‘I started to put my self-worth in numbers on a scale’: How eating disorder cases in men are rising

For Dave Chawner, anorexia began in his teenage years.

What started as weight loss quickly spiralled when he was praised for it. Soon, he was obsessively weighing himself, counting calories, and exercising compulsively.

“I started to put my self-worth in numbers on a scale. I started valuing myself on how little I'd eaten, how much I'd exercised, how long I'd gone without eating,” Chawner, an Englishman in recovery from anorexia, told Euronews Health.

Chawner said his eating disorder slowly developed during his late teenage years, at around 16 years old. He says he did not realise he had a problematic relationship with food and his body.

More than four years later, he realised he may be ill, so he went to the doctor to seek help for depression and was diagnosed with anorexia.

Today, he is living in recovery and says he is “further away” from the disorder thanks to treatments. 

He is using his trade as a comedian to help people with eating disorders. He is currently involved in a research trial that is investigating stand-up comedy as a recovery tool, together with the University of Kent. 

During his recovery, Chawner said he has learned that eating disorders are not diets gone wrong, but mental health conditions.

“It's very difficult to tell when a social drinker becomes an alcoholic, and I think it is very similar to eating disorders,” he said. 

“It's very difficult to tell when that balance tips”.

Eating disorders are one of the deadliest psychiatric conditions, with one person dying from it every 62 minutes in the United States, according to Johns Hopkins Medicine.

Anorexia nervosa predominantly affects women and girls, meaning the rising number of global cases among men and boys has flown under the radar. The UK’s eating disorder charity, Beat, estimates that 1.25 million people in the country live with an eating disorder, around a quarter of whom are male.

Rising cases in men

In the United Kingdom, hospital admissions for boys and men with eating disorders increased by 128 per cent in five years, according to 2021 data from NHS England Digital.

Anorexia can lead to physical consequences such as anaemia, dangerously low blood pressure, bone loss, and organ damage.

According to Beat, it takes an average of three and a half years for someone to get treatment after their symptoms first begin. The long delays are down to patients not realising they are ill. 

Anorexia has one of the highest mortality rates among psychiatric conditions, around five per cent in the first four years, rising to ten per cent of all cases.

Experts say men with anorexia often have worse health outcomes, with the mortality rate eight times greater in men. They are also more likely to be hospitalised.

Up to 20 per cent of all deaths from people with anorexia are from suicide, with a fivefold risk of suicide in men.

“They (men) are much more likely to develop bulimia and to vomit, they'll describe more isolation, they'll often undertake a lot more exercise and they'll often feel a lot more paranoid,” Clive Kelly, a medical consultant at the NHS in the UK, told Euronews Health.

“And all of this adds up to a sense of emasculation. Men describe that they no longer feel like they're male. So there's a huge amount of psychiatric, as well as physical comorbidity that contributes toward the successive mortality,” he added.

Double-stigma

The sense of isolation for men is reinforced by stigma. The long-standing belief that eating disorders are “women’s illnesses” discourages men from seeking help, according to Tom Freeston, a Public Affairs Officer at Beat, told Euronews Health.

“This sort of silence and then shame means that many men delay disclosing their struggles, and actually it has meant that there's research to suggest that then men are more likely to be diagnosed later and less frequently,” Freeston said.

He added that a 2023 survey from Beat found that 53 per cent of UK men felt that someone like them couldn't develop an eating disorder, while 69 per cent of the respondents had never heard about men with an eating disorder..

“People with mental health issues suffer stigma for having a mental health condition, but this stigma is doubled among men with eating disorders,” Emilio Compte, an associate professor at the Eating Behavior Research Center in the School of Psychology at Universidad Adolfo Ibáñez in Chile, told Euronews Health.

Tailored treatments

Clinicians say diagnostic tools for men who suspect having eating disorders and awareness around male anorexia should be improved.

For example, diagnostic manuals often included amenorrhea (absence of menstruation) up until 2013, which left it difficult for men to get an appropriate diagnosis.

Men often report feeling emasculated in female-oriented treatment settings and men are often asked about their pursuit of thinness, which is often seen in women’s cases. Compte and Freeston say men’s symptoms are often tied to the pursuit of leanness or muscularity.  

Even today, many assessment tools focus on thinness rather than the male drive for leanness and muscularity.

“The whole system excluded men from receiving a diagnosis of anorexia nervosa, and this has contributed to the idea that ‘I may not have an eating disorder because I am a man, and men cannot have eating disorders, " Compte added.

Men who are disabled, transgender, non-binary, or from ethnic minority backgrounds are particularly vulnerable, according to Kelly.

"We need to understand each individual's physiology as well as psychology before we embark on a one-size-fits-all approach,” Kelly said.

Medical risks can also differ. Male patients are more prone to gastroparesis, a condition in which the stomach fails to empty properly, which can be fatal if not identified before a refeeding programme, where food is fed directly to the stomach through a tube, begins. 

“I've certainly seen cases where young men have died as a result of aspirating gastric contents. So a really important element for men is to recognise this risk, to scan the stomach to make sure it isn't dilated, to make sure it is emptying,” Kelly added.

Gendered treatment settings may also be a barrier. Men can feel uncomfortable as the only male in group therapy sessions, unable to relate to experiences framed through a female lens. This can exacerbate feelings of exclusion rather than support recovery.

Compte also warned that the conversation around male body image remains decades behind the progress made for women – and that social media has only intensified these pressures, with influencers frequently promoting extreme exercise and restrictive diets.

“There has been a lot of work that has been done for women with body image concerns that I think we have to mirror and repeat among men,” he said.

“To accept the diversity of bodies is not only important for women, but it's also important for men”.

Early intervention is critical

At first, Chawner resisted treatment, but a nurse changed his mind.

“She said, ‘You wouldn’t expect your laptop to work without charging it. Why expect your brain to work without feeding it?’ I think that expert use of tough love was really important,” he said.

After two and a half years of treatment, Chawner said he now feels “furthest away from it than ever,” though he still lives with the disorder. 

Chawner said that while there may be stigma around men with anorexia, he believes he personally benefited from being male in the system.

“The uncomfortable truth is I genuinely think had I been a female and gone to my doctors, had I been a woman and gone with the same metrics, I don't think I would have gotten half as good a treatment as I did,” he said.

Experts said early intervention is critical. They say that eating disorders are a serious mental illness but they are treatable and full recovery is possible.

“There are always people interested in helping you. The sooner you ask for help, the better,” Compte said.

If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, on 0808 801 0677 or beateatingdisorders.org.uk

If you are contemplating suicide and need to talk, please reach out to Befrienders Worldwide, an international organisation with helplines in 32 countries. Visit befrienders.org to find the telephone number for your location.