Eating disorders such as anorexia and bulimia are commonly associated with girls and women. But the National Association of Anorexia Nervosa and Related Disorders (ANAD) estimates that 10 to 20 percent of people with eating disorders are male. The National Eating Disorders Association, which calls eating disorders among boys and men a silent epidemic, puts the number of males with eating disorders at more than 10 million.

According to ANAD, a third of all teenage boys try to control their weight by skipping meals, crash dieting, smoking cigarettes, vomiting, using laxatives and other unhealthy behaviors. For kids who may be predisposed to eating disorders (for example, they have a family history of eating disorders or anxiety disorders) any of these alone or in combination can lead to an eating disorder. Sexual orientation can also put a kid at risk: Nearly half of all boys and men with eating disorders identify as gay.

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Subtle symptoms

Boys and girls with eating disorders are notoriously good at hiding what’s going on. And many of the early warning signs of an eating disorder — cutting out snacks, being more active — may look like a child’s attempts to be healthier. Plus, both parents and doctors sometimes misinterpret or miss the early signs of an eating disorder in boys because they simply don’t think of boys as being vulnerable to these problems.

“Even when boys do present with formal eating disorder symptoms, they’re often misdiagnosed,” says Evelyn Attia, MD, who directs the Center for Eating Disorders at New York Presbyterian Hospital. For instance, doctors tend to order more medical tests for boys than they do for girls, looking for other explanations for their symptoms.

However, the earlier an eating disorder is diagnosed, the better the chances of recovery. Your son may show one, some or all of the following warning signs in the early stages of an eating disorder. If he does, schedule an appointment with his doctor.

A boy with an eating disorder may:

  • Obsess about food and cooking, especially if he's never shown an interest in the kitchen before
  • Cut out entire food groups (especially fat)
  • Lose weight  (more than a pound or two)
  • Talk about wanting to be more muscular or "cut"
  • Exercise every day and become anxious if he can't
  • Put on weight (not all eating disorders are characterized by weight loss; some, such as binge-eating disorder, involve frequently eating large amounts of food without purging)
  • Rush to the bathroom immediately after eating
  • Avoid eating with or in front of family and friends
  • Spend less time with friends
  • Seem noticeably more anxious overall

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Finding a treatment that works

Some people with eating disorders struggle for years. But with early, effective treatment, most boys — and girls — recover fully. “You need to eradicate an eating disorder as quickly as you can,” explains Daniel Le Grange, PhD, director of the Eating Disorders Clinic at the University of Chicago. One of the most effective treatment approaches for kids and teens with anorexia is called Family-Based Treatment (FBT), also known as the Maudsley approach. In FBT, families work with a specially trained therapist to take an active role in helping their child recover physically and psychologically.

One of the hallmarks of anorexia and other eating disorders is an overwhelming terror of food and eating. But eating is a crucial part of the recovery process. In FBT, families (and sometimes friends) sit with a child at every meal and snack to support, encourage and comfort him. Mary Tantillo, PhD, director of the Western New York Comprehensive Care Center for Eating Disorders, describes this approach as “love bombing.”

Families who use FBT say that while the process is challenging, it’s a relief to be able to do something to help their children. (For more information or to find an FBT therapist, visit www.maudsleyparents.org.) For children and teens with bulimia, both FBT and a targeted form of cognitive behavioral therapy (CBT) are effective treatments.

In certain situations, residential or in-patient treatment may be helpful. Some of these programs accept only girls and women, but many — including the one Evelyn Attia directs at Columbia Presbyterian in New York City — treat boys too.

The bottom line for parents: Trust your instincts. If you think your son may have an eating disorder, see his doctor for a thorough evaluation. It can’t hurt and it may just save his life.

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Harriet Brown’s latest book is Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight — and What We Can Do About It (Da Capo Press, March 2015). In Brave Girl Eating: A Family’s Struggle with Anorexia (2010), she wrote about helping her daughter recover from anorexia. With two other parents she founded the Maudsley Parents website as a resource for families dealing with eating disorders. She teaches magazine journalism at the S.I. Newhouse School of Public Communications in Syracuse, New York.