Though eating disorders are typically associated with young women, they can affect people of any age and gender, including boys. Currently, at least one-third of eating disorder patients are men, and rates of disordered eating are rising more quickly in young males than females. These trends accelerated during the pandemic, as many children attempted to cope with heightened anxiety, isolation, and a loss of routine by controlling their relationship with food and exercise. Increased reliance on social media to maintain social connections may also have contributed to more boys developing body image issues over the last several years.
Unfortunately, young men face significant barriers to treatment, and their disordered eating habits often go unrecognized by parents, educators, and doctors. Eating disorders look different in boys, and screening tests are often biased towards female symptoms, making early detection difficult. Boys also face more shame and social stigma surrounding disordered eating, so they’re more likely to experience denial and have difficulty asking for help. As a result of these gaps in treatment, boys are more likely to experience serious adverse health outcomes from having an ED.
What Are Eating Disorders?
Contrary to popular belief, not all eating disorders involve food restriction or result in significant weight loss. An eating disorder is defined as any sustained pattern of disturbed eating, such as eating too much, too little, or too selectively, that is severe enough to interfere with daily life. Typically, these changes in eating habits are accompanied by negative or obsessive thoughts and feelings about food, weight, or body image. In some cases, sufferers may also engage in extreme, compulsive exercise. Eating disorders are a form of mental illness, and as such, they require professional treatment.
What Types of Eating Disorders Are Most Common in Males?
Males make up just 20% of anorexia patients and 30% of bulimia patients, which is one reason why eating disorders are harder to spot in boys. Males are more likely to suffer from lesser-known EDs; 43% of those with binge eating disorder are male, for example, and up to 77% of people diagnosed with Other Specified Feeding and Eating Disorder (OSFED) are male. Men also constitute 67% of avoidant/restrictive food intake disorder (ARFID) patients. (ARFID differs from anorexia in that patients with ARFID do not under-eat due to body-image issues or a fear of gaining weight. Their behaviour is often driven by extremely limited food preferences and anxiety surrounding eating, such as a fear of choking or vomiting.)
What Causes Eating Disorders in Boys?
Eating disorders occur due to a complex mix of genetic, social, and psychological factors. Studies suggest that eating disorders can run in families; children are 11 times more likely to develop an ED if they have a close relative who suffers from one. Experiencing anxiety or depression also significantly increases a person’s risk of becoming eating disordered.
Emerging research suggests that learning and developmental disorders may play a role in disordered eating (both due to differences in the brain and the negative self-image that often accompanies these conditions). Kids with ADHD, for example, are more likely to suffer from bulimia and binge eating disorders than their neurotypical peers. ADHD is also linked to the development of ARFID, as is Autism Spectrum Disorder, sensory processing disorder, and developmental disabilities.
Finally, social pressure to achieve unrealistic body ideals can also influence the development of eating disorders in susceptible individuals. Participating in activities where there is a significant emphasis on body size and weight, such as wrestling, equestrian sports, or the performing arts, can trigger disordered eating in at-risk boys. Excessive use of social media can also worsen body image issues in boys. According to one study, the more social media accounts an adolescent has, the more likely it becomes that he'll experience disordered thoughts and behaviours around food.
What Are the Symptoms of Eating Disorders in Boys?
Eating disorder symptoms vary depending on the type of ED a person has, and eating disorder signs in boys often differ from those seen in girls. Because boys face different boy image pressures than girls, they often express a desire to be lean and muscular rather than small and delicate, for instance.
Unlike girls, many boys with restrictive-type EDs initially attempt to gain weight (in the form of muscle mass), which makes them more likely to engage in excessive exercise early in their disorder. However, they often turn to food restriction later, either to increase muscle definition or because they sustain an injury that inhibits their ability to exercise.
Other signs of eating disorders in boys include:
- Rapid fluctuations in weight (either losing or gaining weight).
- In the case of binge eating, hiding or hoarding food.
- Compulsive exercise (exercising multiple times a day, exercising when tired, ill, or injured, or becoming distressed or restricting food when unable to exercise).
- Excessive use of performance-enhancing supplements or drugs.
- Expressing frequent dissatisfaction with body image, or avoiding any activity that might involve exposing the body, such as swimming.
- Use of appetite suppressants or laxatives.
- Restrictive behaviour around food, such as skipping meals, fasting, or avoiding certain foods or food groups.
- Preoccupation with food; e.g., an insistence on meal planning, grocery shopping independently, or eating on a very rigid schedule.
- Changes in mental health, such as increased depression, anxiety, mood swings, or social withdrawal.
- Becoming very defensive or sensitive when questioned about food, eating habits, or body image.
- Physical symptoms, such as reduced energy, fainting or dizziness, a decline in dental health, digestive problems, or swollen cheeks (a sign of chronic vomiting).
What Should You Do if You Think Your Son has an Eating Disorder?
If you suspect your son has an eating disorder (or is at risk of developing one), start by tackling the stigma surrounding male eating disorders. Don’t accuse your son of having a problem, and don’t blame yourself for his condition. Many children with loving, supportive parents develop eating disorders, and some of the most significant risk factors for EDs, like genetics, are beyond parents’ control. Before you broach the topic of disordered eating with your son, give yourself time to process your feelings and reach out for support.
When you’re ready to approach the issue calmly, take the steps below:
- Arrange a visit with your son’s healthcare provider. Even if your son isn’t ready to discuss his eating disorder, a complete medical examination is crucial to check for health problems, such as anemia and cardiovascular abnormalities.
- Look for treatment options in your area. All eating disorders, regardless of type or the sufferer’s gender, require medical treatment, usually in the form of an in-patient or out-patient program. Alternatively, some EDs can be managed with help from a GP and an experienced mental health professional (provided that the patient doesn’t need urgent medical, nutritional, or psychological intervention). Boys often do best when placed in programs that focus specifically on male eating disorders, both because these programs are more attuned to their experience and because this approach reduces stigma. It’s critical to help your son understand that EDs are not a “female problem,” and that he isn’t alone in his struggles.
- Once you know what resources are available locally, talk to your son. Avoid using the phrase “eating disorder” initially, and do not mention your son’s weight or body size. Instead, let him know you’re concerned about the changes you’ve noticed in his behaviour or demeanour. E.g., “You’ve been so quiet and withdrawn lately, and you seem tired and cold all the time. I’m worried about you. Is there something I can do to help?”
- Give your son information about eating disorders in males. Because male eating disorders are so under-represented in the media, your child may not even realize he has a problem. Discussing articles about eating disorders in boys, or talking about male celebrities who have struggled with EDs, can help your son better understand his experience.
- After your son enters treatment, encourage him to stay on track, but don’t nag, berate him, or use ultimatums. Remain patient and supportive and work closely with your son’s treatment provider to ensure continued progress. Recovery can’t be forced, and relapse frequently occurs early in the treatment process. Take heart in knowing that it’s usually only a temporary setback, and make sure your son knows that you love and accept him no matter what.
- Avoid drawing attention to changes in your child’s body as he gets better. For many people with EDs, even positive body-oriented comments (such as, “You’re looking healthier!”) can trigger panic and make relapse more likely. To affirm the benefits of recovery, focus on achievements not related to food, weight, or size; for example, “You’ve been doing so well in school lately; I’m so proud of you!”
- Set a positive example. Don’t make critical statements about your body or engage in harmful behaviours, such as dieting or over-exercising. Make family mealtimes an enjoyable experience where everyone comes together to enjoy nutritious, satisfying food and socialize.
Remember that it’s normal, and expected, for people with EDs to resist recovery at first. Your child is being asked to give up his primary coping mechanism and a significant part of his identity, so it’s natural for him to be frightened. Your role as a parent is to provide emotional support, guidance, and medical care until your child wants to get better for his own sake. In time, many people with eating disorders recover fully, especially when they’re given access to appropriate treatment early in their disease.
