Eating disorders in men and boys: All you need to know

It’s common for people to change their eating habits from time to time. But if dieting and concerns about your body shape and weight are becoming obsessive and starting to impact your physical health, psychological well-being and social functioning, you may be at risk of developing an eating disorder.

We spoke to the Clinical Supervisor of Butterfly’s National Helpline, clinical psychologist Dr Tania Nichols, about eating disorders in men and boys. Here’s what you need to know.

What are eating disorders? 

Eating disorders are very serious, complex mental illnesses characterised by disturbances in thoughts, feelings and behaviours towards body weight and shape, and/or towards food and eating. 

Types of eating disorders can include:

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• Other specified feeding and eating disorders and
• Avoidant/restrictive food intake disorder

What is disordered eating?

One of the greatest risk factors for developing an eating disorder is disordered eating, in particular dieting. Restricting the amount or type of food you eat, eating compulsively or having irregular or inflexible eating patterns are all forms of disordered eating.  

“We know that making some changes to your diet or lifestyle can be positive, such as cutting down on alcohol, eating more fruit and vegetables and being physically active,” Nichols says. 

“However, dietary changes can progress to disordered eating and potentially an eating disorder when you start to become obsessive and inflexible about what, when and how much you’re eating; when there is fear and anxiety around adhering to rigid food and/or exercise rules; and when concerns and behaviours around eating, body shape and weight interfere with physical health and psychosocial functioning.”

Disordered eating sits on a spectrum ranging from normal eating to an eating disorder and may have some of the same symptoms and behaviours as eating disorders, but at less frequent or severe rates.

How common are eating disorders in men?

Eating disorders can affect people of any gender, age, race, sexuality or socioeconomic status. More than one million Australians currently live with an eating disorder, about one-third of whom are male. 

According to Butterfly, 55-77% of people with other specified feeding or eating disorders are male; approximately 43% of people experiencing binge eating disorder are male; and about 20% of people with anorexia and 30% of people with bulimia are male. 

“There has been a long-held misconception that eating disorders predominantly affect females — that they are a ‘female disorder’. The stigma associated with this misconception may present as a barrier to men seeking and engaging in eating disorder treatment. Greater awareness of eating disorders in the male population and reduced stigma around mental health concerns is leading to more men seeking help,” Nichols says.

What causes eating disorders and disordered eating in men?

The factors that contribute to the development of an eating disorder can be complex, and involve a range of biological, psychological and sociocultural factors. 

According to Nichols, some factors that may place males at increased risk of developing an eating disorder include:

• Direct or perceived pressure to change appearance and weight
• External and internal pressure to adhere to the prevailing ‘lean and muscular’ appearance ideal
• Experiencing body dissatisfaction, negative body image and/or distorted body image
• Mental health conditions, such as depression or anxiety
• Media and social media influences
• Family and peer influences
• Engaging in occupations, sports and activities that emphasise body weight and shape requirements, such as athletics, dancing, modelling or horse riding
• Medical conditions, such as Type 1 or Type 2 diabetes or coeliac disease, and
• Identifying as part of the LGBTIQ+ community

“An eating disorder may develop partially as a coping mechanism for managing uncomfortable emotions,” Nichols says.

What are the signs of eating disorders in men?

Butterfly describes the following as signs and behaviours that can be associated with eating disorders in men:

• Weight fluctuations, including sudden weight loss, or weight or muscle gain
• Body dissatisfaction, negative body image and low self-esteem, closely tied to appearance
• A preoccupation with body weight, shape and appearance
• Obsessive behaviours relating to body weight and shape, such as repeated self-weighing or body checking
• A focus on muscle toning in the pursuit of leanness and muscularity
• Changes to diet and behaviour, such as counting calories, skipping meals, intermittent fasting, avoiding food groups or changes in food preferences
• Rigid thinking and behaviours around food being ‘good’ or ‘bad’ or an obsession with eating only ‘clean’ or ‘healthy’ foods
• Concealing food wrappers or eating in secret
• Binge eating
• Signs of vomiting such as swollen cheeks or jawline, calluses on knuckles, dental decay or damage, or frequent trips to the bathroom after meals
• Fatigue
• Lowered testosterone
• Fainting or dizziness
• Cold sensitivity
• Compulsive, excessive exercise, even if injured or unwell
• Distress at not being able to exercise
• Social withdrawal from friends or family
• Avoiding activities that expose the body, such as going to the beach
• Wearing loose or inappropriate clothing, such as layers of clothing during hot weather, to conceal the body
• Misusing laxatives, diuretics or appetite suppressants
• Misuse of supplements and/or use of anabolic steroids or any other performance or image-enhancing drugs
• Heightened anxiety or irritability around mealtimes, and
• Depression, anxiety, self-harm or suicidality

Risks associated with eating disorders

“Eating disorders can lead to severe, long-term and sometimes life-threatening medical consequences, including cardiovascular, gastrointestinal, neurological and endocrine concerns,” Nichols says.  

According to Nichols, eating disorders also impact cognitive and psychosocial functioning, resulting in:

• Reduced concentration
• Decision-making difficulties
• Mood concerns
• Social withdrawal
• Disability, and
• Increased risk of death due to medical complications or suicide

Suicide is a major cause of mortality for people affected by eating disorders.

“Eating disorders have one of the highest mortality rates of all psychiatric illnesses, due mostly to suicide and physiological complications,” Nichols says. “Eating disorders can also develop alongside other mental illnesses, such as depression and anxiety, and this can make recovery and returning to full health even more difficult.”

How to get help for an eating disorder or disordered eating

It’s important to see your GP first if you have any of the signs or behaviours of eating disorders or disordered eating. Early intervention can have a marked difference on an eating disorder’s severity and duration. 

Your GP can prepare a mental health care plan (or an eating disorder treatment plan if you qualify for one) to give you access to subsidised mental health sessions. You will also be referred to a psychologist and in some cases a dietician. 

A paediatrician may also be involved to support boys.

You can find psychologists, dieticians and other allied health professionals who are qualified to treat eating disorders by searching Butterfly’s Referral Database.

There can often be a waiting period to see these specialists. In the meantime, you can contact the Butterfly helpline for support by calling 1800 ED HOPE (1800 33 4673), chatting online or emailing support@butterfly.org.au. Butterfly’s confidential and free support is available 7 days a week from 8am until midnight (AEDT).