Mar 15, 20183 min read

Males Have Eating Disorders, Too

“I think I had a stress fracture before I broke my foot,” Rippon said, “and I think that was absolutely because I was not getting enough nutrients.” - The New York Times

My February was centered around watching the Olympics (constantly).

While watching sports, what quickly catches my eye is how athletes have different body shapes (read a prior blog post on that topic here). What also quickly catches my attention are athletes that look slim, gaunt in the face, out of place among their competitors, and, really, out of place within their own bodies.

Adam Rippon, 10 pounds lighter than he currently is, skating in 2016.

Source: The New York Times

I was stoked when Purdue’s sports nutrition department (@boilerfuel) highlighted American Figure Skater Adam Rippon's disclosure of his eating disorder, since:

Men and eating disorders seem to be a taboo topic.
The Olympics celebrate the epitome of athletic excellence, and Adam used this time to build awareness of his condition—especially for men.

Are Males Affected By Eating Disorders and Disordered Eating?

When you look through the research, what becomes apparent is that:

Yes, some male athletes do indeed have eating disorders.
It's heavily skewed towards women and weight-sensitive sports (e.g., figure skating, wrestling, gymnastics).

The National Eating Disorders Association (NEDA) estimates that 33% of male athletes are negatively impacted by disordered eating behaviors, including binge eating, purging, laxative abuse, and/or fasting for weight loss. Other research reports a range of 0-19%.

Isn’t zero percent a good thing?

Not necessarily.

Why is The Research on This Topic Misleading?

I think it's misleading due to how studies are designed and how participants are questioned and evaluated.

A meta-analysis by Chapman and Woodman (2016) came to the conclusion that the research in men isn’t as prevalent as it should be—and that “has been severely hampered by the diagnostic tools that have been available for the study of men.”

Case in point:

For the most part, men aren’t included in the study populations. So how can we fairly evaluate risk and prevalence among male athletes?
The Eating Attitudes Test and the Eating Disorder Inventory, two of the more commonly used eating disorder screening tools, were developed using female athletes—not males. Meaning that these tools may not resonate with or be sensitive enough to capture high-risk males.
Popular screening tools aren’t using the language that males would interpret as problematic to their condition. For instance, males are more likely to have a desire for leanness and muscularity versus a reduction in body mass or thinness. If we ask the wrong questions, we receive the wrong feedback.

Take-away Message: Include Male Athletes in the Conversation

Similar to how we’re rewriting Hollywood in the post-Harvey Weinstein era to protect women, we need to create environments where men feel able to come forward and seek ongoing help about their relationships with eating and their body.

When screening, treat all athletes of all sports and genders the same: Ask them about their possible history and present thoughts regarding disordered eating, eating disorders, and body image.
Talk about disordered eating directly with males, up front: Be blunt and communicate how dietitians are thinking about the topic, too. Leverage your opportunity at the beginning of the season (or whenever you first meet athletes), tie it into education posted in the team room, or use it as a topic for a team talk.
Learn who your team's influencers are and educate them: Not all coaches and support staff are comfortable with the topic matter and may not even know the signs, symptoms, or language used by high-risk athletes.
Listen to your athletes: Any time an athlete begins down the path of intermittent fasting, gluten-free, dairy-free, veganism—anything that restricts food intake—I listen up. Are these changes related to improving performance, body image, and/or weight related? Asking one extra question during a consult to help clarify intent isn't a waste of time.