A Comment on “Eating disorder symptoms in middle-aged and older men” (Mangweth-Matzek, Kummer, & Pope2016)

by Brian Pollack

Key Points from the Article:
- Males aged 40-75 years of age participated.
- 6.8% of males reported having eating disorder symptoms
- Only 9% of those men were identified on the EDE-Q
- Male ED questionnaires are needed

In a recent research study published by Mangweth-Matzek, Kummer, and Pope (2016) in the International Journal of Eating Disorders (http://onlinelibrary.wiley.com/doi/10.1002/eat.22550/abstract), 6.8% of 470 males aged 40-75 who participated in the study report having current eating disorder symptoms including: (1) a low BMI, (2) binge eating, (3) binge eating and purging, or (4) purging without binge eating. This is in line with current estimates that more females than males struggle with symptomatology (Hudson, Hiripi, Pope, Kessler, 2007).

But there’s a caveat…

What is astonishing about the numbers is that there is an obvious misrepresentation taking place in terms of testing and reporting of ED symptoms in middle aged males. We don’t hear about these cases but, as a male therapist, I get these calls more than ever.  In the past few months I have spoken with an increasing number of middle aged men and their families, who call in desperate and unsure where to turn because no one knows what to say or how to handle the problem.

These are families that are at their wits end. In one particular case the father figure was creating an atmosphere of neglect because his obsessive thinking was run by eating disorder actions. When I began working with this gentleman, the initial questions were not about how he felt – you see he felt his gym habits and over exercising were normal. He wanted to know how he could continue and find more happiness in his life. He struggled to see his day to day behaviors were causing problems. Emotions were avoided and actions were the focus of discussion. Being a man from an older generation, finding the proper language and approach was a challenge. Concrete in nature he was unaware of the effects within his psychosocial sphere. It wasn’t until trust and a mutual language was built over multiple sessions that discussion about feelings, shame, guilt, and impairment of social and relational functioning came to light.  It can be challenging for men to speak about this stuff.  In a world where common themes in our national dialogue surround women fighting for influence, this man had it.  He was afraid of losing it.

As professionals, we have come to understand that the EDE-Q and similar diagnostic assessments don’t do male sufferers justice, and yet not everyone knows this.  Although the frequency of middle-aged male eating disorders is close to the norms reported in the professional advocacy groups across our country, is there something we are missing?

The middle-aged male experience is being overlooked.

So, what are we missing?  The current metrics and questionnaires are based on a long history and misunderstanding that eating disorders are a “woman’s disease.”  This is placing men at risk as cultural norms, clinical education, and poor awareness are creating a vacuum that overlooks male sufferers.

The most poignant observation in the piece is that only 3/32 (9%) of the men who reported current eating disorder symptoms were captured using the cutoff on the EDE-Q, a common “gold standard” measure of eating pathology within the field. This is striking and signifies that current measures of eating pathology lack sensitivity in men. This is likely a result of the EDE-Q and other measures being largely based off of white females; as a result, the extreme behaviors that men experience have become overlooked.

Of particular interest is how much middle aged men utilize exercise as a compensatory behavior. This is acceptable by a large majority of the population and an easy way that many men hide their behaviors. You’d be surprised that not only young males and females are intensely controlling their diet and physicality.  Having worked closely with men who struggle, they often feel as though their “body is getting away from them” and will start to excessively exercise to achieve leanness.  They aren’t obsessed with loss of weight – they want muscle – they want the body they had when they were younger and that is where dangerous territory can take hold – the use of anabolic steroids.  Imagine how many athletes, how many gym goers, how many men are trying to use steroids to maintain an ideal which can cause such harm. There is a growing amount of data about adolescent males and young adults, but I struggle to find studies about this issue focusing on middle-aged males.

So what does this mean for all of us?

We need to pay more attention. We need to do something. We need to come together and build prevention systems and measured approaches.

We are at an interesting crossroads in which history is repeating itself.  What once happened to women in our mass marketed media is now happening to men. This study demonstrates that middle-aged men struggle with eating disorders just as women do.  Yet, there is very little representation for men who are older; when I get a call from a male in his 40’s+ I often find they are disappointed in the inability to get help. They call multiple institutions, residential and day programs, even hospitals – yet they are often told that because of their age they aren’t appropriate for the program. I recently worked with an older male who felt as though no matter how hard he tried, no matter how much he obsessed over getting treatment, there was no one to help.  He ultimately sought treatment at a program with a much younger, less relatable crowd of mostly young women. It was his only option to find safety from the disorder that has run his life for 20+ years.

What do we do?

We have an opportunity to build awareness with more socially accepted consumerism and advocate for better interventions, awareness and most importantly, prevention to make sure that no one has to live with an eating disorder. Middle-aged men are one of the unknown faces of eating disorders and maybe there’s a way to help within our own healthcare system.

In my opinion, if we want to make the most impact, going after consumerism is not going to be where a community of professionals is going to get the most “bang for their buck.”  The system is too large and the players are likely short sighted with opposing intentions.

But where the real progress can be made is with awareness and prevention.  My suggestion is that we begin reaching out and educating the substance abuse rehabilitation community about the hidden dangers of anabolic steroids and the quest to be lean. This is a focus professionals in the field inherently understand and hold as a concern.  A strong partnership for a more well-rounded preventative system would create a dialogue between two very large communities.   Perhaps starting at the local agency or detoxification unit may be a great place to plant the seed and being a conversation.  We need to figure out how both communities can work together to help improve care for middle-aged men with eating disorders.