When most people talk about eating issues, especially eating disorders, they think of women. It’s not without reason. 85-90% of people diagnosed with eating disorders are female, yet might those statistics be skewed by other factors? 40% of binge eaters are men, but binge eating is only one form of an eating disorder. Do men silently struggle with body image and food because it’s perceived a woman’s issue?
What about biological differences in males versus females and how those affect metabolism, activity levels, and hormones? Do socially constructed gender differences in the way men and women perceive body image, relationship to food, and strength expectations change our perception of a prevalence of struggle? Are the emotional and psychological factors that underlie these issues different for men? Does it change the statistics when we factor in differences in sexual orientation and people who are gender-nonconforming? There’s not a lot of research out there, but we can certainly discuss what we know about risk factors and the differences between the sexes.
Biological Differences in Males Versus Females
We know that females are designed to have more body fat than males. Females typically store their fat distribution in the hips and thighs whereas males tend to store more in the abdominal region. Science hasn’t identified exact reasons for the difference in body fat distribution, but there’s a suspicion it has to do with differences in hormones, hormone receptors, reproductive function, and enzyme concentrations.
Risk Factors for Eating Disorders
What we know is that there are certain temperament types that predispose people to develop an eating disorder. A methodical or cautious temperament type can predispose someone toward anorexia. A sensitive or explosive temperament type is a predisposing factor for bulimia. Anorexics with a binge/purge subtype show a combination of the aforementioned types, and it’s suspected something similar is true for binge eaters. These types appear in both men and women fairly equally. And everyone who suffers from an eating disorder has a low relationship to self, linked to low self-esteem and functioning.
Let’s also look at the psychological, chemical, and life transition factors that can either trigger the expression or protection against developing an eating disorder.
Chemically, we know low serotonin (depression) is involved. The same gene involved in substance abuse is involved in eating disorders. Psychologically, we know low self-esteem, obsessive-compulsive disorder and/or impulsive behavior, anxiety disorders, and relationship problems can all contribute to developing an eating disorder. All of these, as well as life transitions, can happen in men as well as women.
So, is social pressure different between the sexes? Are men suffering just as much, but stigmatized into silence? Or both?
Socially Constructed Gender Differences: Myths and Facts
Myth: Eating disorders are just about vanity
Fact: There are many stressors that can trigger an eating disorder. Certainly, body dissatisfaction is a factor. But many people who have body dissatisfaction don’t develop eating disorders. While some people with eating disorders get into it because they think it will make them more attractive, that’s not what keeps it going. And men are gaining increasing pressure to achieve an ideal body image from the media.
Many people underweight from eating disorders will acknowledge that starving oneself is not pretty. People who purge will often admit that purging can feel like a pretty ugly habit, feeling shame for doing so. Many people’s eating disorders function to make them look sick, to avoid unwanted sexual attention or the pressures of becoming an adult. For some it functions in just the opposite way—to get their needs for love and affection met through passive means. This often happens in a support system that struggles with emotional intelligence. For others, the rigidity of an eating disorder and an underweight body can be a trophy of perfectionism they have with them wherever they go. Eating disorders are very competitive, but come from a very low sense of self-esteem, so there’s never a sense of enjoyment that accompanies attaining the desired weight or physique. Rather, it’s a constant dangling carrot.
Myth: Eating disorders are a women’s disorder
Fact: Although women suffer disproportionately, 10-15% are men and that number is probably skewed by the stigma for men to get help. One in every three women and one in any four men are on a diet. Yet, food issues tend to be seen as a woman’s issue and women and gay men suffer disproportionately from, or are more frequently diagnosed with, eating disorders compared to heterosexual men. Each gender can translate their social fears and relationship problems into their relationships with food and body.
Myth: If men have eating disorders, they must be gay
Fact: While there’s no statistical difference between hetero and lesbian or bisexual women and eating disorders, gay men are disproportionately found to have body image disturbances and eating disorder behavior. Gay men are thought to only represent 5% of the total male population, but among men who have eating disorders, 42% identify as gay. That also means that the other 58% of men with eating disorders identify as heterosexual (there may be a small percentage that identify as bisexual, omnisexual, or asexual).
Myth: Men can’t get eating disorders because they’re supposed to be bigger
Fact: This gender expectation may explain why there’s a higher prevalence of men in the binge eating statistics. However, many men with eating disorders go unrecognized because their symptoms are written off as going the extra mile for athletics. For example, many men with bulimia learned it first in sports that require weigh-ins, such as wrestling, boxing, gymnastics, and horse racing. Running is the most addictive exercise for people with a predisposition to addiction, and track runners and triathletes often meet the criteria for anorexia, yet men (and many athletic women) get praised for this discipline even when it’s at the expense of their health.
Another hidden disorder for both men and women is orthorexia, which often thrives in progressive and fit cities. Orthorexia is a preoccupation with nutrient dense, organic foods to the point that there is guilt if one goes outside of these rigid rules or extreme anxiety to adhere to these rules. We often see repetitive use injuries and joints being blown out long before they need to in otherwise healthy young adults. That’s because in orthorexia the drive for perfectionism, through food and athleticism, is not checked by rest, recuperation, and moderation. It appeals to masculine qualities.
Myth: Men don’t have sexual or emotional trauma
Fact: Many men develop eating disorders due to emotional or sexual abuse from an athletic coach, a trusted family member, friend, schoolteacher, or religious figure. Because of the stigma for men to come to terms with being sexually abused, and because it’s common for men to question what that means about their sexual orientation, many men don’t get the support they need.
Sometimes there’s not a physical sexual trauma, but there may be a feeling of emotional incest in which an adult confides in and relies on the boy as though he were a romantic partner. This can feel confusing for emotional and psychological boundaries. When this happens, men, just as women, can act it out with food when they feel they don’t have words or even know how to describe what’s wrong.
Men also are disproportionately shamed out of their emotions compared to women. They can be ridiculed, called names like “girl” and “gay,” as if those were insults, as a means to confirm male privilege and alpha male status. For men who don’t fit into an alpha male stereotype, they can feel less than adequate. Yet that very feeling is also what may simultaneously trigger the eating disorder, and keep men from seeking help.
Many of the differences that lead to disproportionate representation of women and gay men in eating disorders are differences in how sexism can operate in peoples’ gender and gender expression, and the need to attach to a significant other for love, security and status. Sexism hurts men too, no matter what their sexual orientation, because it creates a paradigm in which to be a man means to dominate, to limit emotional awareness and expression, and to never be vulnerable.
If you’re a man who doesn’t fit into that box, it can often be difficult to know how to embody what it means to be a man with positive role models. It’s time to stop the objectification of our bodies. It’s time for men to embrace that they have emotions, too, and that’s part of the wholeness of being a man. It’s time to stop stigmatizing men for having feelings that are difficult or for needing help of any kind. If you’re a man and you recognize some signs and symptoms of disordered eating or eating disorders, you have a right to recover.
The Institute for the Psychology of Eating
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