Severe Eating Disorders in Men
Medical complications and cultural stigma delaying diagnosis and treatment contribute to severe eating disorders in men and boys.
Recent estimates suggest that men and boys account for 15 to 20 percent of individuals with eating disorders. (Hudson et al, 2007) This figure represents a marked increase from previous estimates, which assumed males accounted for just 10 percent of the eating disordered patient population.
In pursuit of society’s unrealistic body ideal, nearly all males with eating disorders engage in purposeful restriction (96 percent), while 40 percent overexercise and 23 percent use methods of purging (including self-induced vomiting and laxative abuse). (Norris et al, 2012) Many males with eating disorders have a prior history of obesity/overweight, often with weight-related bullying.
In general, eating disorders become more severe over time, as behaviors progressively damage nearly all of the body’s essential organs and systems. However, even among men who are relatively new to the illness, the medical consequences of eating disorders can emerge quickly. Bradycardia (heart rate less than 60 beats per minute) is the most common medical complication in males with anorexia nervosa, as the parasympathetic nervous system slows in an attempt to conserve energy. While cardiac issues are not specific to men with eating disorders, low heart rate in a male is more often inaccurately attributed to an “athletic heart” and rationalized in clinical settings. Endocrine dysfunction is another complication of severe eating disorders in men. Low testosterone places males at increased risk for osteoporosis because this hormone is a protective factor against low bone mineral density.
Shame, stigma and gender stereotypes about eating disorders as a women’s illness prevent many men and boys from discussing their disorder with family, friends and healthcare providers. And while menstruation ceases in severely underweight females, males have no comparable physiological indication signaling the medical consequences of weight loss and malnutrition. Even body mass index (BMI), a widely used tool used to screen for an eating disorder, is more likely to be falsely elevated in men given that males have greater proportion of muscle mass and BMI fails to distinguish between lean body mass and fat. It is better to use percentage of ideal body weight (IBW) to gauge illness severity in males with anorexia nervosa or ARFID. These factors delay diagnosis and treatment of severe eating disorders in men, as their illness is overlooked in traditional medical settings. The illness intensifies over time, causing more severe weight loss, co-occurring medical complications and compromised cognitive function. As a result, men with eating disorders often require medical stabilization when they do present for treatment, and some studies suggest that mortality rates are higher for men with eating disorders than women with eating disorders, and that the risk for osteoporosis is also more elevated in men.
The good news is that the majority of medical complications of severe eating disorders are reversible with nutritional rehabilitation and weight restoration. Treatment should not only address the unique medical complications facing males with eating disorders, but also acknowledge the psychosocial recovery challenges facing men and boys. The sooner a male patient seeks treatment, the better their prognosis will be.