Eating disorders/disordered eating and the athlete triad are often associated with females but there is a growing amount of evidence to suggest that it is becoming more prevalent within males too.
Indeed in my own clinic this year, around 1/3 of the cases of disordered eating I have worked with, have been in males ranging in age from 15-40 years.
In all cases, working with eating disorders is a challenge; there is no straight line to recovery.
However, In the case of a female sufferer, the physical signs of low energy availability, over exercising and restricting food intake are made apparent physically by weight loss but also physiologically via the cessation of menstruation.

In the male sufferer there are few visible physiological signs, making it more difficult to assess the degree of damage to the body.

In the female athlete triad it is widely accepted now that athletes can actually hold a fairly normal weight but still be affected due to having low energy availability. When a female athlete consumes less than 30 Kcal/Kg fat free mass either as a result of restricting their intake or being unable to meet their training demands, it affects the hypothalamic hormones and stops the production of Oestrogen. This in turn can then have an impact on bone density especially if menstruation stops for as little as 3 consecutive months. If a sufferer is also very low in weight and showing signs of disordered eating, there will be concerns regarding her blood pressure, pulse rate and increased pressure on heart, lungs and skeleton as her body fights to stay alive.

How does this differ in boys/men?

As already mentioned, there is a missing corner with regards to the actual triad (suggesting its more of dyad) as there is no link to cessation of menstruation but surely low energy availability in males will also see a reduction in the sex hormone testosterone and what effects does this actually have?

Indeed, studies in male bodybuilders have demonstrated that prolonged energy restriction does cause a reduction in testosterone and growth hormone.Indeed, studies in male bodybuilders have demonstrated that prolonged energy restriction does cause a reduction in testosterone and growth hormone.

Effecting anabolic pathways, even when the athletes consume high protein diets. In the case of the body builder as long as this is just short term in the lead up to a competition, there is no lasting damage or concern.
Interestingly the male sufferers I have worked with have all presented with very low body fat composition, increased desires to be lean but strong and have an excessive relationship with lifting weights in the gym. What may have started as a general interest to build muscle soon becomes an obsession with controlling their food intake; becoming fixated on reducing carbohydrate and fat from their diet to a dangerous level, while still spending hours exercising daily.

As is often seen in cases of disordered eating and body dysmorphia, there is a drive for control and “perfection” usually unrelated but soon becomes expressed through food restriction. The determination to achieve a strong athletic body in male sufferers can quickly develop into a negative cycle; they reduce their dietary intake, push their bodies through punishing exercise programmes, all the time telling themselves that they are actually enjoying their new found “healthy lifestyle”. Ironically this new regimen is doing the complete opposite; preventing anabolic pathways and increasing catabolic pathways, breaking down muscle to provide energy and moving further away from their body composition goals.

A low weight and restricted energy intake is always accompanied by irrational thought processes and a louder inner voice as the eating disorder takes on an even stronger hold. As well as affecting anabolic pathways, a reduction in these sex hormones will result in low bone density; some of this may well be counteracted by the fact that the male sufferer performs a higher percentage of weight bearing exercises but damage to bone health is still a problem that needs to be highlighted when working in this field.

If energy intake and weight can be restored fairly quickly then there does not seem to be long term damage; but if it is a lengthy return to normal weight and eating, the individual may be more at risk of stress fractures and osteoporosis in later life.

So while the third point of the (triad) triangle may be missing in males, there are still symptoms to look out for:

• Low energy (although initial this will present with endless amounts of “restless” energy)
• Low mood
• Poor sleep patterns
• Increased irritability
• Withdrawal from social circle
• Loss of libido
• Lack of concentration
Male or female it is always difficult to ask for help when dealing with disordered eating but I think it is even harder in males. As wrong as it is, it is accepted by society that women generally have issues with their body image and poor relationships with food. This is not so the case for males, making this condition even more isolated, secretive and dangerous if left unaddressed.

What are your thoughts on this often sensitive area?
Have you or somebody you know experienced disordered eating within their sport?


Sharing is Caring….lets raise general awareness of an increasingly common issue within sport!

Thank you to Renee for writing this insightful blog, its certainly an area that requires much more attention, appropriate discussion and qualified support. You can also check out Renee’s previous blog; ‘Performance Scales’ ( exploring the increasing problem of disordered eating and the negative effects it can have on health.

Renee McGregor - Sports Nutritionist

The Author – Renee McGregor

Sports Nutritionist and Registered Dietitian BSc (hons) PGDIP (diet) RD PGCERT (Sportsnutr.)

Renee is Sport Dietitian with Team Bath, a keen runner and is extremely passionate about making sport nutrition practical and simple to follow. She provides advice to a range of athletes from recreational to elite; including athletes competing at both the Olympic and Commonwealth Games. She also works to support patients through the National Eating Disorders Charity, Anorexia and Bulimia Care as well as Somerset and Essex Eating Disorders Association.
Check out her website here and follow Renee here on Twitter