More data on male eating disorders is slowly emerging.

Research into eating disorders in middle-aged and older individuals is growing, but still lags behind that of younger groups. Information about older men is especially lacking. Men are seldom included in eating disorder studies, although this, too, is improving.

Kai K. Kummer and Barbara Mangweth-Matzek, of the Medical University of Innsbruck, Austria, recently reported a possible connection between a drive to excessive exercise in older men and development of disordered eating (The Aging Male. 2023. 26:1,2154571). Hormones may also be at play, according to Drs. Kummer and Mangweth-Matzek.

The drive for ideal body image in males is different in males than for females. Instead of a desire for thinness, body image among men seesaws between losing weight to get rid of body fat and gaining weight to add muscle mass (Curr Psychiatry Rep. 2017. 19:32). The combination of leanness and muscularity means men may ingest excessive protein or use restrictive eating behavior, a pattern resembling bulimic binges. In addition, this behavior can lead to chronic purging, with vomiting or laxative use after binges.

In an earlier study, Dr. Mangweth-Matzek and colleagues assessed eating behaviors in a group of Austrian men 18 to 80 years of age who regularly attended fitness centers (Eat Weight Disord. 2022. 27:1765). A total of 307 men displayed high rates of disordered eating, as shown by Eating Disorder Examination Questionnaire (EDE-Q) cutoff scores (5% to 11%), as well as by DSM-5 eating disorder symptoms (10%). While the EDE-Q cutoff scores did not differentiate between age groups, there was a clear decrease in eating disorder symptoms with increasing age. Binge eating and bulimic symptoms, with excessive exercise as the purging method, were the most common forms of disordered eating.

Purging method: using excessive exercise

Among aging males, excessive exercise is often used as the purging action of choice. In one study, around one-fifth of team sports members between 18 and 25 years of age had a diagnosis of an eating disorder, and military veterans were more likely to use excessive exercise as a means of purging (BMJ Open Sport Exerc Med. 2021.7: e001161).

According to the authors, the current interest in healthy living and lifestyles often masks eating disorder symptoms among middle-aged and older men. In addition, age-dependent testosterone levels in aging males seem to present a time of susceptibility to disordered eating among older men. So-called andropause isn’t easily compared with menopause since, unlike the onset of menopause, it occurs gradually over a number of years, according to the authors.