Eating disorders have been long considered an affliction of women, but yet, the National Eating Disorders Association predicts that 3% of American men are affected. In Singapore and Malaysia, rates are much higher, with approximately 8.7% and 13.5% of males being affected, respectively, according to a review.

Furthermore, Australian researchers noted that "the prevalence of extreme weight control behaviours, such as extreme dietary restriction and purging" may be increasing at a faster rate in men than women. Other studies have shown that suicide rates are also 20% higher in eating disorder patients, with anorexic individuals 31 times more likely to attempt suicide than the general population.

For decades, the media has been blamed for fat-shaming women. But now, thanks to photos of half-naked, perfectly sculpted male bodies in fashion ads that surfaced a generation ago, men have plenty of images to make them feel inadequate.

With those comparisons, men develop eating disorders - skipping meals, cutting back on portions, eating enough only to blunt their hunger - when they cannot achieve the same standards of physical form.

Medical professionals do not recognise eating disorders in men

For men, it is usually detrimental as they bear the double stigma of having a mental illness - especially one normally categorised as female - and insist that they are fine or not recognising that they are sick or in need of help. Medical professionals are also not responding to the problem quick enough. It was only in 2013 that the official criteria for diagnosing eating disorders in US included men.

"Why do we not think that this is a male disease? Because even the academics aren't bothering to put the time and effort into it," said Andrew Walen, who became a therapist in Columbia after a 20-year battle with eating disorders.

It took decades for women with eating disorders to be recognised and men have only begun to come forward and "it could be 20 years before we see anybody really starting to speak up and say this is a problem that is epidemic," Walen adds.

Male eating disorders tend to focus on body shape and muscles

"10% of those who suffer from eating disorders are male."

This passed-around conclusion from an unscientific sampling in the 1980s has been pushing men to the margins and now mental health professionals realise that they have vastly underestimated the problem, says Leigh Cohn, editor of Eating Disorders: The Journal of Treatment and Prevention.

The difference between male and female eating disorders is that males tend to fixate on the shape of their bodies or a certain body type rather than their weight, according to Dr. Arnold Anderson, a researcher from the University of Iowa.

In some men, probably due to genetics, psychological distress or other reasons that are not understood, the desire to be perfect becomes a fixation that dominates all else. A Canadian study in 2015 reported that about one-third of regular male gym-goers admitted to taking worrisome levels of bodybuilding supplements, with some continuing despite developing kidney problems and being advised by their doctors to stop.

Others lifted weights compulsively, tearing muscles and joints, requiring surgery to reconstruct them. A separate study also showed that 7.6% of men were engaging in unhealthy behaviours, using steroids to build muscle and lose fat.

Some eating disorders also arise from trying to heal from abuse, trauma or bullying, creating a need to control circumstances that otherwise feel uncontrollable. It can coexist with drug addiction, alcoholism or depression, at any age but emerge significantly in adolescence and young adulthood. Anorexia, bulimia and binge eating are the most common forms for men, accompanied with the obsessive need to exercise to build muscle or burn calories.

Societal stigma makes treatment more complex

But even if men admit that they do have an eating disorder, it is hard to find help - as programmes are usually catered to women - and it is also more difficult to treat. Many hospitals do not look past the gender discrepancy and do not admit men with eating disorders.

Doctors are also not recognising that their male patients have an eating disorder due to their own misconceptions. Men are also constantly reminded that their disease is seen as feminine -which is culturally perceived as weakness - making treatment more complex.

Perhaps it is time to fit men with eating disorders into a theoretical and clinical framework that has been largely focused on the physical, psychological, and emotional development of women. Diagnostic criteria should also be refined to accommodate men and more targeted awareness and prevention efforts should be developed for these men.

Because why can't men have an eating disorder, too? MIMS

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