Adolescent Male Athletes and Anorexia: Problems and Treatments

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Introduction

Society is well aware of the problem of eating disorders when it comes to females but are less aware of this growing problem when it comes to the male gender.  The actual statistics of males with eating disorders is hard to establish because men are often reticent to admit to these problems because of the stigma involved of it being a female problem.

It is becoming more apparent that male eating disorders are substantially on the rise and this paper will study how these disorders can develop, the damage they can cause and how to successfully intervene when the disorder is identified. The paper will concentrate on the eating disorder of anorexia with the understanding that bulimia and binge eating are also growing problems.  The causes of eating disorders are varied and personalized in nature but there are psychological, physical and societal influences that can predispose someone to develop them.

Development of eating disorders in adolescent male athletes

Males with anorexia account for 5-10% of all cases and of these 45% are involved in sports or athletics where control of weight is important for optimal performance. This contrasts with only 9% of those females with anorexia (). These statistics point to certain types of sports becoming risk factors for some males in developing an eating disorder.  These particular sports are differentiated by three contributing factors for why a male athlete might restrict their caloric levels.

In a sport where certain bodily aesthetics are necessary factors for success the athlete may restrict their eating to meet these standards. Examples of these types of aesthetic standards could include figure skating, diving and dancing. These athletes might become obsessed with appearance and develop a flawed body image. 

Male athletes often become involved in competitive sports, such as wrestling and boxing, where the need for “making weight” becomes a necessity. The athlete may then engage in dangerous eating behaviors such as starvation diets, use of laxatives and diuretics, layered clothing and vomiting in an attempt to meet an established weight. 

Athletes can also be involved in sports where low body fat composition is important to their performance.  Distance runners keep their fat content low and indulge in carb loading before their competition.   In fact, distance runners and females with anorexia share certain similarities that might predispose them to eating disorders (Parks & Read, 1997).  These include high-self expectations, tolerance of physical discomfort, and emphasis on lean body mass.

Risk factors

Even within the previously mentioned sports, most male athletes will not develop anorexia.  Certainly, there must be personal psychological or environmental characteristics that make some male athletes more susceptible than others.  Research has indicated that eating disorders in adolescent male athletes results from combinations of low self-esteem, elevated levels of self-critical perfectionism and depression.  Depression has been shown to play a greater role in eating disorder for men than women ().  It has also been reported that adolescent male athletes with eating disorders typically have lower levels of emotional intelligence than their peers. In response to negative environmental stimuli and socializing they often use avoidance and emotion-oriented coping skills ().

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Male athletes with anorexia are also not immune to the social pressures of the media perceptions of beauty and health.  Adolescent males can feel elevated levels of stress to conform to socially derived ideals of attractiveness and masculinity.  They will then adopt abnormal exercise and eating behaviors in order to find acceptance in their perspective of the social world.

Adolescent Cognitive Changes

Adolescents are particularly prone to the development of eating disorders due to emerging changes in their cognitive reasoning.  As children enter the adolescent stage they begin believing that they and aspects of their lives are becoming the focus of everyone’s attention (Berk, 2014).  They believe that people are watching and are aware of every detail of their lives.  This distorted thinking leads many adolescents to worry excessively over their hair, the clothes they wear and in general how they appear to others.  Psychologist Jean Piaget called this faulty thinking process the imaginary audience (Berk, 2014). 

At a time when adolescents are overly concerned about how they appear to others and are sure that others are examining them in detail, their weight begins to be a prime concern to them.  Their self-esteem hinges on how they believe people see them.  Adolescence is also a crucial time in bodily changes leading to adulthood and media messages about how their bodies should look combined with the belief that others are constantly judging you can cause some adolescents to take extraordinary and damaging measures to obtain the “ideal” image.

Interventions

One of the biggest problems for adolescent male anorexics is the simple fact that the diagnosis of an eating disorder often goes unnoticed.  Society is much more aware of the problems of anorexia when it comes to females and this can actually increase medical problems for males later in life.  A stigma exists for males with eating disorders because anorexia and bulimia are female problems and men are often reticent to report their suspected eating disorders.  Males often naturally carry less body fat than females and extreme thinness may be seen as a physical adolescent phase – that they are still growing into their adult bodies.  This can often mean that male eating disorders may not be detected or treatment started until severe damage occurs.

As in any physical or psychological problem, the earlier the intervention the more likely there will be a better outcome.   One of the best ways that parents, schools and athletic personnel can help prevent male athletes from developing eating disorders is simply knowing that they can and do exist within the male gender.  Teachers and coaches are often asked to watch for signs of suspected abuse and illness in their students and education programs about eating disorders in males should be implemented in schools.  Unfortunately, in many sports crash dieting and fluid restriction are ingrained as a natural part of the process. 

When a male athlete is diagnosed with an eating disorder it becomes important to begin psychological education that involves not only the athlete but his coaches, parents and teammates as well.  A new outlook that emphasizes personal health over physical performance needs to be initialized.  The professional counselor can introduce the reality that this eating disorder will eventually, if not already, lead to poorer performance in their chosen sport.  This message is put into a context that the athlete will understand.  Ultimately, the counselor might recommend that the young male abstain from their sport until their body becomes stabilized and a nutritional balance is being maintained.  This is where the parents and coaches may have to make a physical stand and remove the young man from athletics until the problem is firmly under control.

It must also be remembered that there are underlying mental and environmental factors that contribute to eating disorder that must be addressed before the problem can be considered controlled.  It is entirely possible that the young male derives what levels of confidence and self-esteem he has come from participating in his sport.  There should be consideration as to whether removal from the sport would cause more damage mentally than if he remained in the sport carefully monitored and in an agreed upon diet and exercise schedule. 

Health professionals who work with these athletes need to understand that the athletes’ involvement in their respective sports are extremely important for their self-esteem.  Therapy and treatment for the body issues and eating disorder will most likely be ineffective if the professional advises quitting the sport. Treatment should be focused on weight restoration and metabolic balance through a nutritional plan, conducted by a certified dietitian, combined with psychotherapy that addresses problems with body image and any other contributing factors.  Therapy for the patient should be individualized but parents, team-mates, and coaches can also be included due to their influence and potential support they can provide to the athlete.

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Anorexic male athletes also have a higher incidence of depression and substance abuse than do females and the use of professional psychiatrists becomes even more necessary to treat these co-morbidities. 

Conclusion

The adolescent male athlete can be quite susceptible to eating disorders and the involvement in certain sports may play a large part in their development.  Why the young athlete develops an eating disorder is multi-layered and includes the desire for a socially acceptable appearance, a way to boost self-esteem and a method to increase their performance levels.  Young male athletes see their athletic skills as a way to be accepted, a way to cope and perhaps as hope for their futures.

These young athletes are in a particularly dangerous position because anorexia and other eating disorders are seen as predominately a female problem and treatment for the afflicted male can be delayed because of perceived stigma or general oversight.  This makes the identification and treatment of eating disorders in males extremely important and a review of current athletic weight standards should be undertaken.  The male ego, media inspired physical standards and dangerous athletic practices help create sometimes fatal eating disorders.

References

  • Adams, V. J., Goldufsky, T. M., & Schlaff, R. A. (2016). Perceptions of body weight and nutritional practices among male and female National Collegiate Athletic Association Division II athletes. Journal of American College Health, 64(1), 19-24.
  • Berk, L. E. (2014) Development through the lifespan (6th ed.) Upper Saddle River, New Jersey: Pearson
  • Cohn, L., Murray, S. B., Walen, A., & Wooldridge, T. (2016). Including the excluded: Males and gender minorities in eating disorder prevention. Eating Disorders, 24(1), 114-120. doi:10.1080/10640266.2015.1118958 
  • Giel, K. E., Hermann-Werner, A., Mayer, J., Diehl, K., Schneider, S., Thiel, A., & Zipfel, S. (2016). Eating disorder pathology in elite adolescent athletes. International Journal Of Eating Disorders, 49(6), 553-562. doi:10.1002/eat.22511
  • Obsessive Training Leading to Male Anorexia in Athletes. (n.d.). Retrieved July 18, 2017, from https://www.eatingdisorderhope.com/information/anorexia/male-athletes
  • Parks, P. M., & Read, M. H. (1997). Adolescent male athletes: Body image, diet, and exercise. Adolescence, 32(127), 593.
  • Pustivšek, S., Hadžić, V., & Dervišević, E. (2015, November 18). Risk Factors for Eating Disorders Among Male Adolescent Athletes / Dejavniki Tveganja Motenj Hranjenja Med Športniki V Adolescenci. Retrieved July 16, 2017, from https://doi.org/10.1515/sjph-2015-0008
  • Ray, S. L. (2004). Eating Disorders in Adolescent Males. Professional School Counseling, 8(1), 98-101.

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