Men With Eating Disorders are Underrecognized and Underserved

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    February 26 – March 4 is National Eating Disorders Awareness Week for 2017. Nurses at all levels of practice must stay vigilant in their assessments to help discern which patients may be suffering from an eating disorder. With that in mind, it is important to remember that men with eating disorders are often underrecognized, and therefore underserved.

    Men With Eating Disorders are Underrecognized and Underserved

    Health news headlines in late 2016 drew attention to a Wisconsin man, Max Briles, 26, who passed away from complications related to anorexia nervosa. The Chippewa Herald reported that Briles declined treatment, at least in part, because he did not wish to be the only man in his treatment group.

    While eating disorders are still popularly thought of as diseases that primarily affect women, many researchers and medical professionals readily acknowledge that more men are suffering from eating disorders now than ever before. In fact, some sources claim that 40% or more of the individuals currently suffering from binge-eating disorder today are male.

    Sociocultural factors significantly influence the onset and treatment of eating disorders in both men and women. We live in a highly visual culture where appearances matter, where multiple generations have grown up with cyber-bullying, and without healthy, well-balanced, tangible, real-life role models. In this environment, disordered eating emerges as a response to the need for control. Eating disorders are often triggered by trauma, and then exacerbated by the mandates of weight-related athletics, perceptions shaped by media, perfectionism, self-esteem, and social anxiety.

    Nurses must be able to identify active and potential eating disorders and ensure the patient receives the correct treatment. To identify disordered eating in a male patient, it is important to recognize not only the precursors and triggers of disordered eating, but the ways in which men are most likely to respond.

    According to information in a recorded webinar * featuring Dr. Theodore Weltzin, a well-known expert who specializes in treating males with eating diorders, men express dissatisfaction regarding their life circumstances differently than women. "They go straight to a behavior," Weltzin says. To help identify men with eating disorders, Weltzin recommends that providers and caregivers integrate targeted questions that specific to men's experience into their history-taking process.

    Exploring the following topics with your male patients may help them open up in ways that provide opportunities for deeper probing and better care.

    → Have you been a victim of bullying, either in person or online?
    → How would you describe your desire for a more muscular body? (It may be helpful to phrase this question in terms of a 1-10 scale.)
    → To what extent do you feel your body's appearance influences your ability to get a date?
    → Are you experiencing issues or concerns regarding your gender identity?
    → Do you have a history of sexual abuse?
    → How do you express your masculinity?
    → Are you satisfied with your body?
    → Are you experiencing decreased sexual desire?
    → Do you participate in weight-related sports?
    → Have you recently experienced the loss of a father figure?
    → What do you do to gain control of different situations in your life?

    While not all of these questions will be appropriate to ask each and every patient at every encounter, the point is that explicitly asking relevant questions that are specific to a male patient's experience will not only help build trust and rapport but will help reveal the truth. It is important to remember that signs and symptoms of eating disorders may be hidden or masked by other conditions or concerns, and the patient may be ambivalent about seeking treatment. By asking targeted questions, providers and care givers show they are aware that the man in front of them may be suffering from an eating disorder.

    There are many factors to consider in a comprehensive care plan for men with eating disorders. Asking the right questions, and knowing what male-specific treatment programs are available in your area are great places to start. Some additional factors to consider are encapsulated in the WHATS UP DOC mnemonic for eating disorder care.

    National Eating Disorders Week is dedicated to heightened awareness around eating disorders. During this week and every week, let's be sure to remember the men we care for and consider that they, too, may need treatment for eating disorders. Let's pledge now to get more men the treatment they need and deserve.

    *The following video is a recording of a 2015 webinar featuring Theodore E. Weltzin, MD, of Rogers Memorial Hospital. The recording is a detailed update on treating eating disorders in males, includes personal insights from two patients, and is more than one hour in length. Dr. Weltzin specializes in treating males with eating disorders. Rogers Memorial hospital provides behavioral health at multiple locations in 5 states.

    Check out the following Males and Eating Disorders Treatment Update video by National Eating Disorders Association

    Have you known or cared for males with eating disorders?

    How will the information provided here help you provide better care in the future?

    Sources and Resources

    Eating disorder kills man | |

    NIMH >> Eating Disorders: About More Than Food

    Males get eating disorders too. Eating disorders in men and boys

    Symptoms and causes - Eating disorders - Mayo Clinic

    Get in the Know: Males and Eating Disorders | National Eating Disorders Association

    Males and Eating Disorders

    Men With Eating Disorders Often Ignore Symptoms
    Last edit by tnbutterfly on Jun 14, '18
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  3. by   dirtyhippiegirl
    My last EDU hospitalization was with a guy who had severe bulimia. Something that was talked about and I hadn't thought about before is that the portrayal of mens' figures by media/advertising is just as unrealistic and photoshopped as those of women. My friend was obsessed with the perfect six pack -- but those are just as likely to be photoshopped as a model's flawless skin or perfectly proportioned body.
  4. by   Lane Therrell FNP, MSN, RN, HTCP
    Women's health is a specialty, but in my experience, men's health is all too often forgotten. You bring up a great point about how Photoshop influences men's body image too. I'll never forget a 22 year old male patient of mine who insisted that I feel his biceps every time he came in for an office visit. At first, I thought he was hitting on me, but then I realized he was obsessed with his body image. We talked about it, and I assessed him for eating disorders. Fortunately, he did not have an eating disorder at that time, but we took the opportunity to talk about healthy vs unhealthy body image, and the potential for and consequences of eating disorders. I sincerely hope our conversations helped him avert trouble in the long run.
  5. by   Atl-Murse
    What source is suggesting 40% are male. Cite or lose credibility
  6. by   Lane Therrell FNP, MSN, RN, HTCP
    Links to sources are listed at the end of the article. Interestingly, if you dig deeply into the topic, you will find that the statistics vary, which is beyond the scope of this article. The ultimate takeaway is that more men than you may think are affected.
  7. by   SaltySarcasticSally
    I really liked this post because I think a lot of men's health and mental issues aren't recognized enough. I didn't grow up with any males in my household but now that I have two boys I have become acutely aware that men face many of the social pressures to look a certain way that women do but it's not "manly" to talk about it. We have eliminated terms like "be a man" or "man up" from our vocabulary in our household because I think it just sends such a negative message to young boys that they cant talk about things like their body image or emotions surrounding their body.
  8. by   Lane Therrell FNP, MSN, RN, HTCP
    Good for you for doing your part to support positive body image and affirmative health language for men.
  9. by   dirtyhippiegirl
    Quote from Atl-Murse
    What source is suggesting 40% are male. Cite or lose credibility
    Something like 35% of men in the US are obese. I don't think it's too off based to think binge eating among men is that high.