With the exception of binging on food, eating disorders are seen almost exclusively as a female thing, and it certainly is true that girls struggle with these disorders more than boys. Yet eating disorders among boys and young men are on the rise. “Pediatric wards are seeing more eating-disorder cases overall, with boys making up an increasing share of patients,” notes Julie Jargon. Michaela Voss, medical director of the eating-disorders center at Children’s Mercy Hospital in Kansas City, Missouri, says that before the pandemic, 1-2% of her patients were male. That number currently stands at 6%–a threefold increase. (Jargon, 2021) Some now estimate that as many as 1 in 7 males will experience an eating disorder by age 40. (Tauber, 2021)
“Up until now, the vast majority of research on eating disorders and body-image problems has focused on females,” says Dr. Jason Nagata. “Because there have been so few studies on men, there’s not great data.” (Flax, 2022) Yet a few recent studies have suggested the problem might be more prevalent than suspected. A 2019 study that surveyed 7th and 8th-graders in Australia found that in the prior 12 months, 45% of boys had engaged in risky behaviors to control weight, such as skipping meals and exercising compulsively or exhibiting unhealthy attitudes toward food and body image. (Jargon, 2021) This doesn’t mean these boys have or will go on to develop an eating disorder, (the overwhelming majority will not), and we certainly don’t need to be raising the alarm about exercise in our severely obese society. But it means a large number of boys are body insecure and dabbling in extreme ways of controlling weight or build. It can be a short and quick slide from these types of behaviors into full-blown anorexia or bulimia.
The nature of eating disorders in boys
Eating disorders in boys have many similarities to what we see in girls. Despite popular belief, boys are just as concerned about body image as girls, and they, too, are affected by what they see on social media or the ripped and tone bodies on display throughout popular culture. Just like girls, boys compare themselves to these images and feel like they don’t measure up. Just like girls, boys want to be attractive and desirable.
In a 2020 study of 1,000 Instagram posts that examined how the male body was depicted, it was found that the majority of posts showed full body or upper body shots, and the majority were lean and muscular. Lean and muscular men also yielded significantly more likes and comments. (Flax, 2022) Unsurprisingly, people find fitness attractive. But it means that boys, too, are apt to compare themselves to a lofty ideal. One could even strongly argue that the standard is much tougher for boys than for girls: whereas girls merely need to slim down, boys must do the same while also getting big and muscular, sometimes unnaturally so.
The one key difference between boys and girls, and the thing that’s always protected males from the most severe forms of these diseases, is that boys are working toward a very different type of body ideal. Whereas females seek to be small, thin and petite, the ideal for males is large, ripped and muscular. (Our eBook Understanding & Overcoming Eating Disorders discusses the biological origins of these body ideal differences.) A 2018 study of adolescents found roughly 40% of boys who were of normal weight were actively trying to gain weight and get bigger. (Flax, 2022)
All-out starvation doesn’t serve these ideals, which helps protect boys from the harshest consequences a lot of the time. That said, there’s still plenty of room for boys to fall into anorexia or bulimia. Boys who are chubby may resort to such techniques to take off fat, and once they go down that path, these behaviors can become a habit and it’s harder to stop. Boys, just like girls, can get hooked on extreme regimens as a means of deriving a sense of control in an otherwise chaotic world. Boys, like girls, may receive praise or affirmation when they initially take off weight, and continue these habits until they’re sickly looking. Starvation may bring out the 6-pack abs every boy strives after, just not through the healthier ways other people achieve them. Boys, just like girls, can suffer from body dysmorphia.
Boys typically fall into an eating disorder for one of two reasons: 1) An obsessive desire to look fit, toned and attractive; or 2) In service to a sport they wish to excel at.
Sean Canfield’s struggles started in 7th grade, when he tried out for his school’s wrestling team. After lining the boys up, the coach “did the caliper test,” says Sean, now 24. “They grab your skin to see how much fat you have.” Before that, “I had always thought of myself as physically fit and athletic,” but “I left there not quite feeling so much like that.” In an effort to lose weight he became anorexic. At first he liked the changes, but when injuries left him sidelined, he turned to diet as the one thing he had control over, and his anorexic habits became more of a psychological crutch.
“When you are starved, your brain chemistry is all over the place,” he says. “For me, instead of something that gives nourishment and happiness, food became a way of asserting control, so I had to flip all of that.” (Tauber, 2021)
Griffin Henry had a lifelong dream of being a baseball player. He had been playing since the age of 7, and the goal was to get scouted and earn a full-ride baseball scholarship before eventually turning pro. He wound up falling into anorexia after college baseball coaches told him he needed to improve the speed of his 60-yard dash.
“I was a big dude,” says Griffin, now 20. “I thought that slimming down would make me faster, so I started running a lot and watching what I ate. A lot of his dieting and exercise tips came from Instagram influencers. “I put a lot of pressure on myself,” he says.
As he started to drop weight, his muscles popped out, and he began to look cut. Friends and relatives gave him compliments. “I was never big on how I looked and what people thought of me but I started seeing results in my body that I hadn’t seen before, and I liked that,” he says. But like so many others, he wound up taking it to an extreme.
Just half a year after receiving the advice to improve his 60-yard dash time, he was hospitalized with a diagnosis of anorexia nervosa. At the time of his admission, the 6 foot 1 inch 17-year-old weighed just 152 pounds, and his heart rate was below 50 beats a minute. (Jargon, 2021)
Eating disorders in boys are more likely to go undiagnosed
Unfortunately, it’s easy for an eating disorder in boys to go unnoticed. “There is so much shame and stigma around eating disorders for boys that many will never seek treatment or care,” says Jason Nagata, an assistant professor of pediatrics at the University of California in San Francisco. (ibid) “Doctors don’t think to evaluate a male child for an eating disorder,” adds Oona Hansen, who has acted as a mentor to those struggling. (Tauber, 2021) Because they tend to go unnoticed for longer, doctors say eating disorders in boys are often more severe by the time they get into treatment.
Just like girls, boys can be good at disguising the symptoms. “I tried as hard as my eating-disorder brain would let me to act ‘normal,'” say Sean, the wrestler whose story we discussed earlier. “I would eat normal amounts of food in their presence and then restrict everywhere else. I tried very hard to throw a shade over their eyes.”
It can be hard to talk about these things. “Eating disorders counter everything you’re told is masculinity in our culture,” says Matt Tauber. It’s therefore important that parents, teachers and coaches be proactive in watching out for the signs on their own.