Men's obsession with body image
Summary
The field of eating disorders (EDs) is, and always has been, primarily a female one. Even from Sir William Gull's first description of "hysterical anorexia" in the 19th century, it was understood to be a condition that occurred mainly in young women. This very lack of mention of men has skewed the concept at all levels to this day, from the training of psychiatrists and psychologists to the general idea that EDs are a female disorder . In fact, according to Eller (1993), 40% of internists and 25% of psychiatrists believed that anorexia nervosa could only be found in women. While this data is relatively old, the literature on this subject has not changed much.
Almost everything we know about eating disorders comes from research conducted with women. Because we had greater access to women, knowledge developed from there, based on the idea that eating disorders wouldn't differ between the sexes . Does the flu manifest differently in men and women? Or psychosis? Exploring symptoms in men was therefore considered redundant and also avoided a problem: it's difficult to conduct research without a sample. There were few men with eating disorders in healthcare resources, and often a small sample skews the statistics. We already had two reasons not to look at these men: it's redundant, and there are too few of them. The consequence, for this and other reasons, is that they were left out of studies, prevention programs, and treatments.
Eating disorders in men
Eating disorders and muscle dysmorphia in men
So, do men also have eating disorders? The answer is yes, and in higher numbers than is commonly reported. A recent study on the prevalence of eating disorders in the male population in Spain (Rica et al., 2023) showed prevalence rates virtually identical to those found in similar studies for women (i.e., 1.4%). However, eating disorders manifest themselves differently depending on gender.
Based on biological, emotional, and relational vulnerabilities, eating disorders (EDs) underpin problematic behaviors stemming from body dissatisfaction and the pursuit of change that provides peace, control, security, or anything else someone associates with a particular physique and feels they desperately need. This mismatch between the ideal body and the perceived body differs between men and women . Generally, men tend to aspire to a physique in which muscle mass and/or visibility are fundamental. Women, on the other hand, pursue an ideal in which thinness is the ultimate goal. These differences lead to different expressions of risky behaviors related to body change. In the case of men, these behaviors include increasing the quantity and frequency of food intake, increased protein consumption, the use of supplements, and a compulsive relationship with physical exercise.
At the extreme end of this psychopathological continuum of Muscle-Oriented Eating Disorders (MOEDs) we find muscle dysmorphia (MD), what the general public knows as muscle dysmorphia . Initially, muscle dysmorphia was described as the inverse of anorexia nervosa. Men with extremely muscular bodies who perceived themselves in a distorted way as thin, frail, and weak. Men who spent long hours lifting weights at the gym and whose attention to their diet was as obsessive as that of anorexia nervosa. They also resorted, in up to 10% of cases, to the use of anabolic steroids to increase their muscle mass , despite the dangerous consequences of these substances. Regarding its prevalence, the aforementioned Spanish study showed rates of muscle dysmorphia practically equal to those of eating disorders in the male sample (i.e., 1.3%), in line with studies on the prevalence of eating disorders in women.
In men, risky behaviors focus on increasing the amount and frequency of food intake, increasing protein consumption, using supplements, and having a compulsive relationship with physical exercise.
Of course, there are also cases of predominantly restrictive eating; many individuals experience binge eating, and others, when they binge, feel the need to purge. All these symptoms of eating disorders or muscle dysmorphia carry a more somber prognosis , with greater obsessive symptoms, higher comorbidity with substance use, and a greater presence of childhood obesity/overweight, the latter being present in up to 40% of male eating disorder cases. This figure is particularly alarming when compared to the childhood obesity/overweight rates in Spain consistently reported by the ALADINO study (AESAN, 2025). These symptoms also have a later age of onset than those observed in women. While the peak incidence of eating disorders in women is around age 14, in men it is between 17 and 19. This places us in the university years, where prevention efforts for these disorders are practically nonexistent.
When physical exercise becomes an obsession
Let me state from the outset: being physically active and exercising regularly is healthy in the vast majority of cases. It only becomes dangerous in a small percentage of cases, and those of us who work with people who suffer from their relationship with their bodies sometimes feel that it's more prevalent, given the population we work with. Even so, Western societies are not as physically active as they could be, and this is an extremely complex problem that we have yet to solve. Recently, the writer Sergio del Molino (2025) reflected on this, among other things, in an article published in Ethic .
Fitness culture and social media have promoted an ideal of a muscular and defined male body . This pressure can lead to an unhealthy relationship with exercise, where physical activity becomes an obsessive obligation rather than a source of well-being. The constant pursuit of a perfect body can trigger anxiety, depression, and social isolation . We know that 90% of men who exercise do so to increase or make their muscle mass more visible; of these, 70% will alter their diet to achieve this goal, and 10% will resort to ergogenic substances such as steroids (Eisenberg et al., 2012).
How to avoid becoming obsessed with having a muscular body
For some men, lifting weights at the gym becomes an obsession, while for others, endurance exercise (e.g., cycling) serves their purpose in pursuing a "lean" physique. The pathological relationship with physical exercise is a complex construct filled with labyrinthine terms that often lead to confusion. Exercise addiction? Excessive exercise? Compulsive exercise? These terms are frequently used interchangeably and are generally associated with excess. Does someone who trains four hours a day have a problem? Not necessarily. Studies indicate that, regarding eating disorders and body image, compulsive exercise is the construct most strongly associated with psychopathology. Some indicators that may suggest a problem with one's relationship with training include:
- Regulate your emotions through exercise.
- I train because I can't stand the prospect of not doing it.
- Feeling guilt or anxiety if I don't exercise.
- Prioritizing it over my social or family ties.
- Combine it with extreme diets.
Men, mental health and vice versa
Mental health is a predominantly female field. Of the more than 9,000 psychologists who graduate each year in Spain, around 80% are women. The majority of users of mental health services are also women , particularly in eating disorder units. Men, except for very specific pathologies, do not usually receive this type of help. Perhaps they don't need it? Men have almost three times the rate of completed suicide compared to women (INE, 2023; 2024) and constitute the bulk of the world's prison population. It seems that men experience significant difficulties in their emotional regulation, but among their options, seeking professional help does not appear to be high on the list. Faced with high levels of psycho-emotional distress, men tend to exhibit externalizing behaviors (aggression, hyperactivity, etc.), while women typically regulate themselves internally (anxiety, depression, etc.). Women make more suicide attempts, but more men die by suicide.
Fitness culture and social media have promoted an ideal of a muscular and defined male body. This pressure can lead to an unhealthy relationship with exercise, where physical activity becomes an obsessive obligation rather than a source of well-being.
It's curious how we've apparently been slow to consider certain male behaviors indicative of mental health problems, while others aren't even considered or questioned. Hordes of men have filled planes to Turkey for hair transplants. I wonder if a scenario involving women seeking medical tourism for breast augmentation or liposuction would have received the same treatment. If we had been talking about body acceptance or the tyranny of aesthetics. Or how easy it is to find out how to do a steroid cycle by typing on YouTube, without content moderation policies taking any action.
Men's actions have usually been less criticized and questioned. It's often assumed that men are fine and can handle it, that nothing bad will happen. A woman I was seeing told me that a guy she was dating had just come back from a double Hyrox session and a 300km bike ride, saying his mouth tasted like blood and he wasn't going to eat dinner. She was telling it as an anecdote. She, having been through that in the past, saw that it wasn't healthy, but he wasn't in that state. The relationship didn't last long.
It is essential to promote a new vision of masculinity that allows for vulnerability, emotional expression, and self-care.
Traditional masculinity has promoted the idea that men should be strong, self-sufficient, and emotionally controlled . These norms can make it difficult for men to recognize and seek help for mental health problems. To reduce the gap between the known prevalence of male mental health issues and the reality of consultations, it is essential to foster a new vision of masculinity that allows for vulnerability, emotional expression, and self-care . It's not about being less of a man; it's about integrating things that have always been there on an emotional level.
We're taking steps in that direction. The "Por huevos" campaign, featuring actor Paco León, is one example. Another example of this shift is how the popular Movember movement (growing a mustache during November) has broadened its focus from prostate and testicular cancer awareness to men's mental health. We all have a challenge ahead of us. Let's give it our all.