Can men have eating disorders? Advice to a friend.

I recently received a question from a female friend regarding one of her male friends.  She was unsure how to delicately approach him as she was concerned about his weight.  She stated that he is 5’9” and only weighted 95 lbs.  If this is true, he has a body mass index of 14.  Any body mass index under 18 is considered significantly underweight, so he is SERIOUSLY underweight.  Someone his size should weigh, at a minimum, 125 lbs. to about 160. Additionally he seems to demonstrate additional addictive behaviors. Many only associate anorexia with females.  However, this condition affects males as well.

Here are some of the questions I would like to ask him and discuss with him, but I do not have the right to diagnose him.  Regardless, we as a community should discuss how to work with our friends who have dietary challenges. If I was speaking to my friend I would have an informal discussion such as this:

Does he work out, or does he just live off alcohol, caffeine and smokes as you suggested?  The reason I am asking is because anorexia, which he may very well have, is not limited to just females.  More and more men are suffering from this as well.  I can’t diagnose it but either he is anorexic or he has a SERIOUS physical illness (or unknown drug addiction) and should seek medical attention. Either way he is starving his body and alcohol and caffeine are just empty calories. 

Anorexic individuals very often have control issues.  Perhaps there are things going on in his life that he feels he cannot control, such as his job, finances, relationships etc. When this happens people often look to things they can control, such as the food they eat.  Another associated condition is called body dysmorphia.  This condition occurs and is very often associated with anorexia or eating disorders, when a person looks in the mirror and what they see looking back at them is not reflective of reality.  He may look in the mirror and think he looks just great while the rest of us see that his is significantly underweight. Also, there could be issues of low self-esteem, need for acceptance, and he finds that not eating allows him to control these emotions.

So, what can you do to help change his behavior is the big question.  The best choice would be for him to go to a physician and let that person explain the severity of his low weight and how it severely impacts how his organs function and his overall health. But, you can’t force someone to go to a physician. There is a chance that if you start directing him on how to eat that he may retaliate and ignore you, or just eat less because of his fragile emotions.  Once he feels that he is on the defensive it is less likely he will listen to you. Try really hard not to be judgmental about his negative eating behavior, but express your concern that you never really see him eating.  Make sure he knows that you are concerned about his welfare and that you care for his health.  One thing that could help would be to invite him to situations that have food or where there is public eating going on.  Encouraging him to eat in front of others hopefully will make him more comfortable with the process.  If he likes to drink (which I am not encouraging) then bring him to a happy hour that has a buffet and maybe make up a small plate for him and others so as not to be conspicuous.

Clinically speaking, you want to encourage your friend to be interested in and intrigued by why he is not eating enough. Perhaps ask him if there are things going on in his life that are stressing him out (thereby causing the lack of eating) and be an open ear for him.  You do not have to make him feel that he needs to be heavy, just normal. Try and encourage him to snack throughout the day.  He may not be ready to sit down for a steak dinner at this moment, but small snacks will help him to not feel that he is overindulging. 

The best recommendation that I would give my friend would be to seek out qualified medical and psychological assistance, but often individuals without a lot of support systems are not open to this type of advice.  And, as the person of concern is a male, he may be reluctant to the option that he has an eating disorder.  Getting information and finding the right help is important. But, being a good friend and keeping an eye out for those who need assistance is the best thing a person can do.  We must break the stigma that eating disorders are only for females.