More than 10 million men are affected by eating disorders in the United States alone. Yet, we aren’t doing enough about it.

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Signs of an eating disorder are often harder to spot in males than in females. Getty Images

Leonie Holt of Australia has battled anorexia her entire life. Her health was at its worst her first year of marriage, when she weighed 97 pounds at 5 feet, 4 inches tall.

It’s been an ongoing battle, but she’s thankful to say she’s in a fairly healthy place today.

One thing she never thought to prepare herself for, though, was the fact that her son may one day experience the same difficulties with his body and weight.

“At 13, my boy started showing signs of depression and anxiety,” Holt recently told Healthline. “He had been a thin-to-medium-build child until around 10, and then, similar to me at that age, he became overweight, eating quite a lot of comfort food.”

While she says her son wasn’t outright teased for his weight, and was a popular kid in general, “Kids did make remarks, which hurt.”

Just a year later, she says, “His dieting started after a kid in his class laughed when he said he planned to get fit over the holidays. He began losing weight quickly, and looked great, so of course he received lots of compliments. But then more weight started coming off.”

That was when Holt noticed her son was skipping meals, exercising too much, and flat out refusing any food with sugar.

“He and I were at the movies one day when he was 15. He was 6 feet tall and told me he weighed 63 kilos (139 pounds). I told him that I knew his magic number was 60 (132 pounds), because I’d had a magic number in my youth as well. Then I told him that if he reached that weight, I was going to have no choice but to have him hospitalized.”

Stories like Holt’s are more common than many people might think.

According to the National Eating Disorder Association (NEDA), eating disorders impact as many as 10 million men in the United States alone.

Research has identified a “significant genetic component” to both anorexia and bulimia nervosa.

Approximately 3 to 3.5 percent of males will be impacted by an eating disorder, according to Shiri Sadeh-Sharvit, a clinical psychologist with Palo Alto University. And while family history can absolutely present as a risk factor for a boy developing an eating disorder himself, it isn’t the only one.

“Unfortunately, the same factors that influence women and trigger them to perceive their bodies negatively and engage in unhealthy behaviors to change their bodies to cultural standards can also manipulate boys into feeling differently about their bodies,” Sadeh-Sharvit explained.

She said that media images of highly muscular bodies, that also usually appear hairless and tan, can “distort the perceptions boys and young men have of their own bodies and trigger them to engage in behaviors that are unhealthy in order to shape their bodies differently.”

These distorted perceptions contribute to one of the main differences between boys and girls when it comes to the presentation of eating disorders.

According to Dr. Cora Breuner, a spokesperson for the American Academy of Pediatrics (AAP) and a member of the Division of Adolescent Medicine at Seattle Children’s Hospital, girls with eating disorders are generally trying to be thinner while boys are usually striving to be more fit.

“Sometimes girls want to disappear, and sometimes they just want to fit into a size zero,” Breuner said. “There isn’t a size zero for boys, which is interesting to note.”

She explained these differences are even further defined when eating disorders are present among members of the trans community.

“In both trans males and trans females, the goal isn’t necessarily to be thin, but rather to have more the body type their gender affirmation calls for. So a trans female would try to lose weight and have a smaller frame while a trans male with an eating disorder is generally trying to be more lean, muscular, and fit,” she said.

It’s actually because of these differences that eating disorders aren’t always identified in boys as quickly as they are in girls.

There are two key barriers to treatment for boys struggling with eating disorders, according to Sadeh-Sharvit. And the first is under-recognition of these disorders by parents, teachers, and health providers.

“Boys don’t always lose a lot of weight, they just become focused on getting lean and increasing muscle tone. And that’s not necessarily perceived in our culture as a troubling sign. It’s not seen as worrisome as a woman who may lose a lot of weight,” Sadeh-Sharvit said.

Because it’s socially acceptable for boys to want to gain muscle and to spend a lot of time at the gym, parents and healthcare professionals are less likely to recognize when that behavior becomes unhealthy.

The second barrier to treatment is the higher stigma for mental health issues for males in general, and eating disorders in particular, as they’re often considered a “feminine” problem, according to Sadeh-Sharvit.

“It’s more socially acceptable for women to feel bad about their bodies than males,” she said.

Beyond that, clinicians who specialize in eating disorder treatment aren’t always readily available. Most work in urban communities, and treatment can be expensive. It’s not always covered by insurance companies either.

With summer vacation now in full swing, that desire to be fit and muscular may become more obvious for some boys who are struggling with their body image.

For parents who don’t know whether or not to be concerned, Breuner and Sadeh-Sharvit recommend watching for the following signs:

  • not finishing meals
  • insisting on making sure there’s no fat in their food
  • adopting extreme diets, such as veganism
  • exhibiting a preoccupation with their own body
  • asking about ingredients in food
  • withdrawing from peers (for example, avoiding a pizza party because they don’t want to eat)
  • lying about whether or not they’ve eaten
  • increasing the intensity and length of their workouts

“If done in moderation, these are highly acceptable behaviors,” Sadeh-Sharvit said. “But it’s when they appear adamant — for instance wanting to work out even when there is no available time or they are already sick or in pain — that parents should consider whether or not what they are seeing is a sign of an eating disorder.”

Breuner added that an obsession with cooking shows, or suddenly baking things they refuse to eat, can be a sign of concern as well. This is especially true if it’s not something they’ve ever done before.

“This is sometimes a way of vicariously eating,” Breuner said.

Then there are the more obvious, telltale signs of bulimia:

  • bloodshot eyes
  • breath that smells like vomit
  • a bathroom that smells like vomit after use

However, Breuner explained that bulimia often develops later on in an eating disorder pattern, 6 months to a year after other signs of a disordered relationship with food and their body may have begun.

In any case, she says that if a parent is concerned, they should consult with their child’s pediatrician right away.

“Don’t just wait to see if they’ll just work it out on their own, because that doesn’t work. As soon as you think something is going on, that’s a sign you shouldn’t ignore,” she said.

That was exactly what Holt did, ensuring her son had the support in place to receive treatment for his eating disorder. And shortly after she threatened to hospitalize him, he seemed to turn a corner.

“For some reason, that hit a nerve and he began sensibly gaining to a fine 80 or 85 kilos,” she said.

At 25 years old today, her son still struggles with “food guilt” and feels anxiety about his weight, which gets worse during times of high stress.

However, Holt says her son remains committed to therapy and continues to take steps forward.

Holt says both she and her son have concerns about the young men who may be struggling today.

“He and I both feel boys are now bombarded with media images of 6-pack body builders, which is compounding the problem for boys,” she said.

Sadeh-Sharvit agreed, pointing out that parents can help their boys by not only modeling healthy behavior themselves, but also by paying attention to what their boys are watching and the toys they’re playing with.

“Studies have shown that adolescent boys that play with action figures feel bad about their bodies following the game. Even short play leads to negative body image in boys compared to playing with a toy figurine whose shape is similar to the average male,” Sadeh-Sharvit said.

While Barbie’s impact on how young girls perceive their bodies has been debated for years, the same can’t be said for boys’ buff superhero action figures.

But eating disorders don’t discriminate, and it’s time we started talking about it.