Severe Eating Disorders in Men

Monday, June 12, 2017

Eating Disorders in Men

300300p27278EDNmainACUTE1706 03 MedicalMonday S WellesHistorically, eating disorders are often portrayed as affecting primarily women. However, we now recognize that eating disorders affect a large number of men as well. In the United States, 10 million men will suffer from a clinically significant eating disorder within their lifetime. Societal pressures for men to decrease their percentage of body fat are widespread, just as they are for women. Unfortunately, these societal pressures can push men to develop eating disorders, leading to harmful medical consequences.

Men with eating disorders are high risk for severe medical complications, and some studies suggest that mortality rates for men with eating disorders are actually higher than for women. Often, the diagnosis of an eating disorder is delayed in men because eating disorders in men are still under-recognized. Common “red flags” used for assessing the degree of medical compromise in women—amenorrhea, low body mass index (BMI)—do not exist in male patients with eating disorders, potentially causing delayed referrals to appropriate levels of care. Unfortunately, this may result in men not being referred for treatment until they are severely malnourished. Therefore, it is critically important for primary care physicians, psychologists, dieticians, and other front line providers to be mindful of the possibility of an underlying eating disorder in their male patients and refer them for treatment as early as possible.

Of note, although BMI is still commonly used, it is now widely recognized to be a poor measure of adiposity. This is particularly true in men, because it fails to distinguish between lean body mass and fat. BMI will often be falsely normal in men with eating disorders because men have a greater proportion of muscle mass. Therefore, it is particularly important not to overlook men with eating disorders by relying on a misleading value, such as a normal BMI. 

Additionally, it is important to increase public awareness that a large number of men in the United States are affected by eating disorders. If you or a loved one has any of the following symptoms, talk to your doctor about whether you may have an eating disorder:

-Excessive dieting, restricting intake
-Intense fear of gaining weight or becoming fat
-Preoccupation with body building, weight lifting, or muscle toning
-Compulsive exercise
-Dislike of body size/shape
-Recurrent episodes of binge eating