Coexisting with our ongoing obesity epidemic are eating disorders characterized by unusual patterns of restricted eating and distortions of a person’s body image. Normally, we have a fairly accurate view of what we look like. People with distorted body image can be convinced that they are obese when in fact they are in danger of starvation.

Traditionally, eating disorders have been viewed as a problem for women, but much less typically for men. However, contemporary research suggests that increasing numbers of men are experiencing eating disorders (Hudson, Hiripi, Pope, & Kessler, 2007) and body dissatisfaction (Pope, Katz, & Hudson, 1993). As many as 25% of individuals with eating disorders today are male. Rates of eating disorder are about 6 times higher among homosexual and bisexual men compared to heterosexual men, although sexual orientation does not seem to be associated with any additional risks for eating disorder among women (Feldman & Meyer, 2007). In addition, some men appear to suffer from muscle dysmorphia, a body distortion problem in which they see themselves as 90-pound weaklings even though they spend hours each day developing muscle at the gym (Chung, 2001). These men are more likely to experiment with anabolic steroids in order to increase muscle mass (Rohman, 2009).

Anorexia nervosa is characterized by the maintenance of unusually low body weight and a distorted view of the body as obese. Anorexia literally means “loss of appetite.” Anorexia nervosa is dramatic, but rare, affecting about 1% of women and 0.3% of men (Hudson et al., 2007). Anorexia nervosa is one of the few psychological disorders that can actually kill, with up to 10% of patients eventually dying from the condition (APA, 2000). Other symptoms include interruption of normal menstruation, very dry and yellow skin, fine downy hair (lanugo) on the face and other parts of the body, increased sensitivity to cold, and cardiovascular and gastrointestinal problems.

Bulimia nervosa is characterized by cycles of binge eating, in which unusually large amounts of food are consumed, and purging through the use of vomiting or laxatives. Bingeing is often followed by feelings of depression, disgust, and a sense of lost control. Bulimia is somewhat more common than anorexia, affecting 1.5% of women and 0.5% of men (Hudson et al., 2007). Binge eating disorder, or binge eating without the other symptoms of bulimia, occurs in about 3.5% of women and 2% of men (Hudson et al., 2007) and is under consideration as a separate category of psychological disorder. About 20% of patients with anorexia also engage in bouts of binge eating and about 8 to 9% follow this bingeing with efforts to purge (Garfinkel et al., 1996). Fatalities among patients with bulimia alone are rare, but do occur in patients with overlapping anorexia and bulimia.

Environmental factors, especially cultural attitudes toward beauty, can play a significant role in the development of both anorexia and bulimia. Anne Becker and her colleagues were observing eating patterns in the Fiji Islands when American television became available for the first time in 1995 (Becker, Burwell, Herzog, Hamburg, & Gilman, 2002). Prior to this time, Becker reported that dieting was unknown in this culture, which valued a “robust, well-muscled body” for both men and women. The Fijian language has a term for “going thin” that is used to express concern about someone who may be losing weight due to health problems. In the United States, people may say, “Have you lost weight? You look great!” In Fiji, a person is more likely to say, “Are you okay? You look like you’re going thin.” These cultural norms underwent nearly overnight change with the introduction of American television, with its frequent images of glamorous, ultrathin actresses. Suddenly, 74% of the adolescent girls in Becker’s study reported themselves as being “too big or too fat.” Teens began to report dieting with the same frequency as their American counterparts.

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