Male Eating Disorders in the LGBT Community

by Anne Hall

The increasing prevalence of eating disorders amongst men is something that more and more people are becoming aware of: In the United States alone, 10 million men will suffer from a clinically significant eating disorder at some time in their life (Wade, Keski-Rahkonen, & Hudson, 2011). Parents are increasingly aware that they must watch their sons, as well as their daughters, when looking for signs of a developing eating disorder and this increased awareness is something that should be appreciated.

What some people are less aware of, however, is that eating disorder rates are increased amongst the sexual minority male community compared to their ‘straight’ counterparts. According to the National Eating Disorders Association, 42% of men who seek treatment for eating disorders identify as gay (Carlat, Camargo, & Herzog, 1991). What’s more, outside of the formal diagnosis of a full blown eating disorder, gay men are an incredible 12 times more likely to binge and purge than heterosexual men (Austin, 2004). This leads us to the question of why are gay men more vulnerable to developing eating disorders than heterosexual men, and how can we use this knowledge to provide help and support?

Controlling an Uncertain World

If being a teenager is difficult, then imagine how much more difficult it is to be a gay teen. Whilst many teens struggle with boundaries, with control, and with finding a place in the world that they feel that they fit in, gay teens must also deal with the added complication of coming out to their family, of living in a world that can still be very homophobic, and dealing with a wealth of feelings of shame and confusion surrounding their sexual orientation. Alissa Petee, child and adolescent primary therapist at Washington’s Eating Recovery Center, states in the article “Eating disorders are far more common in LGBTQ communities — here’s why,” that this can make the path to adulthood even more complicated for gay teens, and controlling their food intake by developing an eating disorder can help those teens to feel they have regained some control of their life in a world that all around them seems so uncertain. In males particularly, eating disorders can also develop as a reaction to feeling weak or unmuscular in comparison to their peers, and wishing to ‘bulk up’ in order or meet a perceived societal norm, match the appearance of those they admire, or fit into the perceived stereotype they feel they should be conforming to. What’s more, eating disorders often develop as a result of an interaction between biology and stress, and there are many stressors that result from being a gay teen: harassment at school and work, and the negative reactions of friends and family are sadly still very common.

An Attempt to Change The Body

For men and women that identify as being transgendered, an eating disorder can develop in conjunction with body dysmorphia, as a way of changing the way their body looks, because they have so many negative associations with it in its existing form. There is still a lot of social stigma associated with identifying as transgender, and this can be difficult to come to terms with: many transgendered teens who have not yet accepted they are transgendered (or don’t even have a clear understanding of what being transgendered means) are typically unable to even vocalize what they are feeling or truly understand why changing their body makes them feel better about the way they self-identify. It can be a very difficult and scary time for teenagers without a strong support network, and regaining control through controlling eating can sometimes become the next step if those teens are not presented with other more healthy ways of managing their emotions and dealing with the negative energy that may surround them.

The way in which LGBT individuals receive treatment for their eating disorders may differ slightly from that for heterosexual teens. This is because the eating disorder may be tied up with their LGBT identity, and therefore positive affirmation and coming to terms with their identity may be helpful to overcoming their eating disorder. However each teen is an individual and, regardless of their sexual orientation, there are a myriad of different reasons that teen may develop an eating disorder: it could well be that the eating disorder is not related to their sexual orientation, or that they have accepted their identity but cannot cope with the criticism and judgment of others. Regardless of their sexual orientation, there is no easy path back from an eating disorder. But with the right help and support, determination, and an understanding of who they are, a those teens can soon find themselves walking the road towards mental and physical health.

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 (, 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.

Are use of dietary supplements and performance enhancing drugs also disordered eating behaviors?

by Jerel P. Calzo, PhD, MPH

You might have looked at the title of this blog post and asked yourself why there would be a post about dietary supplements (e.g., protein powders, creatine) and performance enhancing drugs (e.g., anabolic steroids) on a website about eating disorders. Shouldn’t this be on a website about sports or substance use instead?

The first reason for this post is that the topic is timely. Dietary supplements and discussions about performance enhancing drugs have received considerable media attention over the past two months. Media coverage ramped up during the Olympics, as public concerns increased regarding corporate sponsorships and athlete endorsements of dietary supplements during the games. With high school and college football season starting up this fall, parents, coaches, and health professional raised concerns about athletes turning to dietary supplements to build muscle and increase athletic performance. Supplements, doping, and athletic performance are back in the news again with coverage of the cyber attacks on the medical records of Olympic athletes. Stories like these, while often noting the potential dangers of performance enhancing supplements and drugs, still reinforce the harmful message that exceptional feats of athleticism can’t be achieved without the aid of supplements and drugs.

The second reason for this post is that as clinicians, researchers, and supporters of males affected by eating disorders, we need to recognize that performance concerns may be a neglected area of eating disorders work. Thus far, much of the research on eating disorders has tended to focus on the appearance components of body image. For boys and men, body dissatisfaction may not be limited just to how their bodies look, but may also include what their bodies can and cannot do. Turning to dietary supplements with the goal of lifting more and running faster may seem like a quick solution to resolve these performance concerns. The fact that dietary supplements are easily purchased at many grocery and health food stores may lead consumers to think that these products are safe.

Unfortunately, dietary supplements are under-regulated, and run the risk of containing contaminants, dangerous amounts of pharmaceutical ingredients, banned substances, or analogues of banned substances1. In fact, due to the Dietary Supplement Health and Education Act of 1994, which prohibits safety and efficacy prescreening of dietary supplements, the Food and Drug Administration can’t remove unsafe supplements from the market until a healthcare professional files a report with the government that someone has been harmed by a supplement. As a result, serious adverse events occur, including death.

Although there is general agreement on the dangers of performance enhancing drugs, such as steroids, dietary supplements are far from innocuous. As research and clinical work on male eating disorders grows, more attention is warranted on the appearance and performance concerns underlying supplement use, which may also be detrimental to mental health and wellbeing.


1. Cohen PA, Maller G, DeSouza R, Neal-Kababick J. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014;312(16):1691–3.

What Inspires me Towards Working with Males with Eating Disorders?

By Stuart B. Murray, DClinPsych, Ph.D.

Why do I focus my work on eating disorders in males? Shouldn’t I focus my work on something more worthwhile? Something more prevalent? Something less obscure? If you’re planning to study eating disorders in males, won’t it take you 10 years to finish any meaningful study because of how few of these guys there actually are? Why haven’t I decided to step into ‘mainstream’ eating disorder research, because surely no funding body will throw their money away and fund eating disorder research in males, which by default will only apply to so very few people?

Sadly, these are questions I’ve fielded all too many times from colleagues working within the field of eating disorders, at conferences, meetings, and even in casual hallway conversations. Our field is pervasively biased against eating disorders in males. This is reflected in our diagnostic system, which is set up to measure concerns more predominantly reported in female eating disorders. This is reflected in the measurement tools we use to track eating disorder symptom severity, which are often geared towards questions which don’t apply to males, like satisfaction with one’s hips or bust. This is reflected at a clinical institutional level, where many eating disorder residential treatment facilities don’t accept male patients, or when family doctors tell male eating disorder patient to toughen up, forcing them to live unassisted with a horrendous disease burden. This is reflected at an academic institutional level during casual conversations with mentors when junior colleagues are dissuaded away from a career in research relating to male eating disorders. As a result of this longstanding bias, far too many boys and men with an eating disorder are falling through the cracks into an abyss of stigma and marginalization. It is time for our field to change the goalposts.

When I made the decision to study to become a clinical psychologist, knowing it would be an arduous road of many years’ of study and sacrifice, I did so with the primary motivation of wanting to help people. Before I entered into the world of clinical psychology, I had envisioned it to be a panacea of warmth, nourishment and encyclopedic expertise, where all comers are welcomed with compassion and assisted in equal measure. However, as I ventured further into the world of clinical psychology, I realized that this was an illusion. It soon occurred to me that there were distinct subgroups of patients who were deeply marginalized, within an already marginalized population of those suffering from a mental illness.

Few illnesses carry the same stigma as eating disorders, where sufferers are often conceived of as narcissistic, controlling, or even attention seeking. These stigma are profoundly damaging, and can delay treatment seeking and cause far greater suffering. It was with deep sadness that I realized that mental health professionals, my own kind, the world I had conceived of as a panacea, contributed to and propagated this stigma. It was then and there that I decided to devote my therapeutic and research efforts to the male experience of disordered eating. I hoped, and still hope, to help as many males as possible who are struggling with an eating disorder. This takes me back to the origin of my decision to become a clinical psychologist; to help people.

In my journey in working with male eating disorders, I very quickly learned that these disorders do not discriminate along gender lines. Moreover, I learned of the incredible strength many male eating disorder patients carry within them, in navigating a brutally difficult illness, and the disabling stigma attached to it, while stepping forward to seek treatment. Further still, many recovered patients I worked with have gone even further, and have volunteered their own time to help overturn the stigma attached to eating disorders in males, or share their story in helping to connect other males to treatment.

If we can’t stand as a field, together, and advocate for the inclusion of males in eating disorder services, how can we defend the values that drove us all towards the profession of caring for people marginalized by mental illness? Surely we can all see the incredible strength of man who has taken the step to come forward and seek treatment for a life threatening eating disorder, despite society, and even health professionals, telling him that he has a female disease? Then why can we not match our patients’ strength in making our own voice heard in the Ivory Towers, or in treatment centers?

The National Association for Males with Eating Disorders serves as an important platform to share our collective voice in supporting males with eating disorders. One must recognize the paradox of needing to establish a male association for a disorder which profoundly impacts all gender orientations, and it is our hope that all eating disorder organizations and institutions will one day be as inclusive of male patients as they are to female patients. Until that day, we will continue to work towards greater recognition of male eating disorders, and improved treatment options, and reduced stigma.

If Only You Had Known

By Daniel O’Kelly

Dear 15-year old Daniel,

There you were, passed out and gasping for breath, 100 meters from the finish line. You felt fine at the beginning of the cross country race – calm, cool, collected. Victory was in sight. Too bad you had restricted and over-exercised the day before.

You had failed even before you began.

And for what?

According to your logic, the lighter you were, the faster you were. It worked for Kenyans, right? Kenyans have less mass for their height, longer legs, and shorter torsos.1 Those aren’t your genes.

Was it to be the best on the team? Was it to impress your French class crush?

At 15, you had the same testosterone levels as a 5-yr old boy. Your body was literally eating the muscles surrounding your organs because you weren’t feeding it enough. Some people suggested you see a doctor as you exhibited “anorexic-like behavior.” Me? Anorexic?  I’m a male. Anorexia is a women’s issue, right?

Wrong. Anorexia is as much a male issue as it is a female one. Toned, male bodies are as detrimental to the male psyche as slim female bodies are to the female psyche. However, there is a social stigma associated with men acknowledging their vulnerability and seeking help. It could be your brother, your father, the guy in the next cubicle over, or a passerby who needs help but doesn’t seek it because eating disorders are perceived as a “women’s issue.” That thought process can be fatal. Anorexia is the most life-threatening physiological disease out there – twice the death risk of schizophrenia and three times the death risk of bipolar disorder in some cases.2

So, how did you recover?

Truth be told, you are still in the process of recovery. In my experience, anorexia is like a scar – it fades, but never disappears. I have learned to ignore troubling thoughts about food restriction, just like any other uncomfortable thought. Perhaps it came with maturity. Perhaps I began recovering after spending a year in Paris, where people actively socialize over a meal and don’t obsess over gym culture and the nutrition facts. You were a victim of our culture’s unhealthy and distorted perception of what it means to be attractive and “sexy” as a male.

Had you known all this at 15, would you have changed your ways? Would you have eaten appropriately and rested the day before the race? It’s hard to say. Anorexia is a complex, biologically and socially-influenced psychological disorder. However, you can take steps to recover. First, understand what’s triggering. Next, implement a plan to take care of yourself, body and mind, if you ever feel like relapsing. And finally, above all else, seek help – don’t face this beast alone. When family and friends reach out their hand, take it.


1. Fisher, M. (2012, April 17). Why Kenyans make such great runners: A story of genes and culture. Retrieved from

2. Arcelus, J., Mitchell, A. J., Wales, J., and Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry68(7), 724-731.

The Battle between My Eating Disorder and Athletics

By JP Slater

I am a professional marathoner, and for the past 10 years I have also battled with an eating disorder.

My eating disorder started when I began to see great success in my long distance running abilities and only became worse the more success I saw; they almost went hand-in-hand. Elite distance running requires those at the top to be in incredible athletic shape, creating some of the leanest and physically fit people on this planet. It requires athletes to fuel with healthy foods and to have high levels of self-control, thus hiding behind “elite running and healthy living” allowed my eating disorder to carrying on for so long.

One day I realized my life had become more about worrying about eating my next meal than about my athletic success and future. Eating caused me anxiety; it loomed over me like a dark cloud of disaster, making me feel that if I ate something I would be hurting my career somehow, making me run slower. An outsider’s perspective could tell you this is exactly the opposite. When you’re running as much as I was (which on any given week ranged from 110-130 miles per week) eating was what was going to make me better and recover faster. I convinced myself otherwise. I rapidly moved away from eating affecting my running to eating controlling my body-image. Being thin gave me confidence; it made me think I was doing right in life. While I may have appeared to others to be fit and healthy, the way I was maintaining my frame was not.

Through my malnutrition I faced two pelvic fractures setting me back in my career each time for around 12 weeks, though I still proceeded to continue my habits of underfueling myself. It was not until about a year ago when I got a hold of my eating; I was able to put some of the negative self-talk to the side, I saw a therapist, I sought out help, I confronted my problem head on. It has been an uphill battle since, I have seen great rise in my performances being more consistent and seeing great rise in overall athletic performance, I’ve seen my body change and build muscle; I’ve become stronger than ever and feel like I have more life. It has been a slow process and I still work at it every day, but I know it’s worth it. I know that I am helping to save my life. I know that I could not continue down the road I was headed, I know that I still will have battles, but I’m ready for those.

I view myself in a different image now, I view myself as the strong-confident individual I deserve to be, I view myself as worthy enough to fuel my body with what it needs, I see myself as a work in progress because just like in my athletic career, I’m always trying to be better and this is just one more thing I can continue to work at.

Can Men Have Eating Disorders?

Can Men Have Eating Disorders?

Eating disorders continue to be shrouded in stigma; though we’ve made progress in breaking down barriers and obliterating taboos, the fact remains that many people feel uncomfortable talking about this topic. Because of this, much of what people believe about eating disorders is clouded by myth and misinformation. Case in point: There are still many individuals who associate eating disorders with females, as though men cannot ever be afflicted by these serious disorders.

That couldn’t be further from the truth. Fact: Eating disorders are equal opportunity offenders; they don’t care about your age or your race or your sexual orientation, and they certainly don’t care about your gender.

Another fact: Struggling with an eating disorder does not make you any less of a man, any more than a struggle with cancer, diabetes, or depression makes you less of a man. It is a clinical illness, not a choice you’ve made—but the good news in all of this is that male eating disorders can be treated, ultimately leading to lifelong recovery.

How Prevalent are Male Eating Disorders?

Still, you might wonder: Just how common are male eating disorders?

Research suggests that, of the individuals who have either anorexia or bulimia, roughly 25 percent are male; though that is not quite equitable with women, it does represent a sizable quarter of the overall population. And with binge eating disorders, the percentage of males is even higher—some 36 percent.

Overall, some 10 million American men will be diagnosed with an eating disorder at some point over the course of their life.

Are You Struggling with an Eating Disorder?

Since male eating disorders are so common, it is important for males to be aware of some of the signs and symptoms of eating disorders, and to evaluate their own need for possible diagnosis or intervention.

There are several eating disorder warning signs to be aware of. A few of them include:

  • You’re habitually dieting, even if you’re also chronically underweight.
  • Your weight is constantly fluctuating.
  • You obsess over things like your caloric intake or the fat content in your foods.
  • You exercise in excess, feeling extreme guilt and anxiety if you miss a workout session.
  • You engage in secretive or ritualistic eating behaviors—hiding food, eating alone, etc.
  • You experience depression and an overall sense of aimlessness or lethargy.
  • You become isolated and withdrawn, avoiding social functions—especially ones where food is present.
  • You alternate between overeating and fasting.

Is There Help for Eating Disorder Recovery?

If you identify any of those warning signs within yourself, that is not necessarily cause for alarm, but it is ample reason to seek evaluation from a physician or to take an eating disorder screening. Learn more about eating disorders and get a better sense of what you might be struggling with.

If you are diagnosed with an eating disorder, don’t despair. Hope and healing are possible, but do not seek them on your own. You’ll need to enlist the encouragement and support of your loved ones. You’ll also need to enlist professional, medical care.

Seeking therapy or nutritional guidance for eating disorders may sound scary, but it is the best and often the only way to build a foundation for lifelong recovery. So don’t delay. Get diagnosed, and, if necessary, get treated. Embrace recovery today.

This post was written by our sponsors, Castlewood Treatment Center.

Affirmative Advertising: The Campaign for Perfect Men

Our newest post from Sydney Avitia-Jacques.

So far, this blog has been critical of media, giving examples of movies, magazines, and advertisements that portray masculinity and health in shallow, narrow-minded ways. The unfortunate truth is that this unhealthy ideology accounts for the majority of the media that we consume –  but it’s time to talk about a good example, because they do exist and they will make a difference if we rally behind them.

Dressman is a Norwegian underwear company that is promoting a positive, healthy ideology. They say it well on their website: “The majority of people think that our unhealthy obsession with the body is a result of what’s presented in advertising. That’s why we will do what we can to change this. We want to take responsibility…As a first step we’re launching our new campaign for ManUnderwear showing that every man is perfect just the way he is.” Their campaign showcases men that are truly diverse— in age, race, height, weight, muscle composition, and even body hair. Past blog posts have explained how most male models employed in ads are young, Caucasian, tall, thin, visibly muscled, and have hairless torsos; but this collection of models shows careful conscientiousness from Dressman. Their slogan, “Underwear for perfect men,” is a healthy spin on the usual message, which uses the ideal of “the perfect man” to seduce viewers into an ideology of inferiority that is resolved only by purchasing the glorified product. In this ideology, using the same product as “the ideal man” represents a small but necessary step in the consumer’s pursuit of perfection, and will make him slightly less inferior.

The campaign does follow the industry standard of using sexualized bodies and the values associated with them, rather than the functionality of the product itself, to sell the product. The models’ bodies in black and white are showcased in the video, and there is possible editing for a more striking aesthetic in the photos. However, what makes this presentation different is that no body fat, hair, or blemishes are covered up by the editing. This is sexualization without discrimination, telling all men that they can appreciate their bodies without changing them.

Some might question whether attractive values like athleticism and adventurousness, suggested in ads for products anywhere from fast food to jeans, can be portrayed as easily by models without professional athlete bodies and traditional movie star looks. Dressman’s video commercial (view it at proves that the same sleek, exciting energy is produced by using editing and presentation style with any type of man. Athleticism, heroism, and confidence are not exclusive to one body type, so they don’t have to be portrayed by one.

Why isn’t every ad campaign like this? Hiring models with diverse builds and backgrounds is not more expensive. Promoting inclusive self-confidence rather than elitist self-judgment is not more expensive. Promoting positive values that make people feel more comfortable in their own skin does not hurt consumer popularity. The only thing a company might lose from representing a diverse consumer base is a reputation for exclusivity and elitism. We want to see more companies making the switch. Just as Dressman says on their website, “We can’t change the world in a day. But we have to start somewhere.”