Male Athletes And Eating Disorders

In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) updated their criterion for eating disorder diagnoses which included: the removal of amenorrhea (the loss of a menstrual cycle) from the diagnosis criteria for Anorexia Nervosa, and a new diagnosis, Binge Eating Disorder (BED), was added to the manual. Why does this matter? BED is the most prevalent eating disorder among men, and cisgender men do not experience menstrual cycles. These changes in criterion helped to modestly close the widespread gap on men being able to receive an eating disorder diagnosis and subsequent care. Receiving a diagnosis has been, and continues to be a privilege.

Eating Disorders Among Men – Not New

This information highlights the stigma, underdiagnoses, and care that have eluded men for a long time when impacted by an eating disorder. The reality is that eating disorders among men is not a new phenomenon, and certain populations, such as male athletes, are at a greater risk for development of one during their lifetime when compared to their cis-male counterparts who are not involved in sports.  Prevalence data is limited, and some literature estimates that 32.5% of elite male athletes are impacted by an eating disorder, and up to an astounding 85.8% are impacted by disordered eating behaviors (e.g., use of weight loss supplements, “bulking and cutting,” rigid rules around food, etc.).

Risk Factors Impacting Male Athletes and Eating Disorders

There are a variety of risk factors that increase the likelihood of male athletes developing an eating disorder. Prior information has shown that involvement in certain sport types, such as weight-class sports (e.g., rowing, wrestling), sports where leanness is emphasized for success (e.g., cycling, running, triathlon), and aesthetic sports (e.g., diving, gymnastics, bodybuilding). Although these are risk factors for specific sport types, the reality is that a male athlete of any athletic background and sport type may develop an eating disorder.

Another factor that impacts eating disorders among male athletes is the pursuit of traditional male gender norms in sport (e.g., dominance, strength) which predicts greater body image dissatisfaction (specifically regarding muscularity and leanness) and increased eating disorder behaviors. Further, male athletes who are impacted by muscularity-based body image concerns are more likely to abuse supplements. These can include fat burners, weight loss supplements, and steroids.

Signs And Symptoms of Eating Disorders

Signs and symptoms of eating disorders among male athletes share some similarities with female athletes who are impacted by eating disorders. This can impact a variety of markers in their physical, physiological, and mental health. However, male athletes are more apt to underreport symptoms. In addition to that, some medical providers may not have a strong understanding of what or how to medically assess an eating disorder.

Therefore, the following tips may help to reduce eating disorder risk among individual male athletes and athletic teams:

1. Hire sport dietitians, sport psychologists, and medical providers. They should be trained and skilled at assessing for and treating disordered eating/eating disorders in male athletes.
2. Normalize dialogue around mental health. 
3. Promote healthy eating habits which can include flexibility, eating a variety of all food groups every day, fueling around training, hydration, and overall, a focus on fueling in a way that is sustainable for all facets of well-being rather than feeling deprived. 
4. Denounce the use of unsafe supplements such as steroids, fat burners, appetite suppressants, etc. 
5. Eliminate conversations that allow for comparison of muscularity or leanness.

Disordered eating and eating disorders may continue to develop in different sport cultures through time. However, with increased advocacy, awareness, and resources, there is hope that male athletic environments can foster a safer and healthier sport culture. And that these positive shifts can be facilitated in all athletic environments with different gender identities in the future.

References

1. Eichstadt, M. et al. (2020). Eating disorders in male athletes. Sports Health, 12(4): 327-333.
2. Torstveit, M.K. et al. (2019). Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes. BMJ Open Sport Exerc Med, 5(1): 1-8.
3. Blashill, A.J et al. (2017). Anabolic steroid misuse among U.S. adolescent boys: Disparities by sexual orientation and race/ethnicity. Am J Public Health, 107(2): 319-321.
4. Strother, E. et al. (2012). Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eating Disorders, 20:5.

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