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. 2024 Feb 9;121(3):86–91. doi: 10.3238/arztebl.m2023.0246

Eating Disorders in Men

An Underestimated Problem, an Unseen Need

Georg Halbeisen 1, Nora Laskowski 1, Gerrit Brandt 1, Ute Waschescio 2, Georgios Paslakis 1,*
PMCID: PMC11002438  PMID: 38019152

Abstract

Background

Eating disorders are seen mainly as a problem affecting women, not just by the public at large, but also in specialized circles. Although it is true that more women than men suffer from all types of eating disorder, pertinent reviews have clearly shown that they do indeed occur in men, and that the available evidence on the matter is limited. The stigmatization of men with eating disorders makes it harder for these men, and for the relevant professionals, to recognize the symptoms and to seek or provide help.

Methods

This review is based on publications retrieved by a selective search in PubMed on the epidemiological, diagnostic, clinical, and therapeutic aspects of eating disorders in men.

Results

Current estimated lifetime prevalences in men are 0.2% for anorexia nervosa, 0.6% for bulimia nervosa, and 1% for binge-eating disorder; the corresponding figures for women are 1.4%, 1.9%, and 2.8%. Men and women may display different manifestations. Women are thought to be mainly seeking a slim figure and weight reduction; men, a muscular build. The established German-language screening and diagnostic tools, however, do not cover the types of symptoms that are more common in men. Little is known about whether treatment yields comparable results in men and women.

Conclusion

It is important to combat the stigmatization of men with eating disorders and to remove the obstacles to their appropriate diagnosis and treatment. The current methods of screening and diagnosis need to be adapted to take account of the special aspects of abnormal eating behavior in men. It remains unclear whether and how the disorder-specific treatment of these conditions in men should differ from their treatment in women.

cme plus+

This article has been certified by the North Rhine Academy for Continuing Medical Education. The questions on this article may be found at http://daebl.de/RY95. The closing date for entries is 08 February 2025.

Participation is possible at cme.aerztebatt.de

The treatment of eating disorders presents an increasing challenge to the public healthcare system. The most common forms of disordered eating and weight control behaviors are binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) (Table 1). These forms are characterized, for example, by a distorted perception of body image, restricted eating, eating binges, self induced vomiting, misuse of laxatives, or excessive sports activity (1). Persons who are affected will suffer substantial physical and mental impairments (2), partly as a result of comorbid malnutrition, which may exacerbate osteoporosis, for example, or subsequent to obesity which, for example, increases the risk of diabetes. Underweight, overweight, or drastic changes in weight can be a reason to suspect eating disorders but are not necessary characteristics or reliable indicators.

Table 1. Criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, and muscle dysmorphia.

Criterion AN (6B80)*1
(M: 0.2 %, W: 1.4 %)*2 		BN (6B81)*1
(M: 0.6%, W: 1.9 %)*2 		BED (6B82)*1
(M: 1.0 %, W: 2.8 %)*2 		ARFID (6B83)*1 MD (6B21)*3
A Significantly low body weight because of restricted energy intake (defined as weight below the minimum normal weight or expected weight in children and adolescents) Repeated episodes of binge eating (consumption of objectively large food volumes in circumscribed time with experienced loss of control) Repeated episodes of binge eating (consumption of objectively large food volumes in circumscribed time with experienced loss of control). Eating disorder that manifests as not covering the food and/or energy need; association with relevant weight loss, diet related malnutrition, dependent on tube feeding or nutritional supplements and/or clear impairments to psychosocial functioning Excessive preoccupation with perceived deficits in the external appearance (here: body too small or insufficiently muscled)
B Marked fear of weight gain or getting fat, or sustained behavior that counteracts weight gain Repeated compensatory measures to prevent weight gain (eg, self induced vomiting, misuse of laxatives, diuretics, or excessive sports/exercise) Eating binges include at least three of the following symptoms: eating more quickly than usual; eating until feeling uncomfortably full; eating although not physically hungry; eating alone because of shame about the amount; self revulsion and/or feelings of guilt after excessive eating Disorder cannot be explained with a lack of available foodstuffs or culturally accepted behavior (eg, fasting) Repetitive behaviors as reactions (eg, checking in the mirror) or intellectual actions (eg, comparison with others)
C Distorted perception of one’s own figure/body weight, excessive influence of body weight/figure on self image or lacking comprehension regarding the severity of underweight At least one eating binge per week on average over a three month period Obvious psychological strain as a result of eating binges Disorder does not occur in the context of anorexia or bulimia; no indications of body image disturbance Obvious psychological strain because of excessive preoccupation with the perceived deficiencies in appearance
D Excessive influence of body weight/figure on self image At least one eating binge per week on average over a three month period Disorder is not the consequence of a physical disease or another mental disorder Preoccupation with appearance is not better explained with an eating disorder (eg, if fears persist about body fat or weight)
E Disorder does not exclusively occur during the course of episodes of anorexia nervosa No compensatory measures as in bulimia nervosa and eating binges not exclusively during the course of bulimia nervosa or anorexia nervosa
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*1 ICD-11 classification; *2 estimated lifetime prevalence for AN, BN und BES (7); for ARFID and MD only few point estimates are available to date.

*3 MD, as specification of body dysmorphic disorder based on the DSM-5

ARFID, avoidant/restrictive food intake disorder; AN, anorexia nervosa; BN, bulimia nervosa; BED, binge eating disorder;

FM, men; W, women; MD, muscle dysmorphia

In the public’s perception as well as in specialized circles, eating disorders are traditionally viewed as disorders affecting women (3), but pertinent review articles have clearly shown that they also occur in men and that the evidence is limited (4–6). For this reason it is important that doctors of all specialties are informed about eating disorders in men and acquire basic competencies for tackling these adequately/appropriately. This review article summarizes from a clinical-scientific perspective selected events and unanswered questions regarding the specific symptoms, the diagnostic evaluation, and the treatment of men with eating disorders.

Method

We undertook a selective literature search in PubMed for studies published in German and English that appeared between January 2000 and May 2023, using the search terms “eating disorders AND (men or male)”. We gave preference to systematic reviews, meta-analyses, and controlled trials that focused explicitly on eating disorders in men.

Furthermore we included relevant studies on the prevalence of eating disorders, relevant studies from our working group, and the S3 guideline for the diagnosis and treatment of eating disorders. As we are aware of the gaps in the evidence we present a narrative summary of selected results that illustrate the clinical relevance and the need for healthcare provision and research. Where available we report effect sizes (OR, odds ratios) and 95% confidence intervals (in square brackets).

Results

Epidemiology

In contrast to common perception, eating disorders affect not only girls and young women but also older adults, persons in gender and sexual minorities (LGBTQ+ persons), persons in ethnically diverse groups, and men (3). A systematic review of all general population based prevalence studies published between 2000 and 2018 that used validated diagnostic instruments (7), estimated the worldwide lifetime prevalence of eating disorders in men to be 0.2% (anorexia), 0.6% (bulimia), 1.0% (binge eating disorder), and 3.6% (eating disorders not otherwise specified, which do not meet the criteria for the complete picture of other categories). By comparison, women’s rates are 1.4% (anorexia), 1.9% (bulimia), 2.8% (binge eating), and 4.3% (eating disorders not otherwise specified), but according to the Global Burden of Diseases Study (8) the global, age-standardized 12-month prevalence of anorexia and bulimia in men rose to higher values percentage-wise, from 96.7 [69.2; 128.0]/100,000 in 1990 to 117.9 [84.6; 156.1]/100,000 in 2019 (about 22%). In women during the comparison period an increase from 205.8/100,00 to 231.5/100,000 was documented (about 12%) (9). The estimated 12-month prevalence of binge eating disorder in Germany in 2013 was 100/100,000 in men as well as in women (10). The ratio of men:women therefore varies overall between 1:2 and about 1:4. The fact that this ratio is rarely reflected in clinical treatment settings indicates potential under-provision.

Recent data from the COPSY Study (11) have shown an increase in symptoms of eating disorders in boys in Germany as a result of the COVID pandemic (OR 1.75 [1.18; 2.58]) and a decrease among girls (OR 0.45 [0.33; 0.61]. The extent to which the increase in symptoms has led to a differential increase in diagnoses is currently not clear. In the UK, for example, eating disorders fell in boys and rose in girls as a result of the pandemic (12).

For the US, a registry study provides indications of an increased prevalence of eating disordered behaviors in men from marginalized ethnic and cultural groups, especially as regards bulimia (lifetime prevalence in men from a Latin-American background: 1.73% versus Western men: 0.08%) (13). A review of culture-comparison studies concluded that weight control behavior and binge eating affect men from marginalized ethnic groups to a greater extent (14). A further review showed that rates of eating disorders in homosexual or bisexual men are higher than in heterosexual men (15). According to a meta-analysis, symptoms of an eating disorder are more strongly pronounced in trans men than in trans women and cis women (16). The degree to which sociocultural factors entail different risks for eating disorders for men and women is not sufficiently known.

An initial case-control study recently compared the risk of death between men and women over a time period of ca 6–12 years (17). The age and sex standardized death risk (OR) was increased for men with anorexia (4.93 [2.36; 9.07]) and also for women with anorexia (5.29 [4.32; 6.40]), bulimia (1.57 [1.15; 2.09]) und eating disorders not otherwise specified (EDNOS) (1.91 [1.38; 2.59]). Because of the small case numbers in men in the study (188 men versus 5296 women), however, it may be assumed that the death rates in men with bulimia (1.42 [0.39; 3.63]) und EDNOS (1.93 [0.40; 5.65])—which did not reach significance, similarly to those in women—can be explained with the fact that the study was insufficiently powered. The survival period for men with anorexia was shorter than for women.

Symptoms

Disturbances in body schema—that is, a distorted perception of one’s own body—are regularly present in persons with eating disorders. In spite of similar causes of eating disorders in men and women, indications are—according to two narrative reviews—that the extent of body schema disorders and associated dysfunctional behavior patterns are guided by different culturally shaped body ideals (18, 19). While women are thought to be mainly seeking a thinner body (slim figure ideal), men are thought to focus on muscle definition (that is, with a low body fact percentage, but not a classically “thin”) body (mesomorph body type—V shape: broad shoulders, musclebound chest and upper arms, and a narrow waist). Recent network analyses of larger samples from the general population have shown that muscle related attitudes (the desire for more muscle mass) and behaviors (excessive weight training, use of food supplements, and/or anabolic steroids) are associated with symptoms of eating disorders, such as body dissatisfaction, restricted eating, and binge-purge behaviors (20, 21). Indications exists that these associations might be more pronounced in men of a homosexual orientation (22). Since these studies had a cross sectional design, however, no conclusions can be drawn about the predictive power of muscle related worries for eating disorder symptoms.

According to comparison studies, a great phenotypic overlap exists between eating disorders in men and so-called muscle dysmorphia (23). Muscle dysmorphia is characterized by the worry of not being muscular enough or the fear of losing muscle mass, even in persons who are objectively muscular (24). Disordered eating behavior can also occur in muscle dysmorphia, but in this scenario the individual obsessive preoccupation with one’s own muscles (not weight) is at the forefront (Table 1).

The clinical relevance of muscle related behavior is also underlined by the retrospective evaluation of the adverse events reporting system of the US Food and Drug Administration. An analysis of 977 reports showed that intake of preparations to build muscle or reduce weight was associated with medical complications (7.6% hospital admission, 1.84% life threatening events, 0.61% death) (25).

Diagnostic instruments

It is often difficult to diagnose reliably eating disorders in men because of the partly differing symptoms and the sliding transition from healthy to pathologic behavior, because many people play sports or exercise, follow dietary rules, or are unhappy about their figure. Currently diagnostic criteria no longer (categorically) exclude men (1), but established German-language screening and diagnostic instruments—for example, the Eating Disorder Examination-Questionnaire (EDE-Q)—are only partially validated for men (26) and mostly do not record the named symptoms that are more common in men (27). A recently published study by Laskowksi et al (28)—the first to investigate the factor structure of the German -language EDE-Q for men with eating disorders—confirmed body dissatisfaction and (more) weight related concerns as independent dimensions, which indicates further causes of body dissatisfaction in men (for example, the desire for a muscular build) that have to date not been reflected here. The EDE-Q and similar instruments can therefore not adequately reflect eating disorders in men (as well as, partly, in women too [29]) and should only be used with relevant reservations. For individual dimensional eating disorder-related questionnaires, more liberal cut-off values for men have been suggested so as to identify suspected cases earlier on (26).

Independently of the need for new and further developments of German-language instruments that considers common symptoms in men, it should be assessed in the individual case scenario whether a specific behavior (for example, undertaking weight training/strength sports, adhering to certain dietary rules) indicates a risk to physical or psychosocial health or a subjective psychological strain that should prompt treatment, and whether the criteria of an eating disorder (Table 1) are met (30).

Treatment

Psychotherapy is generally the most important building block in treating eating disorders. In case of high-grade anorexia and malnutrition, inpatients nutrition management is required (30). Psychotherapeutic approaches with meta-analytically confirmed effectiveness (vis-à-vis “treatment as usual”) are:

  • Psychotherapeutic guideline methods, such as cognitive behavior therapy for anorexia, bulimia, and binge eating disorders in adults, as well as bulimia in minors

  • Psychodynamic psychotherapy for anorexia in adults

  • Family based approaches for anorexia, bulimia in minors.

  • Interpersonal therapy for anorexia, bulimia, binge eating in adults.

No indications exist that any specific psychotherapeutic approach is superior (4–6, 30). Table 2 summarizes the expected effects of therapy for primary outcomes.

Table 2. Therapeutic effects for primary result parameters of psychotherapeutic treatment of anorexia nervosa, bulimia nervosa, und binge eating disorder.

Eating disorder Samples Outcome Effect
AN 87.7–97.9%
women		 BMI increase/week inpatients (6 month follow-up) 0.19/0.25 (adults/adolescents)
BBMI increase/week outpatients (6 month follow-up) 0.04/0.08 (adults/adolescents)
BN 99.1%
women		 Abstinence from binge eating episodes (end of treatment) 51% [44; 58]
Abstinence from compensatory measures (end of treatment) 45% [36; 54]
Reduction in binge eating episodes (before vs. after treatment) SMD = 0.84 [0.73; 0.96]
Reduction in compensatory measures (before vs. after treatment) SMD = 0,67 [0.59; 0.75]
BED 90%
women		 Abstinence from binge eating 53% [45; 61]
Reduction in binge eating episodes SMD = 0.83 [0.45; 1.20]
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Data are based on relevant meta-analyses (e1–e3);

treated cases reported as percentages; 95% confidence interval in square brackets;

AN, anorexia nervosa; BMI, body mass index; BN, bulimia nervosa;

BED, binge eating disorder; SMD, standardized mean difference

The recommendation of the current S3 guideline for the diagnosis and treatment of eating disorders is based essentially on clinical studies, in which—according to our own calculations—men account for about 10.5%, 5%, and less than 1% of the samples with binge eating disorder, anorexia, or bulimia (3). Since to date, only sparse insights exist into the comparability of treatment results in men and women, the question of whether treatment approaches should consider to a greater extent the sex of affected persons and associated symptoms and the etiology remains currently unanswered. A retrospective cohort study by Halbeisen et al (31) recently found in men with anorexia a partially larger reduction in eating related cognitions and a greater normalization of weight (=primary treatment objective in by definition underweight persons with anorexia) than in women. Strobel et al (32) concluded similar results (a higher body weighty at the end of treatment in men with anorexia than in women), with the authors not finding any differences in the remission rates of eating disordered behavior between men and women over the long term (40% men vs 41% women). Men with bulimia over the long term—that is, 1 year after completing specific treatment for eating disorders—had comparable remission rates of their eating disorder (28.6%) as women (25.7%) (33). In men with binge eating disorder, greater normalization of weight was observed (not a central treatment objective in binge eating disorder)and partly a greater reduction in eating disorder related cognitions (31, 34). The extent to which the observed comparability in general and the differences are associated with therapeutic adherence, personality factors, or sex associated physiologic parameters cannot be conclusively assessed because of the lack of relevant studies. Since thus far no indications exist that existing therapeutic services are less effective in men, it seems practical to follow the current guidelines.

Discussion

Eating disorders do affect men, but phenotypic differences between the sexes that are not considered in commonly used diagnostic instruments can hamper an early diagnosis. Effects on care provision and treatment results have not been sufficiently researched because of the lack of primary data. Impressions of affected persons (systematically summarized by Richardson and Paslaki [35) underline the need for paying attention ion a more targeted way to eating disorders in men in healthcare context. The double stigmatization—the shame of the disorder on the one hand and the conflict with masculine identity of the other—makes it unlikely in the medical and therapeutic context that men mention their eating disorder symptoms themselves. Consequently, the challenge for doctors to probe for eating disorders in men, to mention them when suspected, and to refer men to suitable treatment (36) is even greater (case report eBox).

eBox. Case Report of a Patient With an Eating Disorder.

Initial contact with the primary care physician

19-year old Jonas presented to his primary care physician because he was not able to pursue his usual activities (university degree course, sports, semiprofessional association football) because of his continually deteriorating physical and mental state. The loss of functioning had existed for more than a year and had shaken Jonas in terms of his self image and had forced him to explain and justify himself to his social environment (family, sports club). In his despair he turned to the doctor, hoping that he might be able to identify the cause of his symptoms. Jonas reported these as lack of drive, lack of concentration, exhaustion, lack of strength, disrupted sleep, and digestive/gastrointestinal problems. His body mass index (BMI) was ca 19 kg/m2, in the lower normal range.

Motivational interview

The doctor immediately noticed his patient’s reduced psychological-physical state. He asked questions on the patient’s eating habits and exercise behavior, among others. He asked Jonas whether he spent much time thinking about what he ate and whether he spent a lot of time thinking about his weight and his appearance, and whether his weight and figure affected his sense of self worth. Jonas then gradually revealed further problems. In addition to depressive breakdowns and social anxiety he reported pronounced symptoms of controlled eating (avoidance of certain “fattening” foods, calorie counting), a strong urge to move/exercise, and a negative body image, something he had not discussed with anyone else previously. The GP listened attentively, took the symptoms seriously, validated and normalized them, and offered his support. The creation of this atmosphere is likely to have been the deciding factor in breaking the calamitous circle of silence.

The doctor suggested the option of psychotherapeutic treatment—an option he left open for the young man, thus giving him control over how to proceed.

Presenting for psychotherapy and further course

Jonas decided to attend a psychotherapeutic practice. In the initial session he presented full of shame about his symptoms, which in his eyes were a sign of weakness and deficient masculinity. It transpired that his diet had been poor since puberty, that he had been moderately underweight repeatedly, and that he practiced sports intensively (semiprofessional football). Simultaneously he often felt overwhelmed, developed fears of failure, and increasingly often felt an inexplicable sadness (for which he once more felt ashamed). After his Abitur school leaving certificate Jonas moved to a different town/city, and the transition (leaving home, changing location, start of university degree, change of sports club/association) exacerbated the previously subliminal pathogenic dynamic and resulted in decompensation. People in his social environment always regarded him as a healthy, happy boy as long as he was doing fine in school and played football successfully. The looming professional career was seen by everyone (including Jonas himself) as a desirable perspective, and everyone with this opportunity cannot but feel happy about it. Jonas had never communicated the underlying hidden self doubt, fears, and feelings of loneliness to anyone. The psychotherapy aimed to normalize his eating and exercising behaviors and stabilize his weight and, furthermore, aimed to tackle the underlying depressive structure and for Jonas to acquire his own male/masculine gender role beyond stereotypes. Jonas managed to increase his BMI to 20 kg/m2. In the setting of later inpatient treatment (specialist hospital), Jonas succeeded in improving his own access to his inner emotional and physical processes, to admit to his worries, fears/and self doubts, and talk about them openly.

Recognizing eating disorders, taking them seriously, and addressing them

Men with eating disorders may attend doctors’ practices for non-specific complaints, such as digestive problems or mood swings (37). If they present with serious weight loss or gain, a notable increase in muscle mass, or excessive amounts of exercise it is recommended to discuss open and in a non-discriminatory way eating behavior, weight, and body, and to take concerns and stresses seriously. Not all criteria (Table 1) have to be met mandatorily to diagnose an eating disorder; one can, for example, diagnose an “Other Specified Feeding or Eating Disorder” [OSFED]). Body mass index (BMI) alone is not a reliable indicator, because even if they have a normal or higher BMI, men (as well as women) can display eating disordered behaviors in terms of food intake and exercise as well as signs of malnutrition. Excessive sport that is practiced in spite of injuries, at inappropriate times, accompanied by neglect of tasks and duties is still more socially acceptable in boys and men than it is in girls and women (38) and can cover up underlying fears about weight and figure/shape (39).

Indications exist that men are tendentially less open than women to the idea of psychotherapy (4). For this reason it is recommended that professional helpers look for options to improve men’s readiness to undergo treatment, for example by:

  • Using special skills (for example, self disclosure, normalization of symptoms)

  • Linguistic adjustments (using male oriented metaphors, for example, sports based ones)

  • Conversational/communication styles that are most appealing to men (for example, et eye level, clear/transparent, task and target oriented) (40).

Qualitative data show that men experience breaking the silence as a relief later on—even though they initially find it disagreeable (35). In the psychotherapy setting one approach may be to raise aspects of sex specific socialization and convictions as regards the term “masculinity” so as to develop an understanding of fundamental convictions and cognitions that sustain eating disordered behavior in men and increase the risk of relapses.

Referral to appropriate support services is required

Treatment should be offered early on in order to prevent a chronic course (30). Referral to appropriate services depends also on the severity of the disorder. In cases where patients do not represent an acute danger to themselves—for example, as a result of extreme underweight, comorbid self-harming behavior, and/or suicidality—outpatient psychotherapy can be initiated. To bridge waiting times, referral to advice centers or local self help groups can be helpful; these are, however, extremely rare to come by for men. Information on such local services can be found on the website of the Federal Centre [sic] for Health Education (BZgA—(www.bzgaessstoerungen.de/hilfe-finden/suche-nach-beratungsstellen) and the Landesfachstelle Essstörungen NRW [the specialist state office for eating disorders North Rhine–Westphalia—www.landesfachstelle-essstoerungen-nrw.de/infothek).

Consider treatment settings

According to qualitative reports, treatment services and information materials for eating disorders are still mostly directed at women (35). Being the only man in a treatment setting may lead to serious reticence in group therapies and foster/facilitate/promote experiences of marginalization (35). Special group therapy services, family sessions for fathers and their sons, and the intentional involvement of female and male friends or men’s partners can contribute to minimizing a feeling of exclusion. The empirical evidence for creating such typically male treatment services is lacking, however. To shape information provision, psychoeducation, and treatment context in a way that is accessible to men should, however, become more of a given in view of increasing case numbers.

Conclusions

Although eating disorders in men are increasingly finding attention, more research is needed of the development, diagnosis, and treatment in men. We also need a public discourse on the topic eating disorders in men so that information can become more accessible and stigma can be reduced. An inclusive approach that takes those affected seriously as unique individuals might lower barriers to treatment. Furthermore, more research is needed that includes the perspectives of men from diverse backgrounds—among others, regarding ethnic-cultural belonging/identity, sexual/gender identification, and sexual preferences.

Questions on the article 3/2025:

Eating Disorders in Men

An Underestimated Problem, an Unseen Need

CME credit for this unit can be obtained via cme.aerzteblatt.de until 08 February 2025. Only one answer is possible per question. Please select the answer that is most appropriate.

Question 1

Which of the following statements about men and eating disorders is correct?

  1. Eating disorders are only a “women’s/female disease.”

  2. Eating disorders are increasing in men too.

  3. Eating disorders affect homosexual men only.

  4. Eating disorders are equally common in men and women.

  5. Eating disorders also affect men, but not to a clinically relevant extent.

Question 2

Which of the following criteria is not consistent with a diagnosis of anorexia nervosa?

  1. Significantly low body weight because of restricted energy intake

  2. Marked fear of weight gain

  3. Eating binges accompanied by the experience of loss of control at least 1× per week

  4. Marked fear of becoming fat

  5. Distorted perception of one’s own figure

Question 3

Which of the following characteristics is absent in binge eating disorder?

  1. Feelings of guilt after excessive eating

  2. Compensatory measures after binge eating

  3. Psychological strain because of eating binges

  4. Eating binges take place over a time period of three months or longer

  5. Experienced loss of control during eating binges

Question 4

What is the term used to describe a body schema disorder that causes those affected permanent worry that they are not muscular enough, even though objectively they are?

  1. Muscle dysmorphia

  2. Muscle dystonia

  3. Muscle dystrophia

  4. Muscle atonia

  5. Muscle atrophy

Question 5

Which of the following statements regarding eating the diagnosis of eating disorders in men is correct?

  1. Existing diagnostic questionnaires mostly focus in a targeted way on symptoms in men.

  2. Existing questionnaires are only in part validated for men.

  3. The stigmatization of men with eating disorders does not affect their diagnostic registration.

  4. Professional support staff will not overlook eating disordered behavior in men.

  5. In men, a diagnosis of an eating disorder can be made purely on the basis of BMI.

Question 6

According to statements made in the article, what is the percentage of male samples in clinical studies that were consulted as the basis of the S3 guideline for the treatment of eating disorders?

  1. 50–65%

  2. No male samples exist.

  3. 20–35%

  4. About 35%

  5. 1–10%

Question 7

What is the lifetime prevalence of bulimia nervosa in men posited in the article?

  1. 0.1%

  2. 0.6%

  3. 5%

  4. 11%

  5. 20%

Question 8

In individual studies, what therapeutic outcome regarding eating disorders was observed with regard to normalization of weight?

  1. No difference was observed between men and women in terms of weight normalization.

  2. Women with bulimia nervosa were found to have a greater normalization of weight than men.

  3. Greater weight normalization was observed in men with anorexia nervosa and weight loss in binge eating disorder than in women.

  4. Greater weight normalization was observed in men with bulimia nervosa than in women.

  5. Greater weight normalization was observed in women with anorexia nervosa and weight loss in binge eating disorder than in men.

Question 9

Which trend regarding eating disorders has been observed since the start of the COVID pandemic according to results from the COPSY Study?

  1. A decrease in eating disorder symptoms in children of both sexes in Germany

  2. An increase in eating disorder symptoms among boys in Germany

  3. An increase in eating disorder symptoms among girls in Germany

  4. A decrease in eating disorder symptoms among boys in Germany

  5. An increase in eating disorder symptoms in children of both sexes in Germany

Question 10

What should treating professionals pay attention to in a setting of a suspected eating disorder in their male patients?

  1. Patients should be asked for their eating and exercise behaviors openly and directly.

  2. Steps already taken by the patient off their own back should be vetoed.

  3. The patient should be asked for their sexual orientation.

  4. Treating professionals should wait until the patient himself mentions possible symptoms of an eating disorder.

  5. Referrals are often unsuccessful and therefore do not make sense.

Acknowledgments

Translated from the original German by Birte Twisselmann, PhD.

Footnotes

Conflict of interest statement

The authors declare that no conflict of interest exists.

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