Eating Disorders, Body Dysmorphia Rising in Men

Binge eating and body dysmorphic disorders affect a notable portion of adolescents and young adults in the United States, including a growing number of males who are increasingly fixated on muscle-development and their physique.

Brian Pollack, founder and clinical director of Hilltop Behavioral Health in Summit, NJ, says body image concerns in adolescent boys and young men are “exploding” in his world. Pollack specializes in areas that are often overlooked, including eating disorders in men and boys, muscle dysmorphia, athlete eating disorders, body image and adolescent/family treatment.

Despite the growing number of young men obsessively challenged by dissatisfaction in their muscular build, Pollack says few people are talking about it. Research data can fluctuate, but it tends to reveal that about 25-30% of people who struggle with an eating disorder or body dissatisfaction are male. However, at Hilltop, Pollack says about half of the people they support are male. Talking about body image with men can be tough. Men typically remain quiet about it. Pollack says any kind of self-consciousness “goes against male cultural simulation since childhood.”

“This goes against what the research is saying and that’s why it’s something that we, as a culture, need to talk about,” he says.

There is significant evidence of the kinds of pressures young men and boys experience in their daily lives. Online, there are videos and messages about being your best physical self. There are pressures from the so-called manosphere and from “looks-maxers” providing dietary and workout tips that can be dangerous, such as excessive weightlifting without ample rest, taking performance-enhancing drugs and even hitting your cheekbones with a hammer in order to make them appear sharper after they’ve healed.

“Online culture is giving these extreme, and sometimes dangerous messages. If you want to make money in the world, scare people about their health. That’s all most of these influencers do,” he says.

The message is fairly straightforward: Men need to be strong, not creative. They need to have this aura of authority so they project prowess. By objectifying and focusing on strength, it’s become a [dangerous] thing, Pollack says. He points to the Barbie doll and how its shape impacted generations of women.

“Now we’re seeing this with men. We’re getting to this interesting place where men are just as vulnerable and susceptible. There’s a fear of fat,” he says. “But, we need fat. It’s our calorie reserve, it protects us, and it helps with muscle growth.”

In his practice, Pollack highlights some of the means young men are going to in order to get that desired look. Men are obsessed with taking peptides and trying to build muscle because they don’t want to feel vulnerable, he says. There is an increase in the use of GLP-1 drugs such as Wegovy and Ozempic, as well as knock-off versions, for weight loss. Sometimes the highest prescription levels are being micro-dosed in hopes of sustaining weight loss, but that can have some concerning side effects, such as the control of blood sugar levels.

“I’m seeing younger kids facing challenges like binge eating and anorexia,” he says, and points to a rise in GLP-1s prescribed to pediatric patients. “They’re going to younger and younger patients.”

These pressures can also occur in youth sports. Team culture can sometimes go awry and drive a need for physical perfection and peak performance, without understanding the physical and mental need for limits. He says there is an increased intensity in youth sports where young athletes are hyper-focused because they don’t want to lose their spot to someone else.

For parents, Pollack says some signs that could hint at eating disorders or dysmorphia include an obsession with health and physical appearance, where young people are missing out on social experiences and become more isolated due to a perceived need to build muscle, or excel in a sport; mood instability; an obsession with mirrors; poor sleep habits; and a preoccupation about the types and amounts of food being eaten.

He warns against excessive praise in athletics or weight loss because that can enable eating disorders.

“If you’re recognizing these things, it’s better to talk about these things in a calm and relaxing space. I don’t recommend the kitchen table because that can be a scary place due to the traditional intensity of conversations that can happen there,” he says. “Sometimes with kids, it’s really about the parents coming together and approaching this as a team without any accusations in order to address it.”