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Eating disorders don’t discriminate in terms of gender

By guest contributors Olivia Feng, Jessica Gosselin, Swetha Rajah

An estimated one million Canadians suffer from eating disorders. Eating disorders are perceived within society as a “woman’s issue,” and this assumption is reflected by research. Less than 1% of all research relating to eating disorders has focused on men. This is alarming given that eating disorder hospitalizations in Canada have increased by a staggering 416% among 5- to 17-year-old boys over the past 18 years.

These numbers are a stark reminder that eating disorders don’t discriminate in terms of gender.  

Eating disorders significantly harm the physical and psychological well-being of individuals. This is reflected through the high mortality rates among patients. People with eating disorders face a risk of death that is 5 times greater than the general population. So why do eating disorders lack the attention they need, and why is the issue especially neglected among men?

Currently, the Canadian healthcare system addresses eating disorders as individual and isolated cases by focusing on the treatment of physical and behavioral symptoms. This approach, however, is a dramatic oversimplification of how eating disorders impact people’s lives. This also shifts the responsibility for the eating disorder onto individuals, rather than on society.

This mentality also has major impacts on our social and economic systems. Money spent on eating disorder diagnosis, treatment, and research is around $0.70 per patient. In contrast, other psychiatric conditions like schizophrenia receive $50.17 per patient. This makes it hard for parents and caregivers to access treatment for their children. Almost 45% of parents pay for private treatment, despite few having private insurance. As a result, caregivers report reduced income and productivity, higher travel costs, and psychosocial impacts on family life and interpersonal relationships.

Despite growing awareness on men’s mental health, insufficient efforts are made from a public health standpoint in preventing eating disorders. Why? The reasons are complex, but they include the stereotype that eating disorders only impact girls and women, that focusing on eating disorder prevention hinders obesity prevention, and that diet product industries are not a public health priority. Lastly, the challenge in conducting eating disorder research with a public health focus is amplified by the tendency of public health professionals and eating disorder specialists to work in isolation from one another. 

The key to mitigating the rising rates of eating disorders in boys lies in collaborative prevention. This entails minimizing eating disorder risk factors and promoting protective factors. Given the neglect of boys in eating disorder discussions, prevention efforts should prioritize specific factors that elevate their risks.

One main factor is how media messages place immense pressure on men to conform to muscular body “ideals.” Boys as young as 6 years old express wanting to be more muscular, and nearly 50% of teenage boys and men report engaging in muscle-oriented disorder eating or weight control behaviors. These include cycles of “bulks” and “cuts,” and using appearance- and performance-enhancing drugs that get promoted through social media influencers and media portrayals of “perfect” male bodies. These numbers are concerning. We must stop assuming body image concerns only affect girls. 

So how do we integrate a public health approach to eating disorder prevention? 

A first step is to harness political will across a range of professional disciplines, particularly within the public health sector, to collaborate on preventive efforts. This requires breaking down the harmful gender stereotypes and eradicating stigma surrounding eating disorders.

While the body positive movement has undoubtedly brought attention to important issues surrounding body dissatisfaction, our work is not done. We need to face the harsh reality: children, particularly boys, are directly impacted by the pervasive influence of societal expectations on body image, and they need support. We can’t simply celebrate body positivity; the rise in eating disorders should be an indicator that this is not enough. Rather than shying away from uncomfortable truths, we must explicitly recognize the challenges our youth face and acknowledge the need for prevention. 

These necessary changes start with joint efforts from public health and eating disorder specialists in directly addressing risk factors, increasing awareness, and actively working towards prevention. We can then pave the way for a society that promotes the health of our youth.  

About the authors:

Olivia Feng is a doctoral student in the Department of Kinesiology and Physical Education at McGill University whose research focuses on eating disorder prevention in sport.

Jessica Gosselin is a Master of Science in Public Health (MScPH) student at McGill University whose focus is on equity.

Swetha Rajah is a MSc Dental Science student at McGill University who is a trained international dentist from India.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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