More Eating Disorders Research Should Include Men, Say Researchers

False assumptions and the nature of
disorders among men have slowed research.

Several common assumptions have led to the idea that disordered eating behaviors in men are unusual or only a byproduct of other conditions. In fact, disorders among men are far more common than has been estimated, according to Dr. Jonathan Mond and colleagues at the University of Newcastle, and University of Sydney, Australia.

Findings from several recent studies suggest that binge eating is the most common eating disorder in men and women, and that it may be nearly as common among men as women. In two Australian studies, in which participants reported binge-eating at least once during the 3 weeks before the study, 4% to 6% of adult men, compared with 5.7% to 7.3% of women, reported binge eating (PLOS. 1 7:e48450; J Mental Health. 2008. 17:565). While the degree of behavior did not qualify as binge eating disorder (BED), it did show an important trend.

Most assumptions are based on studies among women

Assumptions about the rarity of disordered eating among men may also arise from the fact that current classifications for eating disorders have been derived almost entirely from studies of female patients with anorexia nervosa (AN) or bulimia nervosa (BN). As a result, extreme weight control behaviors used by men may not be assessed or studied. These behaviors may also manifest differently in men than in women, and thus be overlooked. For example, men more often use excessive exercise, steroids and body-building rather than purging as a way of controlling weight and shape  (J Public Mental Health 2010; 9:23). While purging behaviors are less common among men than among women, according to the authors, they are not as uncommon as one may think. In studies such as the 2005 and 2008 Australian prevalence surveys, which examined regular (at least weekly) purging of any type, 0.5% to 1.1% of men, compared with 4.0% of women, reported purging (Int J Eat Disord. 2009. 42:471).

Finally, the lack of any agreed-upon operational definitions of such terms as “extreme dietary restriction” and “excessive exercise” also makes classifying non-purging forms of extreme weight control behaviors difficult, whether these occur in men or women.

Directions for future research

The authors suggest that future research examine overvaluation of weight or shape or, as stated in the DSM-IV, “undue influence of weight or shape on self-evaluation.” Little in the medical literature addresses overvaluation of weight or shape, even though such “behavior” is required to make a diagnosis of AN and BN, and is an important part of the eating disorder psychopathology (Behav Res Ther. 2003. 41:509). In both South Australian studies, overvaluation of weight or shape was reported by from 4.2% to 13.5% of men, compared with 10% to 23% of women.

Impairment of function

Another area for research is the nature and extent of impairment of quality of life associated with excessive exercise among men. Lack of a clear definition may once more slow such efforts. Another factor is that vigorous exercise, unlike purging, is a socially sanctioned method of controlling weight and shape. Dr. Mond suggests that one way to advance research into eating disorders in men would be to examine the correlates of different operational definitions of extreme dietary restriction and excessive exercise in a large, general population sample of men and women. Such a study might shed some light on the specific behaviors that are most strongly associated with quality of life impairment in men and women, as well as delineate the nature and extent of any gender differences in the prevalence of those behaviors.