In September 2020, the BBC released a short documentary following ex-England Cricketer and TV-presenter Andrew (Freddie) Flintoff as he revealed his own struggles with Bulimia and explored what having bulimia meant for him and other men that he spoke to.

Statistics of Male Eating Disorders

When we think of eating disorders, we often think more of women and girls suffering with this particular mental health condition, but it is becoming more and more apparent that there is a proportion of males who suffer as well.

The National Centre for Eating Disorders estimate that males account for about 1-5% of patients with anorexia and about 5-10% of patients with bulimia. They also estimate that about 2% of the general male population suffers with binge eating disorder.

The actual rates of eating disorders among men are thought to be much higher, as there are large numbers of men suffering with eating disorders in silence. Where, as a society, we are likely to notice weight loss in females and prompt them to get some help, we are less likely to notice this in men, and even less likely to prompt them to seek help.

As one interviewee in the BBC documentary noted, there is stigma attached to having a mental illness in the first place, but when that mental illness is seen as a “female mental illness”, there is an added layer of shame that may prevent help-seeking behaviours.

Risk Factors

There are several known risk factors for eating disorders in men, which include:

• A history of dieting
• A history of obesity
• Homosexuality
• And participation in a sport that values thinness or weight control (such as wrestling)
• Comments from an athletic coach
• Being bullied or criticised for their weight
• Illness and/or loss
• A relationship breakdown
• Pressures (such as exams or deadlines)
• A career change

Through the BBC documentary, Freddie Flintoff looks back at his early career, when the press persecuted him for his weight, printing headlines that he was heavier than heavyweight boxer Lennox Lewis. Flintoff stated that this was when his bulimia started.

The Manifestation of Eating Disorders in Men

Some general signs and symptoms of eating disorders in adult men are:

• A compulsion for thinness or muscle building
• Fear of being fat or gaining weight
• Decrease or disappearance of sexual drive
• Obesity or rapid weight gain
• Eating an abnormal portion of food in a short period
• Inability to stop eating when full
• Develop a habit of eating alone, eating secretively
• Late night eating
• Eating even when not hungry
• Negative feelings after overeating like shame, disgust, and anger
• Food hoarding
• Using food as a crutch to deal with strong feelings like stress and unhappiness
• Blaming food, weight, or body image as the reason for failures or successes in life
• Avoiding situations in which food will be a part of, such as parties, family gatherings, and other social events
• Depression and anxiety are common
• Thought of food, weight, or body image consume daily thoughts
• Overeating and then purging through use of laxatives, diuretics, exercise, or vomiting
• Fatigue or constantly being tired
• Feelings of guilt no matter what you do
• Stomach pain that doesn’t go away
• Swollen fingers
• Huge weight swings

This is not an exhaustive list of symptoms, and some people may exhibit symptoms that are not listed here. Furthermore, most sufferers will not exhibit all of these symptoms – this does not mean that they don’t have an eating disorder. Equally, exhibiting a few of these a few of these symptoms does not automatically equate to suffering with an eating disorder. For example, someone might feel fatigue or stomach pain due to a physical problem not related to food.

The male in question may exhibit some of these symptoms and believe that they are completely normal and healthy activities or coping mechanisms. For example, Freddie Flintoff stated that he exercises 9-10 times a week on an empty stomach, and was shocked when someone said that was a lot.

Treatment

Seeking treatment for an eating disorder can be an incredibly daunting thing for a male or a female. It is a crucial time and, if the person that you go to says the wrong thing, it can stop you from trying again for a long time, or even ever again. Male eating disorders being underrepresented in the medical literature and in the media, means that this can be an even more daunting experience for male sufferers.

The expectation that eating disorders are predominantly seen in females can be a major block in accessing treatment for male sufferers, and studies have shown that 60% of men with eating disorders never seek help.

One family that was interviewed in the documentary stated that their son went to the doctor once, and the doctor didn’t recognise his symptoms as an eating disorder, and he was turned away. Freddie Flintoff described a time, during his cricketing career when a new dietician was hired for the England team. He talked himself into telling her everything, but in her introductory speech to the team she stated that she had worked with female athletes in the past and had dealt with eating disorders but “there’ll be none of that here”, deflating Freddie’s courage and causing him to keep quiet about it for another decade.

In recent years, celebrities have been more open about their own struggles with eating disorders, and when you scroll through the lists of who has suffered with eating disorders, you mostly see female celebrities, however there are a few notable exceptions such as Elton John, Zayn Malik, Russell Brand, and now Freddie Flintoff. This will hopefully lead to a wider understanding that eating disorders can impact the lives of men as well as women, and lead to greater access to mental health support for those who are suffering.

Current theory suggests that males respond to the same treatment for eating disorders as females. Therapy for eating disorder must be holistic, embracing physical, psychological, and interpersonal interventions. There are no good quality studies which would help us to identify extra aspects of treatment which would be helpful to men.

Men also benefit from social support, although one major problem is that eating disorder settings and services usually have an exceedingly high ratio of female patients. Many men are reluctant to join groups which are largely composed of women who may be talking about a female model rather than a male athlete. Even so, a group can be good in helping a man to confront the self-esteem issues that may have led him into his problem.

Antidepressants are of variable value in treating bulimia, however, there are no published studies on whether they are particularly useful for males.

The best place to start is with your GP and with talking therapies to get to the anxieties and triggers which underly the eating disorder. If you or someone you care about is concerned about disordered eating and you’d like professional support, then give our team a call. We have appointments available seven days a week. You can reach us by calling 020 8673 4545 or emailing appointments@theawarenesscentre.com.