Dieting and Eating Disorders

11 is easy for anyone who has been exposed to mass and popular culture in the U.S.A. in the past twenty years to believe that dieting is an exclusively female activity and that eating disorders only affect woman. Advertisements for weight-loss companies such as Weight Watchers and Jenny Craig primarily feature women, and young women have also been, until recently, the primary focus of discussions about anorexia and bulimia. Since the 1990s, however, diet companies, doctors, and the media have "discovered" that men deal with body-image problems and struggle with overweight and disordered eating as well. While men have actually been dieting and struggling with eating disorders for centuries, an increasing number of popular and professional publications in the past fif teen years have focused on the unique problems of obesity in men, male dieting, and men with eating disorders.

In twentieth-century Western culture, overweight and eating disorders have largely been perceived as a female problem because of social and ideological gender constructs (Gilman 2004: 4). In the past thirty years, feminist writers, like Susan Orbach, have declared fat a "feminist issue" and sought to understand why women are particularly vulnerable to the "tyranny of slenderness" (Orbach 1978; Chernin 1981). However, this discourse, while essential to understanding the complex relationship between gender, the body, and social power, has neglected and almost effaced a very long history of anxieties about men's bodies and eating behaviors.

Until the end of the nineteenth century, concerns about obesity centered on men's bodies, and men generated the bulk of dietary advice literature (Gilman 2004: 4-5). Even in the early twentieth century when women received "the most biting commentary" on their weight, attention to male standards continued, and both men's and women's magazines featured slim male models (Sterns 1997: 98-9). In fact, during World War I, there was widespread cultural anxiety about the fitness of men's bodies as emblematic of the health of the nation overall. In the first two decades of the century, scientists and physicians sought to create a powerful, "gutsy" nation through transforming men's physical bodies (Carden-Coyne 2005). In the 1950s, diet books written particularly for men began to emerge, and they developed an "immediate and huge" following. This literature, however, rejected the aesthetic concerns most often associated with women and promoted weight loss, instead, as a means of improving one's masculinity and competitive edge (Sterns 1997: 101).

Similarly, the early contemporary literature on men and dieting tended to reinforce the idea that men diet for objective reasons, like health and performance, have more realistic body images, and are not vulnerable to the same aesthetic social pressures that women are. For example, sources on men and weight consciousness in the i980s generally concluded that men do not worry that being fat will make them less attractive or socially acceptable. Instead, they think about fat and losing weight, "mainly in terms of their concerns about health" (Millman 1981: 235-6). Even studies of male eating disorders in the 1980s concluded that men "set more realistic weight goals for themselves, and have a less distorted image of themselves, than do females" (Schneider and Agras 1987: 239). These early discussions placed men in a privileged position in dieting culture by suggesting that their inherent rationality made them less susceptible to vain (pun intended) quests for slenderness. At the same time, however, these writings did a disservice to men by relegating their problems with weight and food to the margins because they included chapters on men and dieting merely as "a concession" to men who claim that it's "just as bad for them" (Ogden 1992: 74).

More recently, scholars have treated the topic of men and dieting much more seriously in an increasing number of book-length projects. This new material also shows more awareness of and sensitivity to the struggles that men have with their bodies and the role that culture and gender expectations play in those struggles (Andersen 2000: 70; Bordo 1999; Grogan 1999: 58-67). In general, research has shown that men desire larger, more muscular (mesomorphic) bodies because greater physicality is associated with desirable masculine traits like strength, power, and aggression (Bederman 1995: 42; Grogan i999: 58). According to silhouette studies, questionnaires, and interviews conducted between i985 and i997, men aspire to muscular physiques, and their self-esteem is influenced by the ways in which they measure their own bodies in relationship to the mesomorphic ideal (Grogan 1999: 59-67).

This measurable body dissatisfaction in men and boys is referred to by some as "the Adonis complex," "a widespread crisis among today's boys and men" (Pope et al. 2000: iii). In this argument, men and boys are preoccupied with the appearance of their bodies but have no outlet for discussing this preoccupation in a society that has taught them not to be "hung up about how they look" (Pope et al. 2000: xiii). The "secret crisis of male body obsession" afflicts adults, as well as teenagers and young boys, who as early as elementary school indicate dissatisfaction with their bodies and who may even grow to develop eating disorders, use steroids, or suffer from depression (Pope et al. 2000: xiii-xiv). While this "crisis" in male bodies is not new, the "Adonis complex" is an important recognition that in contemporary diet culture; men too are concerned about their weight; and they also diet to improve their appearance and self-esteem, as well as their health.

Nevertheless, dieting can be very different for men than it is for women. There is physical evidence that men's bodies respond differently to diet and exercise than women's do. Men are, on average, taller than women and predisposed to have a higher percentage of body weight as lean muscle (Andersen 2000: 69). This advantage in height and lean muscle mass, which contributes to a higher resting metabolic rate in men, may make it easier for men to lose weight and sculpt their bodies (De Souza and Ciclitira 2005: 795). For example, a moderately active 125-pound woman needs, on average, only 2,000 calories a day, while a 175-pound man with a similar exercise pattern needs 2,800 calories ("Good Nutrition"). There may also be even more subtle differences that we have yet to uncover in the ways that men's bodies respond to particular diets. One small study conducted by Tufts University in 2004, for example, found that men responded more effectively to a diet low in saturated fat that was intended to lower total cholesterol (Li et al. 2003: 3431-2).

In addition, while men's health has been receiving more attention in recent years and the percentage of obese males is on the rise, men may be reluctant to diet or seek medical treatment (De Souza and Ciclitira 2005: 794-5; Drewnowski and Yee 1987: 632-3). According to a 1988 study, only 25 percent of men diet at some time in their lives, compared with about 95 percent of women (Grogan 1999: 67). The 1994-6 Survey of Food Intakes by Individuals similarly found that between 24 and 29 percent of men survey reported trying to lose weight. The reluctance of men to diet or report dieting can be attributed to the cultural constraints of masculinity, which construct men as strong and resistant to disease and dieting as a female activity (De Souza and Ciclitira 2005: 794).

Even when men do diet, they appear to approach and understand weight loss in very gendered ways. Men more often than not employ weight-lifting as a method for improving their body image because of the mesomorphic body ideal (Grogan 1999: 69), and, overall, men report exercising rather than counting calories to change their body shapes (Grogan 1999: 79; Drewnowski and Yee 1987: 626). Men may also purchase diet books and engage in activities like dieting groups and weight-loss classes that have traditionally been associated with women (De Souza and Ciclitira 2005). However, these dieters still frame their weight loss in masculinist terms. Echoing the "gutsy" rhetoric of early twentieth-century physical culture, contemporary diet books for men promise "you'll be in control and it will show," and "you'll have more vigor and stamina" physically and sexually (Goor and Goor 2000: 5-6). In addition, British men who joined a slimming class to lose weight asserted that they dieted to improve health rather than appearance. These men clearly viewed dieting for aesthetic reasons as a less legitimate, female activity and tried to distance themselves from it even though behavioral evidence suggested that they were concerned about their appearances (De Souza and Ciclitira 2005: 800).

Despite gendered differences in their reasons for and methods of dieting, men seem to share with women a susceptibility to the eating pathologies that plague consumer culture. Some of these extreme dieting practices, such as the abuse of steroids or human growth hormone, are generally associated with men (Grogan 1999: 76). However, men also fall victim to eating dis orders like anorexia, bulimia, and compulsive exercise, which have traditionally been associated with young women (Andersen 1990, 2000: 205, 2002: 188). While early sources on eating disorders focused primarily on white, middle-class adolescents (Bruch 1978; Brumberg 1988; Chernin 1981), medical professionals have since realized that eating disorders affect members of all ages, races, classes, and genders (Muise et al. 2003: 427). As a result, a growing body of literature on the subject of male eating disorders has emerged since the 1990s, and its authors are concerned with identifying, understanding, and treating pathological eating patterns in men (Muise et al. 2003: 433-4).

Much of this new material employs the rhetoric of "discovering" pressures on men to conform to unrealistic body types and suggests that these pressures are increasing, resulting in "as many as a million men" with eating disorders (Bordo 1999: 168; Langley 2005; Pope et al. 2000: 29; Pappano 2004; Stafford 2006). Still, it is not clear that eating disorders in males have actually increased; it is possible that greater awareness that eating pathologies can afflict multiple populations has merely allowed doctors to better recognize disordered eating in men. One of the first two reported cases of anorexia in 1689 was, in fact, found in a sixteen-year-old male (Andersen 1990: 3), and men appeared prominently in the earliest literature on eating disorders (Silverman 1987). Yet, only 0-5 percent of men reportedly suffer from bulimia (Andersen 1990: 10), and males only account for 10-20 percent of cases of anorexia today (Andersen 2002: 189).

It is difficult, however, to accurately measure the prevalence or increase of eating disorders in men because male anorexics and bulimics have been frequently mis-diagnosed or overlooked by doctors who were culturally and scientifically conditioned to recognize pathological eating primarily in women (Andersen 2002: 188-9). Males with eating disorders may also be underrepre-sented in medical literature because they have been unlikely to seek treatment or reveal their problems to a doctor for fear that their masculinity would be undermined by a "feminized illness" like anorexia or bulimia (Laws and Drummond 2001: 29). Increases in self-reporting of anorexia and bulimia by men and boys may reflect a new comfort with "coming out" as professional discourse, popular literature (Krasnow 1996), and male celebrities like Billy Bob Thornton validate the experiences of men with eating disorders.

While popular media may help men and boys with eating disorders to recognize and come forward with their disorders, it is also implicated in their etiology. Theorists and eating disorder researchers argue that advertising and entertainment media increasingly objectify men's bodies, promote ideals of slenderness, and represent men in unrealistic and damaging ways. Magazines, such as Men's Health and GQ, which give dieting and exercise advice and contain images of hyper-fit male models are frequently mentioned as contributing to unrealistic body ideals and increased body dissatisfaction among men (Bordo 1999: 218-19; Grogan 1999: 67-8; Pope et al. 2000: 32-33 and 45-6). Clinicians, too, see the media as an important causal factor in male body dissatisfaction. One eating disorders program director explains, "With more men's fashion magazines on the market, more emphasis being put on the way men look. Now they're subjected to the same concerns about body image that plagued women for years" (Sterns 1997: 99). Research has shown that magazine exposure increases psychosocial stress and may lead to unhealthy dieting behaviors among male and female adolescents (Utter et al. 2003).

Participation in certain sports, like swimming and wrestling, also seem to contribute to increased risk for developing eating disorders in men and boys (Dale and Landers 1999, 1382; Drewnowski and Yee 1987: 627; Langley 2005: 5). Pressures to "make weight," improve performance, or "bulk up" may lead athletes to engage in unhealthy behaviors, including excessive food restriction, over-exercise, purging, intentional dehydration, or steroid abuse. Men and boys in sports that emphasize muscular development, like bodybuilding, football, and competitive weight-lifting, are particularly vulnerable to a lesser-known disorder known alternately as "reverse anorexia nervosa" and "muscular dysmorphia." Males suffering from this disorder believe that they are overly thin even when they are highly muscular and may use anabolic steroids in an attempt to increase their muscle mass even further (Andersen 2002: 188).

Finally, researchers have also identified other factors, which might place specific groups of men at greater risk of developing eating disorders. For example, several studies in the 1980s and 1990s suggested that gay and bisexual men are more likely to be dissatisfied with their bodies and develop eating disorders than are homosexual or bisexual women or heterosexual men (Siever 1994; Williamson and Hartley 1994; Yager et al. 1988). However, these findings may be complicated by the possibility that gay men are more willing to divulge their problems with eating disorders because they feel less constrained by traditional masculine ideals (Kaminski et al. 2005: 180). It is likely that sexual orientation and homophobia are factors in men's willingness or unwillingness to admit to having an eating disorder or to seek treatment for it; however, scholars agree that more research is needed in this area.

Dieting and eating disorders are not solely the purview of women in contemporary culture despite their over-representation in popular and professional discourse. Like pressures on the female body, body dissatisfaction and dieting in men are powerfully framed by gender imperatives, which demand that men be strong, fit, and muscular but not "hung up about their appearance." This paradox has contributed to what some call a "crisis" for men, who suffer from anxiety about their bodies but cannot express their suffering because it would be considered weak or feminine. As a result, men are less likely than their female counterparts to seek help or to be correctly diagnosed when they do so. It appears hopeful, however, that these barriers to diagnosis and treatment will erode in the future as more and more people come to realize that, in a consumer culture, fat and the fear of it are men's issues too.

SLG/C. Melissa Anderson

See also Anorexia; Banting; Brillat-Savarin; Celebrities; Children; Craig; Hormones; Morton; Nidetch; Self-help; Sexual Orientation; Sports

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