Eating disorders in men are misunderstood

Having a male character in To the Bone is helpful, Victoria Carmichael says.

Netflix recently released To the Bone amid a flurry of criticism that it glamorizes eating disorders. The film tells the story of 20-year-old Ellen, who struggles with anorexia. At a group home, she meets Luke, a man who also suffers from anorexia. Although the film’s content may be a sensitive subject for some viewers, its depiction of a man in treatment for an eating disorder is an important aspect that should not be ignored.

People tend to view eating disorders as a “woman’s disease.” Women are indeed more likely to suffer from an eating disorder than men. However, men make up around 20 per cent of cases by some statistical measures, or, according to Canadian psychiatrist Blake Woodside, account for one in three cases of anorexia and one in four cases of bulimia.

The conceptualization of eating disorders as a woman’s disease means that many men suffer in silence. Indeed, eating disorders in men have been characterized as “underdiagnosed, undertreated, and misunderstood.”

Certain factors have led to this lack of attention to, and understanding of, eating disorders in men.

First, eating disorders in men often present differently than in women, which makes identification more difficult. In comparison to women, studies show that men with anorexia are less likely to express a desire to lose weight. Instead, the focus is on attaining a muscular physique. In other words, men want to get bigger, rather than thinner. For bulimia, research indicates that men tend to engage in excessive exercise rather than vomiting and laxative abuse, behaviours commonly seen in women.

Eating disorders in men often present differently than in women, which makes identification more difficult.

Thus, clinicians may misdiagnose eating disorders in men, as they may appear to be a healthy weight and engage in different behaviours.

Second, because people tend to view eating disorders as a woman’s disease, much of the resources for diagnosis and treatment have been created for women. For example, clinicians and researchers often use certain tools to measure the symptoms of eating disorders. While these assessment tools are widely used and accepted, they were developed and standardized using women. As a result, they may produce unreliable data when used with men.

Likewise, there may be less knowledge in general about eating disorders in men. This means that clinicians, families and friends as well as men themselves may not recognize the problem until it’s too late. This is troubling because without knowledge of an issue, there can be no action.

Third, men are less likely than women to seek professional help for a mental health issue. Some attribute these low rates of service utilization to such traits as stoicism and stubbornness, while others suggest that current treatments are not geared toward men. Research in British Columbia found that most men do not seek treatment for eating disorders, citing reasons such as non-disclosure, not feeling supported or understood, and not feeling comfortable in the female-dominated treatment environment. Sadly, this means men are much more likely to suffer alone and in silence.

What is particularly troubling about this lack of attention and understanding of eating disorders in men is that early detection and treatment is often associated with better outcomes in recovery. What is more, eating disorders have the highest mortality rates of any mental illness. Sadly, research suggests that among those who are diagnosed, men are more likely to die from an eating disorder than women.

To the Bone is a good starting point for a discussion about eating disorders in men. We must shift our view of eating disorders as a woman’s disease to a human’s disease. This conceptualization is more appropriate given that eating disorders affect millions of people across Canada, regardless of gender. Hopefully, this will give a voice to men and bring new support for men with eating disorders.