Suad Ali Nicki Croel Vaughn Lovell Lenore Schroeder

1. Suad Ali Nicki Croel Vaughn Lovell Lenore Schroeder Eating Disorders Among Men

2. What is an eating disorder? Life threatening psychological disorder “Consumed by extreme thoughts, emotions, and behaviors surrounding weight, food, and body shape” (Northwestern). 4 Main types of eating disorders • Anorexia nervosa • Bulimia nervosa • Binge eating disorder • Eating disorders not specified

3. Signs and Symptoms Mental Functioning Cardiovascular Muscular Skeletal Mouth/Esophagus Endocrine Stomach/Intestines Laxative complications

4. General Demographics Estimated 24 million people have eating disorders in the United States Only 1 in 10 men and women get treated 50% meet the criteria for depression Have the highest mortality rates of any mental disorder

5. Eating Disorders in Men Estimated 10 -15% of people with anorexia or bulimia are male • Some reports as high as 25% • Roughly 1 million men, likely underestimated • Men are less likely than women to engage in “typical” bulimic compensatory behaviors Less likely to seek treatment • “woman’s disease” More American men have eating disorders than prostate cancer Problematic exercising is more frequent in men

6. Bias Against Men Stigma around eating disorders in men • Woman’s Disease Doctors less likely to diagnose Insurance companies: “Men don’t get eating disorders” • Fight diagnosis – facilities don’t get paid Tend to have more severe cases as they are sicker for a longer time Mainstream group counseling structured primarily for women • Make men uncomfortable

7. Eating Disorders in Gay Men Among gay men • More than 15% suffer from bulimia • over 20% appeared anorexic Values and norms in the gay men's community promote a body-centered focus and high expectations about physical appearance The greater connection and affiliation with the gay community, more likely to have eating disorders (gay ghettos) In contrast, sexual orientation does not appear to be a factor in women and eating disorders

8. Bias Against Gay Men Social Stigma • Adverse, punitive, and traumatic reactions from parents and caregivers in response stated sexual preference • Many chose not to disclose Gay men continue to experience worse health outcomes than their heterosexual counterparts • Low rates of health insurance coverage • High rates of stress due to systematic harassment and discrimination • Lack of cultural competency in the health care system • Gay men who are also members of a racial or ethnic minority will often face the highest level of health disparities

9. Health Risk Factors –Community Weight History • Childhood obesity Athletic Achievement • To achieve optimal performance, more men than women are motivated to gain/lose weight Obsession with body image and perceived success Lack of awareness and education Larger portion of sufferers gay or bisexual men • Judged on attractiveness in the same way that women are

10. Health Risk Factors – Community Exercise & Body Image • Addictive – Anorexia Athleticism • Compensatory behavior for caloric intake • “Run-away diets’ • Muscle Dysmorphia

11. Health Risk Factors –Social Cultural Media pressures on men for the "ideal body" • Action Figures • Anabolic Steroids • Ideal Body Job or profession that demands thinness. • Male models, actors, and general entertainers seem to be at higher risk than the general population • Avg. male model lost 12 lbs of fat while gaining roughly 27 lbs of muscle over 25 yrs

12. Health Risk Factors – Social Cultural Depression & Shame • Men are expected to hide vulnerabilities – stigma of being feminine • Underreporting inhibits diagnosis and research

13. Health Risk Factors –Environmental Peer pressure Parents miss the signs • Boys are supposed to be tall and thin • Boys are supposed to eat a lot

14. Health Risk Factors – Environment Sexual Abuse • Approximately 30% of patients with eating disorders were sexually abused • For males, sexual abuse is usually underreported • Males often exhibit Asexual behaviors • Disturbed body image Trauma • Childhood bullying is common among males

15. Health Risk Factors – Multiple Steroid & Growth Hormones • Rate of anabolic steroid use is roughly equal to that of anorexia and bulimia in females Chemical Dependency • 24% struggle with alcohol abuse/dependence • Approximately 57% of men with Binge Eating Disorder struggle with substance abuse • Stimulants used to manage weight

16. Healthy People 2020 Goal: To promote health and reduce risk of disease through the consumption of healthful diets and maintenance of healthy body weights. (Healthypeople.gov) Outcomes: A healthy and nutritious diet will not only promote an overall healthy lifestyle but it will also help Americans reduce their risk for many health conditions including chronic illnesses and it will significantly decrease overweight & obesity and malnutrition. Strategies: Ensuring people consume a healthier diet by ensuring: Individuals have the knowledge and skills to make healthier choices. Healthier options are available and affordable. Aiming to improve the social factors that are thought to influence one’s diet Interventions to improve weight through both diet changes and physical activity

17. Health Promotion Theory Theory of Planned Behavior • Behavioral, Normative and Control Beliefs are warped • Those beliefs are impacting behavior Therapy needs to focus on changing beliefs to change behavior

18. Treatment No indication that males would have a poorer prognosis than females • Males may have better outcomes because of their tendency to want to “fix” problems Focus on body dysmorphicdisorder, more specifically, muscle dysmorphia • Understanding of how male body image concerns are different from female concerns All-male therapeutic groups are generally recommended as they encourage vulnerability Address issues unique to males such as weight history, sexual abuse, trauma, sexual orientation, body image, the abuse of exercise, and depression/shame

19. Conclusion Research to-date indicates • Male weight and body image concerns are different from those of females • Males do not generally have a firm drive for thinness, as much as a desire to gain muscle and lose weight • Largely undiagnosed Health care system not set up to support Until more interest and attention is focused on male eating disorder issues, men will continue to be under-diagnosed, undertreated, and misunderstood. • Gay men make up a disproportionate amount of this vulnerable population

20. Get Help National Eating Disorders Association www.nationaleatingdisorders.org 1-800-931-2237 National Association of Anorexia Nervosa and Associated Disorders      www.anad.org 1-800-841-1515 Bulimia and Self-Help Hotline                1-314-588-1683

21. References- Center for American Progress. (2009, December 21). How to Close the LGBT Health Disparities Gap. In Center for American Progress. Retrieved August 5, 2013, from http://www.americanprogress.org/issues/lgbt/report/2009/12/21/7048/how-to-close-the-lgbt-health- disparities-gap/ Collier, R. (2013, February 19). Treatment challenges for men with eating disorders [Electronic version]. CMAJ: Canadian Medical Association Journal, 185(3). doi:10.1503/cmajl09-4363 Darcy, A. M., & Lin, I. (2012). Are We Asking the Right Questions? A Review of Assessment of Males With Eating Disorders. Eating Disorders, 20(5), 416-426. doi:10.1080/10640266.2012.715521 Healthypeople.gov. (n.d.). Lesbian, Gay, Bisexual, and Transgender Health. In Healthypeople.gov. Retrieved August 1, 2013, from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25 Strother, E., Lemberg, R., Stanford, S., & Turberville, D. (2012). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eating Disorders, 20(5), 346-355. doi:10.1080/10640266.2012.715512 Weltzin, T. E., Cornella-Carlson, T., Fitzpatrick, M. E., Kennington, B., Bean, P., & Jefferies, C. (2012). Treatment Issues and Outcomes for Males With Eating Disorders. Eating Disorders, 20(5), 444-459. doi:10.1080/10640266.2012.715527

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