Men With Eating Disorders are Underrecognized and Underserved

Lane Therrell FNP, MSN, RN, NP

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.