For Young Men, Eating Disorders Aren’t Always So Obvious

Cassie Shortsleeve

Society has painted a picture of what anorexia, bulimia, and other forms of eating disorders “look” like — but it’s far from accurate. (Photo: Corbis)

When Nate Nahmias was 16, he decided that he wanted to get fit.

A math- and science-oriented kid, he applied his analytical know-how to his workout regimen and diet. He meticulously planned each lift and run, and ensured every single calorie he consumed was accounted for. But he had a hard time keeping track of it all himself, so he asked his mother to set up an appointment with a dietitian. “I thought that maybe the dietitian would have some tools to help me stay on track with what I wanted,” Nahmias, now 25, tells Yahoo Health. “I thought she would applaud me for all of my hard work and strict diet.

He couldn’t have been more wrong. After calculating his body fat percentage, the dietitian told Nahmias that the number she saw was way too low. “That made me mad,” Nahmias recalls. “I wasn’t at my goal. She told me that I needed to eat certain things that I had strictly forbidden. I hated her — I put so much work into everything and she was destroying it all.” Nahmias left in a fury and became even stricter with his diet and his workouts.

A few months later, Nahmias was malnourished. His exercising and eating regimen had spiraled out of control. “I was so small and frail and so close to death that all I was, was afraid and alone,” he says. “I was scared of my body — afraid that losing any more weight would kill me and afraid that putting on any weight would make me chubby.”

Nahmias went to see a psychologist. He was officially diagnosed with an eating disorder, becoming one of 10 million American men (and 20 million American women) who suffer from anorexia, bulimia, binge eating disorder, or OSFED (other special feeding or eating disorder) at some time throughout their lives.

Unfortunately, Nahmias’ path to diagnosis isn’t rare — especially for men.

“All individuals with eating disorders face certain obstacles in seeking treatment, recognizing that they have a problem, identifying a path toward treatment, and pursuing that path,” Tom Wooldridge, PsyD, chair of the department of psychology at Golden Gate University in San Francisco, tells Yahoo Health. “However, men and boys face additional obstacles.”

That’s because their eating disorders are less likely to be recognized, both by themselves and by others. And once recognized, they face stigma, as eating disorders are often thought of as a “woman’s problem.” This stigma can be accompanied by denial and shame, Wooldridge says.

But while less talked about, eating disorders “do occur more than one would think in young adult males,” Ted Weltzin, MD, medical director of Eating Disorder Services at Rogers Memorial Hospital and spokesperson for the National Eating Disorders Association (NEDA), tells Yahoo Health. In fact, Wooldridge estimates 25 to 40 percent of people with eating disorders are males. And some large surveys suggest that concerns over body image in men have shot up over the last 30 years — from about 15 per cent to 43 per cent of guys expressing dissatisfaction with their bodies. These stats are similar to those experts see in women.

Here’s a problem: “Society typically thinks of eating disorders as anorexia or bulimia — anorexia being ‘getting really skinny and not eating’ and bulimia being ‘eating and throwing up,’” says Nahmias. So, you might wonder, why would men want to do either of those things? “They turn your body frail and unusable — that doesn’t make sense for a man,” he says.

Nate Nahmias, now 25. (Photo courtesy of Nate Nahmias)

But in reality, eating disorders are enormously more complicated than this — especially for males, Nahmias and experts say.

For starters, in order to make an eating disorder diagnosis, a medical professional must consider a slew of different criteria. Generally, if someone shows excessive concern or rigidity around food, weight, and shape, then further investigation and/or support is appropriate, says Wooldridge. “Behaviors such as binging (eating an excessive amount accompanied by a sense of losing control, with guilt and shame afterward), purging (which involves regurgitating food that has been eaten), and caloric restriction all merit concern,” he adds.

And while Weltzin says the general belief is that 25 percent of people with anorexia and 10 percent with bulimia are men, most typically, guys want to build muscle. “It’s not just by chance that men’s magazines have muscular, lean men on the covers,” he says. “Women tend to want to be small. Men may look at their chest, arms, and stomach to try to see muscularity.” This can lead to muscle dysmorphia — which is characterized by an obsession with having a muscular build.

However, men can develop any type of eating disorder, says Wooldridge, who adds that binge eating disorder — recurrent episodes of binge eating — is the most common eating disorder in men, and arguably the most prevalent eating disorder overall affecting 3.5 percent of women and 2 percent of men.

Sometimes, a burgeoning sign of an eating disorder can seem benign. It can start with exercising with a focus on changing the body because of concerns about the body. “At first, it’s not uncommon for men to describe eating disorders as working out, lifting weights, eating more healthy, or engaging in some sort of activity where the goal is to be more fit,” Weltzin says.

But ask a guy with these symptoms if they have an eating disorder, and while they may admit that some of their behavior is problematic, they’ll likely also tell you they don’t have an eating disorder, says Weltzin. Take a recent study that found that risky supplement use in men could suggest an eating disorder. One-third of the men in the study said that they suspected their supplement use was problematic. So why weren’t these men able to ID what could be a seriously dangerous relationship with food and fitness? That reason, in part, has to do with how our society “sees” eating disorders: as a female problem.

The Distorted Eating Disorder Picture

“There’s a stereotype associated with the type of person who gets an eating disorder — stick thin, females, and models. And I didn’t think I met it,” says Justin Shamoun, who developed an eating disorder at age 11.

After all, Shamoun, now 22, was an athlete — he played soccer and ran track. He never appeared too thin. He had friends and went to a good college.

Justin Shamoun, now 22. (Photo courtesy of Justin Shamoun)

So Shamoun brushed off symptoms such as restricting his food, excessively working out, and binging/throwing up. “I would say, ‘I might be dieting and exercising, but that’s not an eating disorder. I’m an athletic male,’” he remembers. Plus, as he says, he was good at hiding his eating patterns from friends and family. “I didn’t think I fit that sculpture of what a person who has an eating disorder looks like or goes through until I got sat down by my friends and realized what was going on,” he says.

What Shamoun eventually realized? Not only did he have an eating disorder — but he’d had one for almost seven years.

There are many reasons men miss eating disorders — or refuse to recognize them — and sometimes, these reasons can keep guys in denial. In fact, men are less likely than women to seek help for an eating disorder. “One of the obstacles to recognition is that men fear they’ll seem less masculine in our society,” Weltzin says.

Shamoun agrees: “I worried that people might think, ‘Oh, he’s dealing with a girl issue,’” he says. “I worried they’d think I was weak and that I couldn’t handle anything.”

There’s also the mental side of things. Eating disorders aren’t just about planning your meals, restricting your diet, or over-exercising, Shamoun says. They’re about trying to gain control over certain aspects of your life. And skewed performance-based body thoughts — “If I were skinnier, I’d be better”, “If I were at X weight, I could be faster”, or “If I had their body, I could do X” — can take over, he says. While these can be markers of an eating disorder, it’s also easy to think that they are just means to getting more fit.

How to Help and What to Do

Simple awareness could be the ticket to helping more men with eating disorders. “If someone had said, ‘Everyday, normal guys battle eating disorders,’ I would have been more open to accepting that I had one or realizing that I had one, says Shamoun, who went through treatment at age 18.

Seeking treatment is also crucial, but there’s a roadblock here, too. “Treatment settings tend to be geared toward women, so oftentimes people aren’t quite sure how to approach men — and men aren’t as comfortable as there’s a lack of identification with other people with the disorder,” says Weltzin. The good news? The majority of evidence suggests men do respond to and benefit from treatment. It might just take a little more digging to find the right medical professionals and treatment centers, he says.

Interviewing potential treatment providers about their experience with men — questions like, “Have you ever helped anyone like me?” and “Do you have experience successfully treating men?” — can help narrow down your path, he says. Organizations like NEDA also have mentors who have recovered from eating disorders and may be able to recommend providers who are familiar with men.

It’s also important to remember that recovery is an everyday thing — it’s not just, “Oh, I went through treatment and now I’m cured,” says Shamoun. While he still has ups and downs, he says, “I don’t have the body that I wanted when I had an eating disorder and the body I wanted was not what I want now.”

Today, Shamoun’s happy with his body — remaining active and even running marathons. “I just approach fitness from a different mentality. Before, I was doing those things because I was thinking, ‘Oh, only people with X body type can run a marathon, so that means if I can run a marathon, I can have that body.’ The truth is that all people with all different kinds of body types can complete all of these things.”

If you or someone you know is struggling with an eating disorder, call the National Eating Disorders Association helpline at 800-931-2237.