How Eating Disorders Develop in Boys & Men

Eating disorders affect men and boys at nearly the same rate as women, yet they often go undiagnosed due to stigma and misconceptions. Males may develop eating disorders driven by muscularity desires, body dissatisfaction or pressure from sports, social media, and peer expectations. Risk factors include sexual orientation, athletic involvement and occupational demands that emphasize appearance. Understanding male-specific symptoms and treatment needs can improve early recognition and recovery outcomes.

Eating Disorders in Males

Eating disorders are often considered a female illness, but more men and boys are receiving treatment than ever before. From 1999 to 2009, hospitalization of males for eating disorders increased by 53%. Despite misconceptions about eating disorders and gender, the reality is that anyone of any gender or sex can suffer from an eating disorder.

Eating disorders in men frequently go overlooked and undiagnosed despite how many men and boys suffer from their own body image issues. It’s commonly repeated that only 10% of those with eating disorders are men, a statistic that only captures presentations at clinics and hospitals. This statistic likely underestimates the prevalence of eating disorders in men and boys. Population-based studies indicate an almost equal prevalence of eating disorders between men and women.

Presentation of Eating Disorders in Men & Boys

The presentation of eating disorders often differs between men and women. Men tend to be driven by a desire for muscularity rather than the desire for thinness seen in most women with eating disorders.

While all eating disorder symptoms occur in males, a 2012 study found that purposeful restriction was by far the most common behavior, demonstrated by 96% of men with eating disorders. 40% engaged in over-exercise, while only 23% engaged in purging (including laxative abuse) and 15% engaged in bingeing.

Muscularity-driven eating disorder

Muscularity-driven eating disorder (MDED) is a term that describes abnormal eating patterns and excessive exercise with the intent to achieve greater muscularity and the fear of being too small. While MDED is not a diagnosis, it can be a useful term for men to use to describe their lived experiences.

In the last twenty years, numerous studies have focused on the drive for muscularity in males dissatisfied with their body image. In a survey of almost 15,000 young adults, 22% of males and 5% of females reported muscularity-focused disordered eating behaviors. Males are much more likely to desire increased muscularity than females, but not always. While females tend to have a fear of gaining weight, males do not necessarily object to weight gain. Men are more concerned with shape than weight as long as the weight is associated with increased muscle mass, more muscle definition or lower body fat.

Men & boys with anorexia nervosa

It’s estimated that 20% of those with anorexia nervosa are male. Presentation of anorexia nervosa is similar in both men and women, as men similarly restrict their food intake or engage in rigid food rules. However, where men differ from women is in their motivations. Women restrict their food intake to primarily achieve the thin ideal, whereas men may either restrict to achieve thinness or to become leaner but still toned, also known as “cutting (weight).”

Anorexia nervosa in men can cause low testosterone, which can cause osteoporosis, lower sperm count and quality and gynecomastia.

Men & boys with bulimia nervosa

Of men with eating disorders, an estimated 30% are thought to struggle with bulimia nervosa. While bulimia nervosa presents similarly in both men and women, some studies suggest men with bulimia nervosa experience less concern about eating and don’t experience as much loss of control when binge eating.

Some experts note that a binge episode is more likely to present through a “cheat meal” – a planned high-calorie meal that can be as high as 9,000 calories that occurs within a usually strict dietary or fitness regimen – in men.

Those with bulimia nervosa are already at an increased risk of coronary heart disease (CHD), but this risk may be compounded in men with eating disorders since men are alreadt at a greater risk of developing CHD than women.

Binge eating disorder in men

Binge eating disorder (BED) is the most common eating disorder diagnosis, with 40% of those with BED being men and boys. Studies also note that men were three times more likely to report a clinically significant frequency of binge eating compared to women.

Other eating disorders in men

Men and boys make up the majority of those diagnosed with some other eating disorders, including 77% of those with other specified feeding or eating disorder (OSFED) and 67% of those with avoidant restrictive food intake disorder (ARFID).

Self-perception & Body Image in Men & Boys

Body image is another area where men and women with eating disorders differ. Men typically have a wider range of body ideals than women and perceive their weight differently. Together these can contribute to the development of an eating disorder.

Male body ideals

Men and boys experience a wider variety of body ideals than women and girls. While females tend to only desire thinness, males desire a range of physique goals, including very thin, extremely muscular and lean muscularity.

From a young age, the media showcases images of impossibly fit men with defined abs and lean muscularity as the male ideal, which is the most desired body type among men. This has been shown to cause negative self-comparisons in consumers, with the goal to sell products to improve health, appearance, weight, muscularity and shape.

Men and women also tend to focus on different areas on the body. While women tend to be dissatisfied with their body from the waist down, men tend to be dissatisfied with their body from the waist up.

Perception of weight

Unlike girls, who tend to perceive themselves as fat at more than 15-18% below population norms, boys learn to perceive themselves as fat at slightly above population norms. This is also when adolescent males are most likely to develop their eating disorder.

Because of the decreased pressure for boys to diet compared to girls, they tend to only do so under certain conditions:

• To avoid being teased again as they were for childhood obesity
• To increase sports performance
• To avoid developing similar weight-related medical illness as their father
• To attract men, if gay or bisexual

Risk Factors for Eating Disorders in Males

Risk factors for the development of eating disorders in men and boys include gay and bisexual orientation as well as sports, hobbies or work.

Gay & bisexual orientation

Research suggests that up to 42% of males with eating disorders are gay, For gay men, a higher BMI, peer pressure, gender role conflict and lower levels of masculinity are associated with greater body dissatisfaction and disordered eating behaviors. Gay and bisexual boys also experience greater rates of:

• Disordered eating behaviors
• Body dissatisfaction
• Purging
• Binge eating
• Diet pill usage
• Fasting

The use of dating apps is also a risk factor for both gay and bisexual men, likely due to the added pressure to achieve a certain body type to attract a partner and the focus on physical appearance on dating apps.

Studies of gay and bisexual men also found that higher frequency of use of social media platforms, particularly those with a focus on appearance, was associated with greater muscularity-oriented body image concerns.

Sports, hobbies & work

Males who participate in sports, hobbies or vocations that incentivize thinness for appearance and/or performance are more likely to develop disordered eating behaviors than their peers.

Sports are a well-studied risk factor for the development of an eating disorder, with 19% of male athletes struggling with disordered eating behaviors and 8% previously diagnosed with an eating disorder.

Athletes with eating disorders can be more difficult to identify and diagnose, due to stigma or a concern their athletic season will be disrupted by treatment. Elevated rates of eating disorders are found in many sports, including:

• Wrestling
• Gymnastics
• Swimming
• Track and Field
• Equestrian
• Football

Certain occupations that emphasize appearance are also at an increased risk of eating disorders, like modeling and dancing.

References

• Gorrell, S., & Murray, S. B. (2019). Eating disorders in males. Child and Adolescent Psychiatric Clinics of North America, 28(4), 641–651. https://doi.org/10.1016/j.chc.2019.05.012
• Eating Disorders in Males. National Eating Disorders Collaboration. Retrieved September 20, 2022.
• Hudson JI, Hiripi E, Pope HG, et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey replication. Biol Psychiatry 2007;61:349–58. 
• Hay P, Girosi F, Mond J. Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. 2015;3(1):1-7.
• Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, Patterson RM, Murray HB, Bryant-Waugh R, Becker AE. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord. 2015;48(5):464-70.
• Norris, M. L., Apsimon, M., Harrison, M., Obeid, N., Buchholz, A., Henderson, K. A., & Spettigue, W. (2012). An examination of medical and psychological morbidity in adolescent males with eating disorders. Eating Disorders, 20(5), 405–415. https://doi.org/10.1080/10640266.2012.715520