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Why Some Men Are Reluctant to Open Up About Eating Disorders

eating disorder in men ill

Verywell Health / Brianna Gilmartin

Key Takeaways

  • Eating disorders can affect people of all genders, but men tend to hide their conditions because of social stigma and expectations.
  • Treatment centers often admit women only, but some have started to include men, or women and non-binary people.
  • Fitness trends and commercials directed at men perpetuate unrealistic body image and contribute to eating disorders as well.

When William Hornby began recovery from an eating disorder in college, he felt overwhelmingly alone.

At the time, the only other people Hornby knew who had eating disorders were women. He found it difficult to talk about his struggles with these friends because he thought their situations were more extreme. Without a safe place to discuss his disorder, he acted like he was fine.

“It's a very specific experience. It's a different experience to have an eating disorder when you are socialized as a man,” Hornby told Verywell.

Eating disorders affect people of all genders and these conditions can be life threatening. But men are often left out of the discussions about eating disorder discovery because of social stigma and treatment centers that have historically only accepted women. As advocates work toward breaking down treatment barriers, they emphasize having more representation to raise awareness for the recovery process.

Hornby sought out a nutritionist and a therapist who diagnosed him with an eating disorder called Other Specified Food or Eating Disorders (OSFED), in which a person has the characteristics of a significant eating disorder like anorexia but doesn’t meet all the criteria. 

While he was thankful for their support, Hornby said, he still longed for a male role model in his recovery. He searched for people like him on social media platforms like TikTok and Instagram to no avail.

Eventually, he took that role upon himself and started talking about his own eating disorder recovery on TikTok. And soon enough, he went viral.

Why Aren't More Men Talking About Eating Disorders?

Joel Jahraus, MD, Chief Medical Officer at Monte Nido, an organization that runs multiple eating disorder treatment centers throughout the country, said that men are often excluded from conversations about eating disorders because society associates these conditions with women.

“Men [who confess about] having an eating disorder puts them at risk, as far as their masculinity is concerned,” Jahraus told Verywell. 

Monte Nido runs 45 locations across 13 states, which consist of residential, inpatient, and partial hospitalization programs for people struggling with binge eating disorder, anorexia nervosa, and bulimia. Currently, about 25% to 35% of all the patients at Monte Nido are men, a significant increase from three decades ago, Jahraus said.

How Serious Is Anorexia?

Anorexia nervosa has the highest mortality rate of any mental illness, including major depressive disorder. A study suggested that men have a slightly higher risk of mortality from anorexia than women. People with anorexia or bulimia can develop bradycardia (a very slow heart rate), tachycardia, (a very fast heart rate) or arrhythmia (an irregular heart rate). If not treated, these conditions can put a person at risk for heart failure or sudden death.

Some men have also been excluded from eating disorder treatment options, according to Michael Chiumiento, PsyD, Clinical Supervisor of Adolescent and Family Services at Walden Behavioral Care, an eating disorder treatment center in Massachusetts.

He told Verywell that certain treatment centers may exclude men from admission if they're structured as residential centers instead of hospitals. These centers often admit people of the same gender for patient comfortability and safety concerns since in-patients have to share bedrooms and living spaces.

In recent years, some women-only treatment centers have started to include men, or women and non-binary people.

Societal Covers and Body Image

It can be easier for some men to hide their eating disorders in plain sight as society normalizes some unhealthy eating and exercise behaviors in men.

Brian Steinmetz, who works in news media in Ohio, has struggled with binge eating as a way to cope with depressive episodes since his mom passed away in 2015. These episodes typically begin as an attempt to comfort himself with food and end in guilt and disappointment. 

But he doubts that his close friends and family know about his condition. A former high school football player, Steinmetz has a larger build and playful personality that have masked his eating disorder.

“I've always been the strong one, the funny guy, the people pleaser,” Steinmetz told Verywell. “I wouldn't want to give off that persona, that 'Hey, I'm not always strong, I do have those moments.’

While Steinmetz’s eating disorder is emotionally driven, some are largely influenced by body image perpetuated by the fitness industry. Most of the fitness advertisements directed at men applaud a specific body type: muscular but slim.

Hornby said fitness trends initially made him think of his body as “not strong enough.” These insecurities manifested into body dysmorphia that contributed to his eating disorder. Workout cycles like “cutting and bulking season” can also mimic the binge-purge cycle in people with bulimia.

Why Is 'Purging' Risky?

Eating disorders that involve purging can increase risk of heart problems as symptoms like vomiting, laxative, or diuretic abuse can deplete the body of essential electrolytes that regulate blood levels and blood pressure.

“The same behaviors that we would cite as really, really concerning in a woman get completely ignored in men,” Hornby said.

Chiumiento noted that he has seen many patients confused about what they want their body to look like, and what it would take for them to get there. “We see this kind of conundrum really where some boys and men want to be bigger and smaller at the same time,” he said.

How Can We Improve Eating Disorder Treatments for Men?

Some eating disorders can lead to malnutrition, which can affect essential organs, electrolyte levels, metabolism, and brain functions. It can also cause substantial weight loss. Both men and women can experience loss of bone density and decline in hair, skin, and nail health due to malnutrition, Chiumiento said. 

Eating disorders can also affect male hormones, sexual organs, and sex drives. In some cases,  patients may lose testosterone or have retracting genitalia, he added.

“Something that probably isn't talked about a lot is that men also experience a significant sacrifice to sex drive and sexual functioning,” Chiumiento said. “Some of the teenage and young adult boys aren't really bringing that up until they're a little bit more comfortable in treatment.”

What This Means For You

Eating disorders are serious physical and mental health issues that can affect people of all genders. If you're struggling with your food intake or eating habits, it could be a good idea to seek help from a physician, therapist, nutritionist, or all three.

Treatment centers like Walden are trying to develop better treatment plans that can cater to a diversity of patients. Currently, Walden is debating if it’s helpful to have a “men only” treatment center for patients who identify as men, Chiumiento said.

Even in personalized treatments, discussions about eating disorders deliver the greatest impact when they’re framed as a universal experience, Chiumiento added. Sometimes, emphasizing gender and identity differences in how people experience eating disorders may reinforce shame or feelings of separation. 

“If I were in a group setting, I might start talking about eating disorders more generally, and how they've interrupted people's life goals regardless of gender or age or sexual orientation,” he said.

But the first step in developing an effective treatment approach is encouraging the patient to show up.

For people like Steinmetz, seeking help doesn’t always feel easy or comfortable because of societal expectations of men. “There’s definitely a stigma for guys to 'bottle it up, and don't talk about it.’ But that's starting to kind of get broken—and I love to see it,” he said. 

As more men open up about their struggles with eating disorders and mental health, the task of seeking professional help seems less daunting.

“I'd love to be more open about how I'm feeling and what I'm going through,” Steinmetz said. “I don't know if I'm quite there yet. I feel like I'm definitely on the right track."

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2 Sources
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  2. Edakubo S, Fushimi K. Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysisBMC Psychiatry. 2020;20(1):19. doi:10.1186/s12888-020-2433-8