Connections between 'clean eating' and orthorexia
How common are male eating disorders?
Women are definitely more likely than men to develop eating disorders - but they don't have a monopoly. UK figures from 2007 suggest 1.6% of men have a problem relationship with food, and US figures put the number of boys and men with eating disorders at a million and rising. But are those figures an underestimate? And is the increase more to do with awareness and readiness to come forward than a real rise in the number of people affected?
The size of the problem
NHS Digital data show a 70% increase in the number of UK men admitted to hospital for eating disorders in the last six years - up from 480 in 2010-11 to 818 in 2015-6. But these men are very much the tip of the iceberg. Out in the community, there are thousands of men coping with eating disorders at the less serious end of the spectrum under specialist help, and many more still hiding their problems from doctors.
Because of their reluctance to admit they have a problem, it's impossible to know how many people have eating disorders. But the best estimates we have suggest men account for about 1 in 10 people with anorexia and bulimia, and perhaps as many as 1 in 4 with binge eating disorder.
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Is the rise real?
In the past, we might have been able to put lower levels of eating disorders down to lack of awareness - since the 1930s, for instance, yearly diagnoses of eating disorders in the USA have increased from 1 in a million to 1 in 20,000. 80 years ago, eating disorders just weren't on the average doctor's radar.
But eating disorders, particularly anorexia nervosa, kill - and that's a statistic that's harder to fudge. People with anorexia are five times more likely to die than other people of their age: for bulimia and other eating disorders (including binge eating disorder), the figures are 75% higher and 92% higher respectively. And those figures are rising too.
What are the experts seeing?
Dr Sandeep Ranote is a consultant child and adolescent psychiatrist, who has specialised in eating disorders for 15 years. She has no doubt she has seen a rise in referrals. "It is a real increase - we're seeing more boys and men asking for medical assessment, support and treatment. I see that as a positive because while we know eating disorders are more common in women, in the past we have struggled particularly to get men to come forward."
Is the rise due to better awareness or to more people suffering? "That's impossible to tease out," says Dr Ranote. "But my personal, intuitive opinion is that we are getting the message out there better, and while the people getting help are still the tip of the iceberg, it's a bigger tip than it was."
Are we asking the right questions?
It's difficult to hide an eating disorder so serious that it's threatening your life, so we can be fairly confident that hospital admission statistics for eating disorders (mostly anorexia) are a fair reflection of the true gender split. In 2015-6, there were about 12 times more women diagnosed in hospital than men.
Perhaps inevitably then, questionnaires to tease out possible eating disorders have largely been developed for, and their accuracy tested on, women. Some researchers have argued that they are less sensitive at picking up eating disorders in men. For instance, widely used tools such as the EDI-3 may underestimate body dissatisfaction in men. In 2012, the Eating Disorders Assessment for Men (EDAM) was developed to address exactly this problem. It's not being used everywhere, but there is more awareness among experts of the different challenges faced by men and women.
Are men worse off than women?
Dr Ranote is clear: "In my mind, we still have much further to go with men than with women. It is slowly becoming more acceptable to admit to an eating disorder if you're a woman, but we haven't seen the same change in attitudes among men. We need to start getting the message out much earlier - going into schools and colleges, so children and young people understand that this is a real illness - a real neuro-biological illness. But the moves made by some sporting bodies, such as the State of Mind campaign from the Rugby League and Rugby Union, are beginning to make a real difference."
She is particularly keen to see progress among black and minority ethnic (BAME) groups, where stigma, if anything, is even greater than among other groups. But here, too, she is quick to highlight the positive work of the eating disorders charity Beat, which has appointed its first male Asian ambassador.
So our specialist's verdict? Yes, men do get eating disorders. Yes, they are common, albeit not as common as among women. Yes, they're getting more common - although whether that's down to more men getting eating disorders, more men coming forward to admit to them, or a combination of both is hard to say. There is more work to be done, but attitudes are changing slowly. So while the future may not be bright, there are distinct glimmers of hope on the horizon.