Boys and men make up one third of all people with eating disorders, but most aren’t getting the care they need

Ross Sonnenblick’s experience with an eating disorder began with a simple competition with a friend. During his junior year of high school, Sonnenblick, now a psychology doctoral student at Drexel University, made a bet with a friend over which of them would look better for an upcoming pool party.

“We were going to be shirtless and showing off in front of girls,” he recalled. “I started paying more attention to what I was eating. I started exercising a little bit more. And then the situation just snowballed.”

Over the next several months, Sonnenblick said he began exercising even more intensely and limiting his food intake. As his weight dropped, his parents became increasingly concerned and eventually decided to take Sonnenblick to get help from a mental health professional.

“All the while I was denying that there was anything wrong,” Sonnenblick said. In fact, the first three psychologists his parents took him to did not even recognize there was a problem. “I was not a woman; I was not a girl. I was a boy whose weight was dropping, but who was still fairly muscular and who, from the outside, just did not fit that typical image of someone with an eating disorder.”

After his parents pushed for a fourth opinion with a new mental health professional, Sonnenblick was finally diagnosed with anorexia nervosa, and began an intense 6-month treatment for the eating disorder. He continued to see a psychologist for several years after the initial treatment ended, who worked with him on his recovery from the disorder.

“I haven’t seen a therapist for 6 years now, and while my relationship with food, eating, and exercise isn’t perfect, it’s considerably improved over what it was in high school,” Sonnenblick said.

[Related: Unrecognized eating disorders in boys and young men]

Eating disorders don’t discriminate based on gender, yet the stereotype persists that they mainly affect women. Boys and men now make up about one-third of those diagnosed with an eating disorder (Mitchison, D., et al., Psychological Medicine, Vol. 50, No. 6, 2019opens in new window). Males who struggle with these disorders face unique challenges, including stigma, misconceptions, and a reluctance to seek help. The differences in symptom presentation from the more widely recognized symptoms in girls and women hinder timely diagnosis and treatment. And while awareness of male body image and eating disorder concerns has grown in recent years thanks to several celebrities sharing their struggles publiclyopens in new window, social media posts promoting the “ideal male” body continue to attract large followings.

“We’ve always recognized that there is a subset of people, many of them boys and young men, who develop an unhealthy relationship with their bodies in the form of trying to become extremely muscular and doing so in a way that starts to really interfere with their lives,” said Lisa Damour, PhD, a clinical psychologist and author of The Emotional Lives of Teenagers opens in new window. “What I believe is happening now, and I’m eager for data to come along to help us get a clear look at this, is that social media and adolescent consumption of content around fitness, weight loss, “getting cut,” is driving a larger population of boys and young men toward an unhealthy approach to their bodies.”

As in Sonnenblick’s case, some boys and men experience more traditional eating disorders such as anorexia nervosa and bulimia, with very traditional symptoms. However, others may actually experience disordered eating patterns just outside an official diagnosis. For example, avoidant/restrictive food intake disorder, also known as ARFID, is a relatively new feeding and eating disorder category characterized by extreme food avoidance/restriction. A 2023 community-based study of more than 2,800 10-year-olds found approximately 6% of children experience ARFIDopens in new window, with no significant differences in prevalence between boys and girls.

Muscle dysmorphia, sometimes referred to as “bigorexia,” is characterized by excessive and compulsive exercise/weight-training, a belief that one is insufficiently muscular, and an obsession with muscle mass, size, and leanness. It is more common in boys and men than girls and women, studies show. Several studies have also found muscle dysmorphia is becoming increasingly common in adolescent boysopens in new window. One study, published in the Journal of Adolescent Health, found by ages 16 to 25, one-quarter of the 4,489 male participants told researchers they were worried about not having enough musclesopens in new window. Eleven percent reported using muscle-building products such as creatine or anabolic steroids.

“While overall, women do experience eating disorders at a higher rate than men do, I think people would be surprised by the number of men who do have eating disorders,” said Tiffany Brown, PhD, a psychology professor at Auburn University and co-director of the Auburn Eating Disorders Clinic, whose research focuses on developing and evaluating interventions for LGBTQ+ and male populations.

Further, because the issue is still so underrecognized in boys and men, they are often more likely to face grave consequences. A study published in JAMA Open Network in December 2023 showed sharp increases in the rates of hospitalizations for boys with eating disordersopens in new window.

“If we’re not looking for something, then we’re really unlikely to diagnose it and certainly bias and stigma come into play with any provider who is making a clinical diagnosis,” Brown said. “There was such a lack of awareness for a long time, and often men were more likely to be diagnosed with depression or something else versus an eating disorder because there has been this really inaccurate mindset that men don’t get eating disorders.”

Boys and men have also historically been excluded from research studies and the diagnostic criteria on eating disorders, experts note. It wasn’t until the release of the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in May of 2013, that the criterion of amenorrhea (loss of menstrual cycle) was removed from the diagnosis of anorexia nervosaopens in new window, allowing boys and men with the disorder to finally be able to receive an appropriate diagnosis and treatment plan. Prior to that, men and boys with anorexia were either diagnosed with the more general diagnosis of Eating Disorder Not Otherwise Specified (EDNOS) or bulimia, restricting subtype.

Another element in the under recognition of this issue in males is eating disorders have historically focused on the idea that the attitudinal, cognitive, and behavioral symptoms are driven by fear of weight gain and a pursuit of thinness, said clinical psychologist Jason Lavender, PhD, an associate professor of medicine at the Uniformed Services University who studies eating disorders and disordered eating among boys and men.

While some boys and men may pursue thinness, male body ideals are often focused more on muscularity than thinness. As a result, they display different types of unhealthy or maladaptive eating, weight control, and body shape control behaviors, often including excessive consumption of protein, obsessive exercising or weightlifting, or even the use of performance-enhancing drugs or steroids.

“So, if [a clinician] is looking for just weight loss, which are the prototypes of what we see in anorexia nervosa, then the behaviors that you see in boys or men who may have maladaptive eating disorder symptoms may look different and may go underrecognized,” Lavender said.

Sonnenblick agreed, adding that nearly all measurement and assessment tools for eating disorders have been developed predominantly or exclusively for women and girls.

“As a result, those measures focus on symptoms that are more common in women, they use language that resonates with women, and they are insensitive to detecting eating disorders in men,” he said. To combat this, Sonnenblick’s dissertation work is focused on developing a screening tool designed to capture disordered eating symptoms in ways that are more relatable to men.

“This would include the more conventional symptoms such as food restriction and purging, as well as ones that are more common in men, such as excessive exercise, excessive pursuit of weightlifting in an attempt to build muscle, even anabolic steroid usage, which is especially prevalent among younger men and boys who might be trying to build muscle,” he said.

To make matters worse, disordered eating behaviors and overexercising, particularly in athletes, is often viewed as socially acceptable, and even encouraged as a sign of being “disciplined,” Brown said. This is true for girls and women as well, but it’s particularly common for parents, coaches, and other people in boys’ lives to reinforce these behaviors.

“Similar to how we’ve reinforced thinness for women, that can set off some dangerous behaviors in young men who are at risk for developing an eating disorder or muscle dysmorphia symptoms,” she said. It doesn’t help that over the past several decades, the idealized male body image has gotten bigger and bulkier. It’s an ideal that has even worked its way into toys and movies: Studies show that action figures have gotten more muscular over the past 25 yearsopens in new window.

“These are literal superheroes that boys are looking up to, and they’re seeing this ideal in a man who’s there to help, and it ties a lot of those masculinity and muscularity things together,” Brown said.

Social media also often perpetuates harmful stereotypes related to body image and eating behaviors, experts said. A 2022 Frontiers in Psychiatry study of American high school students found that those who reported using social media more than two hours daily were 1.6 times more likely to experience body image issuesopens in new window than those who spent less time on social media.

These platforms can inundate users with images of chiseled physiques, creating unrealistic standards. A quick search of “#bodybuilding” on Instagram directs users to nearly 150 million posts showcasing the “ideal” male body.

Research is also beginning to examine the association between social media use and body image or eating disorders, particularly on photo- and video-specific social media platforms. A 2023 review studyopens in new window in PLOS Global Public Health analyzed 50 studies on social media, body image, and eating disorders, from 17 mostly high-income countries. Across the studies, users who gravitated towards specific online experiences, such as disordered eating content, posts focused on appearance, and photo sharing platforms, had a stronger relationship to negative outcomes. Social media users with preexisting body image concerns were at even higher risk of disordered eating and worsened self-image.

“Social media usage is a plausible risk factor for the development of eating disorders,” the study authors wrote, adding that the association is not unique to traditional western cultures. “Based on scale of social media usage amongst young people, this issue is worthy of attention as an emerging global public health issue.”

Another 2023 study found that the type of content consumed on social mediaopens in new window mattered more than the amount of time that was spent on the platforms. Specifically, exposure to weight loss content was associated with lower body appreciation, greater fears of negative appearance evaluation, and more frequent binge eatingopens in new window.

“We’ve always had cultural ideals spread about body image and weight, often through magazines, television ads, and movies, and we still obviously have all of those things, but now with social media, it’s just so pervasive,” Brown said.

Damour noted that much of the concern she has around social media and eating disorders stems from the fact that the algorithms that shape what young people experience online can quickly flood a young person’s feed with images of people who are ultra muscular, ultra thin, or engaging in excessive exercising or other unhealthy practices.

“For adolescents in particular, we have data showing that they are more vulnerable to perceived norms, and so seeing image after image after image of bodies that look different from their own creates conditions where they may think about themselves differently and then start to behave differently,” Damour said.

Social media also allows so many more people to spread potential misinformation in the form of advice about what to eat or not eat, how to exercise, or supplements to take, Brown noted. She added that the rise of generative AI also makes it increasingly difficult for users to recognize whether a photo is real or highly edited.

“These are just things that we have not had in our culture before that in the body image and eating sphere can be really horrific,” she said.

Detecting eating disorders early is crucial for effective treatment. The signs may be subtle, and a child or teen need not meet all criteria for an eating disorder to benefit from intervention, Brown said. Simply being more aware of the fact that body image and eating concerns do occur in boys and men is an important part of the process, she noted.

“For teachers, parents, and coaches, it’s about simply recognizing that those concerns do occur in boys and not discounting that if you’re hearing a boy talk really negatively about their body or expressing frustration with something around body image or eating or talking about bulking up,” Brown said.

Other potential warning signs of an eating disorder include:

• An intense fear of weight gain;
• Ongoing concerns with body weight and shape;
• Unusual rituals, rules, or routines around food;
• Inability or refusal to maintain a healthy weight;
• Episodes of binge eating or purging;
• Excessive or strict exercise/weight-lifting routines.

Brown noted that while taking steps to eat more healthily and exercise more often are certainly positive and, on the surface, should not be cause for concern, if it gets to a point where it’s becoming excessive, it may be time for parents to start paying closer attention.

“If a teen starts to rigidly apply certain food or exercise routines, and it’s starting to impact their social functioning, their ability to go to school or class or engage in coursework, those are things that would be the kinds of things to look out for,” she said.

In terms of what folks can do more broadly around body image concerns and or eating concerns in boys and young men, Brown added that if parents or loved ones are concerned about an adolescent’s behavior, it’s important to step in.

“Parents can start by having an honest conversation with their teen, noting that they really care about them, and they’ve noticed that there’s been some changes in their eating or how they’ve talked about their body and that they wanted to just kind of check in,” she said.

Prevention efforts in schools, within student athletic programs, and at home, that focus on challenging cultural ideals around what an “ideal man” may also prove to be effective in reducing eating disorder and muscle dysmorphia risk factors in boys and men, suggests a pilot study led by Brownopens in new window.

“It’s about having boys and men think about their own values and really try to challenge whether life would actually be that much better if they were to somehow achieve this lean, muscular body ideal. Probably not,” Brown said.