A Hidden Battle: Eating Disorders in Men

By Todd Feist

In the midst of young girls' talk about the pressure to be thin, men's struggles with the same issues are often overlooked.

Brad Peyton has a face that the public and medical community have passed over in their search for people with eating disorders. But he refuses to allow his condition to be overlooked just because he is male.

"At my worst, I felt fat all the time. No matter what I looked like or how I felt, I could always find a flawed area of my body to pick at," says Peyton, now 23. When he first developed anorexia and bulimia, Peyton was 16, a foot taller than anyone in his grade and 225 pounds.

"I lived in my own world," says Peyton, explaining how he suffered through the taunts and jabs of other children. "I think that's what triggered it-simply wanting to fit in."

Being a man has made Peyton's problem especially pressing. In the midst of young girls' talk about the pressure to be thin, men's struggles with the same issues are often overlooked.

Recent studies estimate that one out of six people with disordered eating is male, according to Dr. Arnold Andersen of the University of Iowa School of Medicine, a leading authority on eating disorders in men.

Yet, since many of the screening instruments used for diagnosis are based on questions that come from females with eating disorders, Andersen believes the number is actually higher.

Gender expectations play a role in why many men go undiagnosed, explains Andersen. "There's more than a subtle difference in body image factors between males and females," he says. "We need to add gender-specific questions on our screening instruments to help find males with eating disorders and body image disorders."

According to Dr. Joseph Donnellan, Medical Director of the Eating Disorders Program at Somerset Medical Center in Somerville, New Jersey, instead of seeking professional help "men are much more likely to turn to drugs or alcohol to cope with their problems."

Connie Degnan, Community Liaison for the program at the Somerset Medical Center and a registered dietician, says that outreach advisors have recognized a need to provide equal attention to males and females and are reexamining education and awareness efforts. "While [parents' and educators'] focus still tends to be on girls, there is a trend to recognize eating disorders as gender neutral," says Degnan.

"This change in approach is especially needed because boys are less apt to seek out a coach or educator for help," she explains. "They may be more reticent to admit and discuss any problems they may be having because of their fears of having what is still erroneously perceived to be a ‘girls' illness.'"

According to Degnan, cultural shifts have led to an increase in male eating disorders. "Females have been struggling to measure up to the ‘waif-thin model' ideal for over 30 years, beginning with Twiggy," says Degnan. "Males are now feeling pressured to develop a ‘six-pack' and look buffed and toned."

In addition to suffering alone and hidden, males with eating disorders are at risk for unique health problems. According to a study conducted by Andersen and published in the June 3, 2000 issue of The Lancet, a British medical journal, men who suffer from eating disorders experience a greater loss of bone mineral density than women.

The good news is that effective treatments are already available, according to Donnellan. "We place males and females in the same groups and provide the same treatment plan," he explains.

The similarities in treatment can be attributed to a similarity in motives that underlie disordered eating, says the Somerset Medical Center's Degnan. "An eating disorder often develops during times of major changes in a person's life. It is an attempt to gain control when everything around is uncertain, new and perhaps frightening," says Degnan.

Donnellan points out that an eating disorder is, in essence, a human disease. "It is not any harder to make a breakthrough with men than in women," says Donnellan. "It depends on the individual."

"Of course, we focus on their individual issues, as we do with all of our patients. But most studies concur that the similarities between male and female eating disorder patients far outweigh the dissimilarities," says Donnellan.

But before individual treatment can be implemented, individual risks must be assessed.

Men and women face the same risks in varying degrees. Along with deterioration of bone mineral, people suffering from anorexia and bulimia can develop a staggering number of complications: malnutrition; loss of electrolytes; dehydration; muscular atrophy; hypo tension and hypertension; failure of vital organs; cancer of the throat and voice box; heart attack; stroke; and many other life-threatening illnesses.

If a man goes undiagnosed simply because his physician is not likely to look for the disease, the eating disorder could become fatal.

Although mortality rates for men with eating disorders are yet to be established, recent data from the American Psychiatric Association suggest that people die from eating disorders and substance abuse more frequently than from any other psychiatric disorders. Since, as Donnellan points out, eating disorders in males seem to go hand in hand with substance abuse, the urgency to address the epidemic is acute.

Peyton ultimately had to beat his own anorexia and bulimia. "Getting over an eating disorder is something you have to decide yourself. It's too easy to fool the people who are helping you," says Peyton. "Eventually you can't fool yourself."

But Peyton hasn't stopped with beating his own disorder. Currently, he is working on a film about men with eating disorders, for which he has obtained a grant from the Canadian Arts Council. He hopes to inspire others to grasp the personal strength to overcome what he has lived through.

And his courage is inspiring. "It's a terrible thing, reliving this period of my life. But in the end when others will get to see my film, I know it's going to be worth it."

After attending a state school in the Midwest, Todd has written fiction and nonfiction across the nation, covering a broad range of topics. If you have questions or comments, he can be reached at: toddfeist@hotmail.com

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