RESEARCH
No one really knows the untold number of boys and men with eating disorders who never seek treatment or despite seeking help are misdiagnosed or undiagnosed. Eating disorders among males are underreported and most males never receive treatment.
Traditionally, it has been estimated that about 10-15% of those with anorexia and bulimia in the United States are male.1 Based on 10%, that would translate to a 1:9 male to female ratio of those with eating disorders.
Research since the turn of the century is showing a rise in the incidence of eating disorders in males. According to a 2000 University of Toronto study, 1 in 6 participants who qualified for full or partial anorexia was male.2 Therefore, this study shows that for every one male with an eating disorder there is five females, a 1:5 ratio.
In a National Institute of Mental Health (NIMH) funded large-scale national survey with 2,980 adults at Harvard University Medical School conducted by J. I. Hudson and colleagues3 from 2001-2003, they found that the ratio between male and female eating disorders respectively is 1:3 as opposed to the 1:5 ratio cited by the University of Toronto study. According to these numbers, 25% of those with eating disorders are male, not 10-15% as traditionally estimated.
Specifically, Hudson and colleagues found that 0.3% of men and 0.9% of women reported having anorexia, 0.5% of men and 1.5% of women reported having bulimia, and 2.0% of men and 3.5% of women reported having binge eating disorder at some point in their lives.
The study conducted by Hudson and colleagues also found that people with eating disorders, regardless of the type, often have coexisting mood, anxiety, impulse-control or substance use disorders.
A research study on males with eating disorders by D. Blake Woodside, MD and colleagues4 from Canada reported in 2001 an even higher prevalence rate of males in the eating disorder population than in the Hudson study.
The prevalence rate (weighed) of full or partial eating disorders for men was 2.0% compared to 4.8% for women - a male to female ratio of 1:2.4 respectively. The male to female ratio of full or partial syndrome anorexia was 1:2.0 and for bulimia 1:2.9.
D. Blake Woodside and colleagues study confirmed the results of other researchers of the clinical similarities on most variables between males and females with eating disorders, such as psychosocial comorbidity.
Similar to the results of Hudson and colleagues study, the results of Woodside's study revealed that males with eating disorders showed a wide range of differences from men without eating disorders, such as with higher rates of psychiatric and psychosocial comorbidity (including depression and substance use) than males without eating disorders. But, it was not clear to what extent these differences were the effect of illness or possible risk factors for the occurrence of eating disorders.
REFLECTIONS
It is very likely that the commonly cited figure of one million males with eating disorders in the United States will soon become an out-dated figure for a much higher number. One source, the Alliance for Eating Disorders at www.allianceforeatingdisorders.com/what-are-eating-disorders states, "Eating disorders currently affect approximately 25 million Americans, in which 25% are men." In this statement "men" should technically read "males" or "boys and men." According to this estimate, 6.25 million males have eating disorders, including anorexia, bulimia, and binge eating disorder!
An eating disorder represents an extreme condition, therefore, it is reasonable to assume that there are tens of millions of American males who are obsessed with appearance, weight, food, and exercise, but do not fall into an official diagnosis for an eating disorder. These numbers suggest that the obsessions fueling eating disorders present a serious mental health issue facing our nation.
What seems to point to this rise in eating disorders in men? First, greater awareness about eating disorders in general and that males are affected by the illness too, may account for why more males are willing to come forward to seek treatment.
Secondly, the media and culture over time seem to promote a leaner, more muscular, more defined physique for a man such as is emulated by GI Joe and other toy action figures5 and demonstrated by the smaller chest and waist dimensions for Rootstein's male mannequins.6
Furthermore, articles and advertisements in men's magazines are increasingly promoting diets, in addition to body-building products. Images and values about thinness and muscularity are increasingly being associated with masculine ideals, and these ideals are pushing more men to the brink of eating disorders.
For an illness affecting so many males, it is astounding that so little information and support is available on males with eating disorders.
The Center for Disease Control (C.D.C.) reported that heart disease, the leading cause of death in the United States, claimed 696,947 lives in 2002.7 The American Cancer Society estimated that 564,830 Americans will die of cancer in 2006.8
More males in the U.S. are affected by eating disorders than people dying annually of heart disease or cancer. If these leading causes of death, rightfully receive so much attention, then why is not an eating disorder epidemic affecting so many Americans given the same attention in research and prevention?
STATISTICS
Eating disorders (including anorexia, bulimia, and binge eating disorder) affect up to 24 million Americans of all ages and genders and 70 million people worldwide.
(The Renfrew Center Foundation for Eating Disorders, Eating Disorders 101 Guide: A Summary of Issues and Resources, published in Sept. 2002 and revised Oct. 2003 at www.renfrewcenter.com/uploads/resources/1067338472_1.doc. Note: This estimated figure was created by utilizing current U.S. Census numbers and statistics from the NIMH's guide, Eating Disorders: Facts About Eating Disorders and the Search for Solutions, which estimates percentages for specific types of eating disorders for certain populations, such as anorexia in males. The 24 million amount is higher than the 8-10 million number of people with eating disorders commonly quoted, because it includes all three eating disorders, all genders, and all ages)
Note: Patrick F. Sullivan worked at the University Department of Psychological Medicine, Christchurch School of Medicine, New Zealand.)
20% of people suffering from anorexia will prematurely die from complications
related to their eating disorder, including suicide and heart problems. (The Renfrew Center Foundation for Eating Disorders, Eating Disorders 101 Guide: A Summary of Issues, Statistics, and Resources, published Sept. 2002 and revised Oct. 2003. Visit www.renfrewcenter.com/uploads/resources/1067338472_1.doc)
Only one in ten people with eating disorders receives treatment. (Ruth Striegel-Moore, et al., “One Year Use and Cost of Inpatient and Outpatient Services Among Female and Male Patients with an Eating Disorder: Evidence from a National Database of Insurance Claims,” International Journal of Eating Disorders, 27 (2000) AND Greta Noordenbox, "Characteristics and Treatment of Patients with Chronic Eating Disorders," International Journal of Eating Disorders, 2002, 10:15-29.
Note: If a study was based on the ratio of males with eating disorders to the number of males in treatment, findings would likely reflect a much higher ratio for every one male in treatment, or put another way, a lower percentage of males who have eating disorders would be in treatment.
Anorexia is the third most common chronic illness among adolescents. (Public Health Services Office in Women’s Health, Eating Disorders Information Sheet, 2000 as reported at www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics)
An estimated 40% of those with binge eating disorder are male. (American Psychiatric Association, Diagnostic & Statistical Manual of Mental Disorders, 4th edition - DSM-IV. Washington, D.C., 1994)
CONCLUSION
The higher percentage of males to females with eating disorders being reported by researchers in more recent times seems to point to a trend of an increasing number of males with eating disorders. These studies provide all the more proof that eating disorders do not discriminate between genders.
As an illness affecting millions of Americans, eating disorders are as significant of a national health crisis as HIV, cancer, and cardio-vascular disease, and therefore, should be taken as seriously as these other illnesses.
What is needed is more research, more prevention, financial support from insurance companies, more eating disorder treatment providers, more support to those with eating disorders and their families, etc.
REFERENCES
1. D. J. Camargo Carlat, “Review of Bulimia in Males," American Journal of
2. Erica Goode, "Thinner: The Male Battle with Anorexia," The New York Times,
Sunday, June 25, 2000 AND cited
3. J. I. Hudson, E. Hiripi, H. G. Pope & R. C. Kessler, "The Prevalence and
Correlates of Eating Disorders in the National Comorbidity Survey Replication,"
Biological Psychiatry, Feb. 1, 2007, 61(3), 348-358. An NIMH science update
Feb. 9, 2007 article, "Study Tracks Prevalence of Eating Disorders" can be viewed
4. D. Blake Woodside, MD; Paul E. Garfinkel, MD; Elizabeth Lin, PhD; Paula
Groering, PhD; Allan S. Kaplan, MD; David S. Goldbloom, MD & Sidney H.
Kennedy, MD, "Comparisons of Men with Full or Partial Eating Disorders, Men
without Eating Disorders, and Women with Eating Disorders in the Community,"
American Journal of Psychiatry, April 2001, 158:570-574 AND online at
7. Center for Disease Control (C.D.C.), "Deaths: Leading Causes for 2002,"
National Vital Statistics Reports 2005, 53:17
Table I:1
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