Male Athletes and Anorexia
Article contributed by Sharon McConville, MB, BCh, BAO
Male Anorexia is Real
Much has been made about the female “athletic triad” of disordered eating, menstrual disorders and osteoporosis1, but what about men who engage in sporting activity – are they susceptible to eating disorders too? What do we generally consider to be an eating disorder?
If they have a disorder, what are the risk factors, and how should they be treated? This paper sets out to answer these questions.
Risk Factors For Male Anorexia
Studies show that males account for 5-10% of cases of anorexia2. Interestingly, 45% of males with anorexia are involved in “an occupation or athletic team in which control of weight is important for good performance”, compared with only 9% of females with anorexia2.
This suggests that engagement in sport is a significant risk factor for eating disorders in males. Further research reveals that certain sports carry more risk than others3.
- Firstly, male athletes who participate in activities where aesthetics are judged – such as figure skating or diving – are more likely to be preoccupied with appearance and have a higher risk of anorexia.
- Secondly, male athletes who have to “make weight” for competition, such as boxers or rowers, are more likely to engage in disordered eating behaviours such as extreme food and fluid restriction, or going for “sweat runs” wearing many layers of clothing.
Male jockeys are renowned for their strange eating behaviour, with 69% skipping meals, 30% inducing vomiting and 14% abusing laxatives, whilst some have died from cardiac complications after taking appetite suppressants3.
- Finally, male athletes who take part in sports where low body fat is advantageous, including distance running, are more likely to be anorexic3.
Indeed, startling similarities have been found between a cohort of distance runners and of females with anorexia, including high self-expectations, tolerance of physical discomfort, preoccupation with food, emphasis on lean body mass and even family and socioeconomic background4.
On the other hand, participation in some sports seems to be protective: adolescent swimmers were at no greater risk of eating disordered behaviour than the general population5, whilst one study found that male body-builders were not more likely to have eating disorders than controls6.
What Makes Male Athletes More Susceptible
Clearly, even within high-risk sports, not every male athlete develops anorexia, so what makes some more susceptible than others? One research group showed that, in sports, eating psychopathology results from the interaction of interpersonal difficulties, low self-esteem, high levels of self-critical perfectionism and depressive symptoms7.
They found no difference in these factors across sports type, performance standard or – importantly – between males and females, although it has been suggested that depression plays a greater role in males than in females3.
Recently, is has been shown that male physical education students with disordered eating are more likely to have lower levels of “emotional intelligence” than their peers, and that they tend to use avoidance- and emotion-oriented coping skills8.
Male athletes with eating disorders also perceive more pressure to be thin from television and magazines, and experience higher levels of stress than their healthy counterparts9. It should be noted that most male athletes with eating disorders experience this media pressure as directed towards muscularity rather than low weight per se9,10.
A Late Diagnosis for Anorexia
Despite all of this research supporting the relatively high prevalence of eating disorders amongst male athletes, diagnosis is often late11. This is likely to be due in part to the fact that anorexia and bulimia are seen as ‘female problems’, leading to a perception of stigma around men who suffer, and partly because medical complications occur later in men, who can physically sustain significantly lower levels of body fat than women3.
It has also been suggested that coaches are complicit in male disordered eating behaviours because they are seen as par for the course in certain sports3. Of course, early intervention leads to better outcomes, which means that there is much room for improvement in identification of cases within the male athletic community2.
Proper Treatment Guidelines
Psychiatric involvement in any sporting team is important because of the pressures of performance and it helps to normalise any intervention that has to occur in the context of an eating disorder3 There are a number of specialized treatments to help athletes with eating disorders.
If disordered eating is identified in a male athlete, the first step which should be taken is to instigate psycho-education for the athlete and also for the coach or trainer, emphasizing the importance of health over performance, not least because poor health inevitably leads to declining performance3.
Not Jumping the Gun on Stopping Training
Abnormal eating behavior in and of itself is not an indicator to prevent the athlete from training or competing; however, if there is medical or psychiatric compromise, he should be counselled to abstain until he regains stability. In some cases it may be appropriate for an athlete to be advised to change competition category (as defined by weight), or to change to a sport more suited to his body type3.
As with eating disorders in females, a multi-disciplinary approach to treatment is essential, and Engel’s bio-psycho-social model is seen to be appropriate3. Where males are concerned, the involvement of a psychiatrist is particularly important due to an increased incidence of co-morbid depression and substance abuse3.
Differences Between Men’s Treatment and Women’s Treatment
The psychiatrist should be empathetic towards the athletic psyche, understanding that continued involvement in sport may be highly important to the athlete’s self-esteem3. He should also be sensitive to the fact that some commonly-used medications may be banned in certain sports.
A sports dietitian is crucial to assessing need for restoration of weight and metabolic balance and implementing a nutritional plan, whilst psychotherapy is important in identifying and addressing contributory factors.
It has been suggested that individual therapy is needed, and that ‘family’ therapy should include team-mates, coaches and trainers because of the close-knit nature of the sports community3.
Hope For Success
Recovery is possible for male athletes. One sportsman who overcame anorexia after hospital treatment is Gary Grahl. He wrote in Men’s Health Magazine, “Many people have asked me if ‘total’ recovery is truly possible.
If what they mean is not dieting any longer, or not seeing a fat person staring back at me in the mirror, or exercising to extremes…then I believe recovery is doable…I made the choice to not pattern my life after old, destructive habits.
Over time, I learned to replace them with a new, healthier lifestyle…I wrestled with not liking myself for periods after my hospitalisations, but I didn’t use obsessive exercise and eating rituals to control my situation.
I took on and practiced productive coping strategies …like: journaling, talking to people I trusted, getting involved in my church and the community, reading and writing…” Gary has since graduated with a degree in Allied Health and is now married with a child.
“I’ve learned to embrace the benefits of balance and moderation in all I do. I’ve accepted my temperament and personality style for what is and given up my mock game show Let’s Be Someone Else. I’ve embraced my Christian faith like no other time in my life, making it real and practical. I’ve gone with the punches, not worrying myself to death over things I cannot control. I’ve chosen recovery. So can you.12”
In summary, male athletes are at risk of to eating disorders such as anorexia; certain sports may predispose participants to developing disordered eating; some men are more susceptible than others; a comprehensive treatment plan is essential; and there is hope for sufferers because – with the right help – recovery is possible.
- Birch, K: Female athlete triad. British Medical Journal 2005;330:244
- Braun, DL et al: More males seek treatment for eating disorders. International Journal of Eating Disorders 1999;25:415-424
- Baum, A: Eating disorders in the male athlete. Sports Medicine 2006;36(1):1-6
- Yates, A et al: Running – an analogue of anorexia? New England Journal of Medicine 1983;308:251-255
- Taub, DE and Benson, RA: Research Note: Weight concerns, weight control techniques and eating disorders among adolescent competitive swimmers: the effect of gender. Sociology of Sport Journal 9(1)
- Anderson, SL et al: Comparison of eating disorder index (EDI-2) scores of male bodybuilders to the male college student subgroup. International Journal of Sports Nutrition and Exercise Metabolism 6(3):255-262
- Shanmugam V et al: Application of the transdiagnostic cognition-behavioural model of eating disorders to the athletic population. Journal of Clinical Sport Psychology 5(2)
- Filaire E et al: Relationship between eating disorder behaviours and psychological parameters in male first-year physical education students. International Journal of Sports Nutrition and Exercise Metabolism 2012;22(5):383-391
- Petrie TA et al: Eating Disorders: Psychosocial correlates of disordered eating among male collegiate athletes. Journal of Clinical Sport Psychology 1(4)
- Fernandez-Aranda, F et al: Personality and psychopathological traits of males with an eating disorder. European Eating Disorders Review 2004;12:376-374
- Lindblad, F et al: Anorexia in young men: a cohort study. International Journal of Eating Disorders 2006;39:662-666
- Men’s Health http://www.menshealth.co.uk/healthy/addictions/anorexia-in-men-34344 Accessed May 9th, 2013