes reporting eating disorders. Wrestlers, for instance, are constantly told they need to eat less to achieve a lower weight class; they are up to 10 times more likely to develop an eating disorder than other males.
Bodybuilders are told to eat much more to achieve muscle mass. Swimmers and cross-country runners may be told to undergo extreme eating or dieting to achieve a certain body mass.
Ms. Love and other dietitians and therapists across the country have begun treating male sports figures seeking "the exaggerated buff look," teenagers seeking "the peer group look," homosexuals seeking "the thin, sexy look," middle-aged men seeking binge meals, and athletes trying to improve performance.
"There's a lot more focus on men looking buff now—a real message being sent by media and models," Ms. Love says.
"Male bulimia" often centers on "exercise compulsion," Ms. Love says. "They exercise compulsively as a means for purging or weight control," she says. "It's common with males."
Psychological trauma or a life change also can spur eating disorders in boys and men. About 7 percent of boys who have a chronic illness such as diabetes or asthma also have an eating disorder.
"If you think of the reasons people turn to alcohol or drugs, [eating disorders are] very similar," Ms. Love says. "We often see, with young women and men, that [they are] simply going through adjustments, like puberty, and it scares them. Or they may not have healthy communication in the family, or [there may be] an unhealthy focus on weight in the family because one or both of the parents has had medical problems."
Among young adults with an eating disorder, males are more likely than females to conceal their illness. That means the incidence among young males may be underreported. One study of Navy men found that 2.5 percent had anorexia, about 7 percent had bulimia and 40 percent had binge-eating disorder.
Sexual preference also plays a role in males with eating disorders. In one study, 42 percent of males with bulimia were homosexual or bisexual; 58 percent of males with anorexia said they were asexual.
Most males with eating disorders find a cure by themselves or with therapists; however, some succumb to it.
"Eating disorders have the highest mortality rate because of what it physically does to the body—malnutrition," Ms. Love says. "Heart tissue cannibalizes itself. The most common occurrence is a heart attack."
Even though most treatment centers largely focus on helping women with eating disorders, many are now opening their doors to helping men. The treatment for men and women is virtually identical, Ms. Love says.
"Treating men is the same as [treating] women. The dietitian works on nutrition by increasing food intake if the person is anorexic. The therapist does psychosocial therapy, working on the core triggers at the psychological level," she says.
The treatment of male eating disorders has become so common, she says, that facilities are being devoted to help men only.
Anorexia nervosa is characterized by self-starvation and excessive weight loss.
These are symptoms of anorexia:
Refusal to maintain body weight at or above a minimally normal weight for height, body type, age and activity level
Intense fear of weight gain or being "fat"
Feeling "fat" or overweight despite dramatic weight loss
Extreme concern with body weight and shape
Orthopedic problems, particularly in dancers and athletes, because of compulsive exercising, coupled with emaciation
Refusal to eat in front of others
Ritualistic eating, including cutting food into small pieces
Hypersensitivity to cold
Yellowish skin, especially on the palms of hands and soles of feet; this comes from consuming too many vegetables rich in vitamin A
Thin scalp hair
Feet and hands that are cold or sometimes swollen
Stomach that is distressed and bloated after eating
Confused or slowed thinking; an anorexic patient may have poor memory and lack of judgment
Bulimia nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food—more than most people would eat in one meal—in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse or over-exercising.
These are symptoms of bulimia:
Repeated episodes of binging and purging
Feeling out of control during a binge and eating beyond the point of comfortable fullness
Extreme concern with body weight and shape
Evidence, such as discarded packaging, laxatives, diet pills, emetics (drugs that induce vomiting) or diuretics (medications that reduce fluids)
Regularly going to the bathroom immediately after meals
Suddenly eating large amounts of food or buying large quantities that disappear right away
Broken blood vessels in the eyes, from the strain of vomiting
Swollen salivary glands, which appear as pouch-like areas below the corners of the mouth; these occur within days of vomiting in about 8 percent of people with bulimia
Cavities, diseased gums and irreversible enamel erosion on teeth from excessive stomach acid
Rashes and pimples
Small cuts and calluses across the tops of finger joints, caused by repeated self-induced vomiting, in which a person thrusts the hand down the throat past the front teeth
Binge eating disorder, also known as compulsive overeating, is characterized primarily by periods of uncontrolled, impulsive or continuous eating beyond the point of feeling comfortably full. Although there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression and loneliness, which can contribute to their unhealthy episodes of binge eating. Body weight may vary from normal to mild, moderate or severe obesity.
Other eating disorders can include some combination of the signs and symptoms of anorexia, bulimia and/or binge eating disorder. Although these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. All eating disorders require professional help.
© 2014 Main Line Health