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Collage by Yunuen Bonaparte. Photo courtesy of KoolShooters.

The pressures that girls and women face to achieve unrealistic body ideals have been subject to public concern for some time. A survey conducted by Facebook showing that social media negatively impacts body image in teen girls, for example, may even prompt regulation from Congress.

But girls and women aren’t the only ones who experience negative body image. Approximately 1 in 3 people experiencing an eating disorder is male, according to the National Eating Disorders Association (NEDA).

Behaviors often associated with eating disorders, such as binge eating, purging, and fasting for weight loss, are nearly as common among men as they are among women.

In fact, the prevalence of eating disorders in men is on the rise, according to a recent study in the American Journal of Men’s Health. An estimated 10 million boys and men in the United States will experience an eating disorder in their lifetime.

The assumption among men, and even many doctors, that eating disorders primarily affect women may lead to missed diagnoses.

Due to stigma and feelings of shame, men may deny their symptoms and hesitate to seek treatment.

In order to meaningfully address the issue, it’s important to recognize the particular impacts that eating disorders can have on men, identify who is high risk, and find treatment options.

Eating disorders in women are commonly associated with a desire for thinness and weight loss. But the same is not as often true for men.

“The symptoms that one thinks about for a classic eating disorder are extreme or unhealthy weight loss behaviors, like vomiting or fasting, but the idealized masculine body image is actually not toward that same ideal,” says Dr. Jason Nagata, assistant professor of pediatrics at the University of California San Francisco, where he studies eating disorders in adolescents.

“A lot of guys are trying to get muscular and bulk up, so a lot of those weight loss behaviors don’t actually apply to them,” Nagata explains.

In fact, Nagata’s research has found that masculine body ideals are influencing men’s behavior toward diet and exercise in distinctly different ways.

A recent study found that nearly a third of teen boys in the United States report they want to gain weight. Nearly a quarter of young men also report taking supplements, steroids, or eating more to bulk up.

But the pursuit of extreme weight loss can also be a problem for men, particularly in certain high-risk groups.

Steve Walk, 71, collapsed on the gym floor as a varsity wrestler in high school, enduring anorexia and bulimia to compete in a lower weight class.

Walk, a retired engineer and educator based in Fredericksburg, Virginia, eventually found full recovery. He’s spent years volunteering with organizations like NEDA to help people experiencing eating disorders.

Masculine body image has evolved dramatically since Walk’s school days in the 1960s, with narrowing ideals that have increasingly focused on appearance.

But you can’t always tell just by looking at someone whether they’re struggling with an eating disorder. While there may be apparent signs, “eating disorders are unique in that they have both mental health and physical health consequences,” Nagata says.

Eating disorders can potentially affect every organ system in the body. An obsessive focus on diet and exercise can lead to serious and even life threatening impacts on physical health that require urgent treatment. But that’s not always the case.

Nagata notes that it’s also possible to be physically healthy while experiencing extreme mental distress over diet, exercise, and body dissatisfaction.

Identifying eating disorders among men as a mental health issue is crucial to advancing understanding around them, as has been the case with anxiety and depression in recent years.

Athletes, People of Color, and LGBTQ+ people may be at elevated risk of eating disorders and their associated behaviors.

Body dysmorphia, an obsessive focus on perceived defects in one’s body, impacts women and men at equal rates, according to the Anxiety & Depression Association of America.

Transgender people may experience body dysmorphia in connection with gender dysphoria, the term for distress over discrepancies between one’s body and gender identity.

“Transgender people, and gender diverse people in general, have a lot of body image concerns, because part of gender dysphoria is about appearance,” Nagata says.

Growing up, Henry Giardina, a Los Angeles-based editor, thought he was tuning out messages aimed at young girls about their bodies — prizing extreme thinness and whiteness — because he’s trans and didn’t identify as a girl.

But those familiar pressures wound up resurfacing in modified form as he transitioned.

“I wasn’t actually ignoring them,” Giardina, 33, says in retrospect of messages targeting young girls. “I was taking them in and waiting for the time when they could apply to me.”

After he had top surgery in 2012, Giardina recalls shifting from one locus of body concern to another.

“The problem of my body was kind of done,” he says with regards to his transition. “Then it just became like, the more weight you lose, the more masculine you’ll be.”

Giardina found he regarded waifish male musicians, like Morrissey and Michael Stipe, as a personal ideal of masculinity.

With ongoing help from his therapist, now Giardina works to actively fight the critical voice in his head and listen to his body. “I’m trying to get back to a natural place of recognizing, ‘Oh, your body knows what it wants.’”

“Because of the potential compounding of messages about masculine and feminine bodies, queer men may be at higher risk for eating disorders, due to “both thinness pressures, as well as muscularity pressures, or a combination of both,” Nagata says.

A recent research review found that sexual minority adults have between two to four times greater odds of experiencing anorexia, bulimia, or binge eating compared to cisgender heterosexual adults.

In addition to distinct body image pressures, other minority stressors like discrimination, or psychological comorbidities like depression, may contribute to the prevalence of eating disorders among queer men.

Images of immensely muscular men have grown ubiquitous, circulating apps like Instagram and taking on outsize proportions in the Marvel Cinematic Universe and on billboards and magazines.

Recent admissions by the likes of Olympic diver Tom Daley and “Eternals” star Kumail Nanjiani have pointed to the perils of striving for the extreme muscular physique reflected so widely across pop culture.

But social media algorithms and Hollywood norms continue to propagate body ideals that can be dangerously unattainable.

“Social media was a really, really big factor in my eating disorder,” says Joseph Goldberg, 21, who experienced anorexia, bulimia, binge eating, overexercise, and more, before finding recovery and volunteering to help others.

“I saw all these fitness people [talking about how] to stay lean,” says Goldberg, who is Orthodox Jewish and based in Boca Raton, Florida.

That fed into a fixation on avoiding certain foods not considered “clean,” like sugar and saturated fat. “It got to the point that it would take me two hours to shop for groceries,” Goldberg says, because he would pore over the ingredients on every label.

Broader cultural conceptions of how men are supposed to act also play a role in how men relate to struggle.

“Toxic masculinity and the belief that a man has to keep a stiff upper lip at all times, is one of the main causes of stigma that men can’t have eating disorders,” Goldberg says.

That sense of shame and stigma is one reason men may be less likely to seek treatment, or recognize their obsession with diet and fitness as a problem.

Addressing eating disorders in their early stages increases the likelihood of achieving full physical and emotional recovery, according to NEDA.

That’s why developing screening measures specific to men, and encouraging a culture of openness around the subject, is so important to combatting the disorders.

While eating disorders can manifest very differently in men, language around their diagnosis remained narrowly focused on women until recently.

A number of terms have emerged pertaining to body image problems specifically as they apply to men.

Nagata describes muscle dysmorphia (sometimes known as “bigorexia”) as a preoccupation or obsession with being insufficiently muscular, which may lead to steroid use and excessive focus on exercise. But even that isn’t technically considered an eating disorder.

“Even in the term eating disorders, the focus is on diet,” while one’s relationship to food may only be part of the problem.

Nagata ideally favors an interdisciplinary approach to treatment, including a physical check, mental health evaluation, along with therapy and consultation with a nutritionist, to address all the impacts a patient may be experiencing.

Naming the particular body issues that men face, and raising awareness among those who may be suffering and their medical providers, is critical to developing successful treatment.

Not only that, but knowing that many other men are having similar experiences can be a meaningful part of recovery.

“Understanding that you’re not alone is so powerful,” Goldberg says of his time participating in and facilitating support groups with ANAD (National Association of Anorexia Nervosa and Associated Disorders). Especially because struggling mentally with an eating disorder can feel so isolating.

Over his 50 years of recovery and mentoring others, Walk, the one-time varsity wrestler, has found the importance of ultimately normalizing eating disorders and learning how to co-exist.

“Radical acceptance is a huge piece,” Walk says. “Eating disorders are part of the world, like oak trees and bluebirds. It’s OK,” he says. “But let’s do something about it.”