Why Eating Disorders in Men Are Often Missed

When we talk about eating disorders, most people picture young women battling anorexia or bulimia. But the reality is much broader and far less recognized. About one in three individuals with an eating disorder is male. In the U.S. alone, millions of boys and men will struggle with food, body image, and disordered eating at some point in their lives. Although awareness has slowly grown in recent years, there’s still a long way to go to ensure men’s experiences are fully understood and addressed.

Invisible Battles: Men Facing Eating Disorders

There are several reasons eating disorders in men tend to go unnoticed or unacknowledged. A big factor is stigma – the pervasive but mistaken belief that eating disorders are a “women’s problem.” Many men feel shame or confusion about having symptoms associated with a disorder so widely thought of as female-oriented. The assumption (held by men themselves and even some doctors) that eating disorders primarily affect women can lead to missed diagnoses in males.

Gender norms play into this stigma. Traditional ideals of masculinity prize strength, self-reliance, and stoicism. Admitting to struggles with body image, restrictive eating, or purging goes against these norms, so men may hide their symptoms or avoid asking for help. Many convince themselves that nothing is wrong, or they downplay the problem as just getting fit or “cutting weight” for sports.

Society often ridicules or doubts the men who do speak up. In one UK study, a man shared that his doctor told him to “man up” when he sought help. Moments like this reveal just how deeply these stereotypes run and how powerfully they discourage men from seeking help. Too many end up believing they can’t possibly have an eating disorder, or if they do, that they’re expected to tough it out alone.

Stereotypes and Gender Bias in Diagnosis

Beyond personal reluctance to seek help, systemic issues contribute to underdiagnosis in men. For decades, eating disorder research and clinical criteria were heavily focused on females. For a long time, the Diagnostic and Statistical Manual of Mental Disorders (DSM), the guide doctors use to make diagnoses, featured criteria tailored to women. For example, earlier definitions of anorexia nervosa required the patient to have missed menstrual cycles. A male patient with anorexia, of course, could never meet that criterion, illustrating how male eating disorders have historically been overlooked by design.

Even today, many screening tools and questionnaires for eating disorders use language geared toward women’s experiences and body ideals. “Do you make yourself vomit because you feel fat?” or “Have you missed your period?” are questions that might flag a girl’s anorexia, but could miss a boy who is compulsively dieting to get a six-pack. The classic image of an eating disorder as someone striving for extreme thinness doesn’t always match men’s experiences, so health professionals may not recognize the signs. Medical providers can be unaware of how eating disorders manifest in men and thus fail to notice the symptoms. In practice, this might mean that a male athlete who is dropping weight and experiencing fatigue gets congratulated for his “fitness” rather than being evaluated for an eating disorder. It might mean a man’s dangerous fasting or purging habits are misattributed to stress or gastrointestinal issues.

Another issue is the lack of male-focused resources and awareness in the treatment community. Most eating disorder support groups, promotional materials, and even treatment centers have historically targeted women. Men and boys who do seek help can feel out of place in programs dominated by female patients and staff. This gender bias in the system means men have fewer role models of recovery, fewer tailored programs, and sometimes face clinicians who aren’t fully trained in male-body presentations of these illnesses.

How Eating Disorders Present in Men

One of the reasons eating disorders are missed in men is that they often don’t look the same as in women. While many women with eating disorders focus on weight loss and thinness, men more often fixate on attaining a lean, muscular physique. Research has found that nearly 22% of men reported engaging in disordered behaviors, such as restrictive eating, excessive protein supplementation, or even steroid use, to “bulk up” or gain muscle mass. The cultural ideal for men (the V-shaped, muscular, zero-body-fat look) can drive a different flavor of eating disorder behaviors. This doesn’t mean traditional symptoms never occur in men, but there is an added layer of muscle-focused body obsession that is easy to mistake for normal gym culture.

So, what are some common symptoms and red flags? Warning signs in men may include:

Preoccupation with food, body weight, and shape – for example, constant calorie-counting or mirror-checking, and anxiety about any changes in weight or muscle definition.
Distorted body image — a man might see himself as “too skinny” or “too soft,” even when his body is within a healthy or athletic range. While women with anorexia or bulimia often fear looking “fat,” many men become fixated on the idea that they look small, weak, or not muscular enough.
Extreme restrictive eating or rigid diets – cutting out more and more foods to lose weight or achieve a certain look. Some men label this as “clean eating” or a hardcore training diet, but it can cross into orthorexia or anorexia territory when it’s overly strict and paired with self-punishment for deviating.
Excessive exercise – spending hours at the gym, never missing a workout, and prioritizing exercise over everything else, even to the point of injury. Over-exercising is a common compensatory behavior in men with eating disorders (sometimes in place of, or in addition to, purging).
Purging or other risky behaviors – men may resort to self-induced vomiting, laxative or diuretic abuse, or misuse of supplements/steroids to control their weight and shape. Binge eating in secret, followed by guilt, is also a pattern many men experience but often don’t talk about.

The Consequences of Missing the Signs

Eating disorders are serious illnesses with potentially life-threatening effects on the body and mind. This is true regardless of gender. Starvation, purging, and extreme nutrient deficiencies can damage every organ system in the body. Heart rhythm disturbances, kidney failure, critically low testosterone, and bone density in men – these are just a few of the medical risks.

Men with eating disorders face an alarmingly elevated risk of death. Studies suggest that males with an eating disorder have a mortality rate 6 to 8 times higher than their peers without an eating disorder. Part of the reason is that so many are diagnosed late in the course of the illness, when damage has already occurred.

Eating disorders, by their nature, thrive on secrecy and isolation. A man who doesn’t understand what he’s going through, or who feels he can’t tell anyone, is left battling intense anxiety, obsessive thoughts, and shame alone. Depression often accompanies eating disorders, and substance abuse can develop as a harmful coping mechanism. In worst cases, the combination of physical deterioration and mental despair can lead to self-harm or suicide.

Toward Greater Awareness and Inclusive Treatment

Eating disorders in men are treatable, and men who receive proper care recover at rates similar to women. The first step is breaking the silence and challenging the stereotypes that have kept so many men suffering in the shadows. Public health messages, educators, and media must emphasize that eating disorders affect people of all genders, ages, and backgrounds.

No one should feel invisible or ashamed when facing a mental health challenge. With greater awareness, open conversations, and more inclusive resources, we can help men get the support they need. And with the right help, full recovery is absolutely possible, no matter your gender.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Mental Health Resource Specialists can assist you in finding expert help and support in your community. Contact us now for more information on this free service.

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About the Author: Christian Small, MD, is a board-certified psychiatrist specializing in eating disorders, addiction, and general psychiatry. With training in Psychiatry, Preventive Medicine (Addictions), and Family Medicine from UCSD, he brings a unique, integrative approach to mental health care. Dr. Small is passionate about providing comprehensive, evidence-based treatment and mentoring the next generation of mental health professionals.

Photo by Keiji Yoshiki: https://www.pexels.com/photo/man-push-up-on-white-floor-176782/

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