Binge Eating Disorder: Gender Differences

            As we learned in my last post, binge eating disorder (BED) is the most common eating disorder in the United States, affecting all age groups and genders. BED is usually seen in teens and early adults, and is experienced by up to 3.5% of women and 2% of men. In women, BED usually comes-on in early adulthood, whereas the disorder shows in men around midlife.  

            Historically, all eating disorders have been viewed as a “female problem,” but we now know that men account for up to 25% of all cases of anorexia and bulimia nervosa. It’s thought that this percentage is even bigger within BED. Researchers estimate that 60% of individuals with BED are women, leaving the other 40% to other gender identities. Although the singular cause of BED is unknown, there are likely many social, biological, and psychological factors that contribute to its formation. Without intervention, long-term consequences for all genders include weight gain, high blood pressure, heart disease, diabetes, and more.

In general, the treatment for both men and women with BED is the same; however, gender distinctions can change the therapeutic approach. This can be especially evident during diagnosis. For example, health professionals, such as physicians, dietitians, and psychologists, may immediately recognize eating disorder (ED) signs like extreme dieting, rapid weight loss, vomiting, or the use of laxatives. The problem is that these behaviors are usually exhibited by females and are commonly known ED characteristics. In men, equivalent signs may include intense weight-lifting programs, low-fat/high-protein diets, and taking supplements. Because these behaviors aren’t historically associated with eating disorders or unhealthy habits, boys and men are diagnosed and referred for treatment at a lower rate and usually go unnoticed until their eating disorder is well developed. As a result, Stanford and Lemberg came up with the Eating Disorder Assessment for Men (EDAM), which identifies four “primary domains” for diagnosis—binge eating, muscle dysmorphia, body dissatisfaction, and disordered eating. Useful screening tools like the EDAM hope to mitigate that eating disorders remain underdiagnosed and undertreated in men. 

You might have noticed that the discussion of BED and gender thus far has only included males and females. This is because eating disorders are traditionally assumed to be based around “womanhood” and “femininity,” which creates a cisheteronormative standard that is very harmful to people who fall outside of that stereotype. As a result, men aren’t the only ones left out. Trans and queer individuals who don’t identify as male or female are often overlooked when it comes to eating disorders. The few studies that have researched EDs in multiple genders have found no significant difference in ED occurrence between straight and queer women; however, queer women are less likely to develop anorexia and more likely to develop bulimia and BED. This may be due to the traditional association of anorexia with images of “female beauty” and “femininity”.

Studies that have focused on only male and female genders have had some interesting findings as well. In Gender differences in patients with binge eating disorder, Barry et al. examined gender differences in adults with BED. They found that men and women did not differ significantly in age at first overweight, age at first diet, age at onset of regular binge eating, or number of weight cycles. Men did have a significantly higher body mass index (BMI) and were more often classified as obese. Men and women also did not differ significantly on current BED behaviors, such as binge eating, eating concerns, and weight concerns, but women had a greater body image dissatisfaction. It’s interesting to note, however, that men and women did not differ on current feelings of depression or self-esteem, but men reported more past substance abuse.

Similarly, in Gender differences in binge eating disorder: A pooled analysis of eleven pharmacotherapy trials from one research group, Guerdjikova et al. found that women who enrolled in pharmacotherapy studies for BED treatment were similar in age, severity, and treatment. Men, on the other hand, were older, had less symptoms of depression, and greater frequency of substance abuse. Men with BED also had higher BMIs, systolic and diastolic blood pressures, and were taking more medications for diabetes and metabolism disorders.

Additionally, Striegel-Moore et al. in Gender difference in the prevalence of eating disorder symptoms found that men with BED were more likely to report “overeating” whereas women with BED were more likely to report “loss of control while eating”. Women were also found to “body check,” fast, and vomit more often than men. This could also be due to the historical association of “womanhood” with disordered eating. The established cisheteronormative standard and stereotypes of “femininity” and “masculinity” in genders encourage these differed behaviors.

The National Eating Disorders Association helpline is available for support, resources, and treatment options at https://www.nationaleatingdisorders.org/help-support/contact-helpline. You can always leave a message if the Helpline is not available and a volunteer will contact you.

References:

Barry, D. T., Grilo, C. M., & Masheb, R. M. (2002). Gender differences in patients with binge eating disorder. The International journal of eating disorders31(1), 63–70. https://doi.org/10.1002/eat.1112

Guerdjikova, A. I., Blom, T. J., Mori, N., Casuto, L., Keck, P. E., & McElroy, S. L. (2014). Gender differences in binge eating disorder: A pooled analysis of eleven pharmacotherapy trials from one research group. Journal of Men’s Health, 11(4), 183-188. doi:10.1089/jomh.2014.0041

Fabello, M. A. (2019, August 9). 4 Stereotypes About Eating Disorders and Gender That Need to Go. Retrieved April 14, 2021, from https://www.healthline.com/health/eating-disorder-gender-stereotypes

Marcin, A. (2016, December 18). Binge Eating Disorder History: A Timeline. Retrieved April 14, 2021, from https://www.healthline.com/health/eating-disorders/binge-eating-disorder-history#1959:-First-Mention-of-Binge-Eating

National Eating Disorders Association. (n.d.), from https://www.nationaleatingdisorders.org/

Striegel-Moore, R. H., Rosselli, F., Perrin, N., DeBar, L., Wilson, G. T., May, A., & Kraemer, H. C. (2009). Gender difference in the prevalence of eating disorder symptoms. The International journal of eating disorders42(5), 471–474. https://doi.org/10.1002/eat.20625

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