Eating Disorders in Male Athletes: Factors Associated with Onset and Maintenance

By: Nancy Clark, Sally Hage, and Paula Quatromoni

  As sports dietitians, we are well aware that male athletes struggle with food and weight, just as female athletes do. An estimated 8% of male athletes (1), as compared to 33% of female athletes (2), have pathological eating disorders that can damage their physical and mental health. Another 19% of male athletes likely have sub-clinical disordered eating behaviors (3). If anything, these estimates are low because eating issues in males can be challenging to identify.

      Male athletes with eating disorders are commonly left undetected and untreated. Recent research (4) with MAND member Paula Quatromoni investigated the experiences of 8 male athletes who self-identified as having as having an eating disorder (ED), disordered eating, or compulsive exercise behaviors. In-depth interviews confirmed few male athletes readily seek treatment for their eating disorders. They may believe they are not “sick enough” to justify getting help, and they are generally unaware of the risks they are imposing on their physical and mental health. Some are unaware that their thoughts or behaviors are even disordered.

 Below is a summary of some factors that contribute to the onset and maintenance of disordered eating behaviors in male athletes

Why do eating disorders take root in men in the first place?

     An eating disorder gives a sense of control. While a male athlete cannot control his genetics or his coach’s opinion of him, he can attempt to control his food, exercise, and weight. The male sporting environment embraces and rewards extremes.
     Extreme behaviors can bring desirable results initially – as well as praise. Positive comments from others are validating, confidence-boosting, and perceived as a positive sign that their efforts are paying off. While eating less and training more might look like discipline and dedication to the sport, the extremes can destroy one’s quality of life, to say nothing of dramatically increase the odds of getting a stress fracture, tendonitis, pulled ligament, or other injury due to under-fueling and/or poor nutrition

Factors that trigger disordered eating behaviors

     Male athletes, like females, live in an environment that can easily trigger disordered eating. Triggers include:

• immense pressure to look a certain way to perform well, social media’s idolization of the “perfect physique, i incessant comparison of oneself to others, and a competitive nature and drive to be better than others.

The end result: some male athletes resort to extreme behaviors in their attempt to be able to control their body shape and size. They do extra training and become extra vigilant about their food intake. One small dietary restriction can easily blossom into a full-blown eating disorder.

Social pressures

Advertisements and social media teach men they should look lean and muscular, but no one teaches male athletes the images are photoshopped—or that some of the male models use performance enhancing drugs to help them look so buff. As a result, male athletes tend to suffer in silence with their concerns about their “flawed” bodies. After all, real men don’t talk about this stuff with others. Hence, many believe they are the only ones who eat less and exercise more to fix their flaws. They may not even realize their behaviors are abnormal. Don’t all dedicated male athletes live on salad to be lighter, leaner, and (supposedly) better? Turns out, that is not the key to success.

Seeking help

     Many males have no one to talk to, so they suffer in silence. If a male athlete does try to talk about his experience to a teammate, the teammate might express disbelief and have little understanding of what the athlete is talking about. This can lead to embarrassment and shame.  After all, aren’t eating disorders a woman’s issue?  It’s easier to try to hide the eating disorder rather than share their personal issues.

    Other male athletes don’t even know they have a problem because they have been performing well (to date) and no one seems concerned about their extreme dieting and exercise behaviors. They just get praise for how dedicated and disciplined they are. These positive comments must mean the behaviors are working and paying off (in the short term). But injuries will inevitably ruin the dreams…

In the survey of eight men with eating disorders, only four sought help—and that was when the physical and mental costs of restrictive eating outweighed the benefits. One subject reached out for help after he passed out on the side of the road during a long run. Others acknowledged the loss of sexual interest/function (side effects of under-fueling), and the heightened anxiety, depression, and extreme fatigue just weren’t worth it anymore.

What can we, as sports nutrition professionals, do to minimize eating disorders?

Male athletes need to be educated about:

• fueling wisely to enhance performance and health;

• the benefits of staying away from social media sites that focus on super-fit bodies ;

• the benefits of training appropriately (not compulsively).

Coaches, trainers and sports medicine professionals also need to be educated about warning signs of eating concerns (skipping team meals, complaining about body fatness, avoiding carbohydrates). Just like a torn ligament, an eating disorder is an injury—a mental health injury. Male athletes deserve to be able to comfortably seek help instead of suffering alone and in silence.

If you’ve worked with athletes with eating disorders we’d love to hear strategies you’ve found to be effective! Head on over to our linkedin, instagram, or facebook to comment and re-share this post to spread the word!

References:

1. Sundgot-Borgen, J., & Torstveit, M.K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sports Medicine, 14(1), 25–32. PubMed ID: 14712163 doi:10.1097/00042752-200401000-00005

2. Bratland-Sanda, S., & Sundgot-Borgen, J. (2013). Eating disorders in athletes: Overview of prevalence, risk factors and recommendations for prevention and treatment. European Journal of Sport Science, 13(5), 499–508. PubMed ID: 24050467 doi:10.1080/ 17461391.2012.740504

3. Petrie, T.A., Greenleaf, C., Reel, J.J., & Carter, J.E. (2008). Prevalence of eating disorders and disordered eating behaviors among male collegiate athletes. Psychology of Men and Masculinity, 9(4), 267–277. doi:10.1037/a0013178

4) Freedman, J, S. Hage, and P. Quatromoni. Eating Disorders in Male Athletes: Factors Associated with Onset and Maintenance. J Clin Sports Psychology 2021

Sports Nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Nancy Clark’s Sports Nutrition Guidebook has strong sections on how to manage dieting gone awry. For information about her book and online workshop, please visit www.NancyClarkRD.com.

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