Dr Chuks, a specialist eating disorder doctor, shares his thoughts for International Men’s Day.
Last week’s COP26 was a good starting point. It was by no means conclusive in addressing the phenomenal environmental concerns that we are faced with — but it was a good starting point. Some leaders gathered, some climate goals were set, and some awareness was raised. The 13-day event highlighted just how easy it can be for us to ignore issues that are so urgent in their need to be addressed.
As it stands, the eating disorders service — of which I am a part of — is failing to capture the stories of many men. Such failings are not deliberate, nor do I believe they are malicious attempts to minimise men’s struggles. But they are likely symptomatic of a society ignorant of the pervasiveness of eating disorder psychopathology. The belief that eating disorders evade men, is still predominant. And, consequently, men are frequently underdiagnosed and undertreated. The need is now urgent.
“As it stands, the eating disorders service — of which I am a part of — is failing to capture the stories of many men.”
In February of this year, American clothing brand, Tommy Hilfiger, and British body activist, Jameela Jamil, launched an Exploring Body Neutrality and Body Image online course1. This has proved deeply popular amongst both women andmen. Indeed, the ever-increasing body dissatisfaction amongst men2 has led to many reaching out for such interventions.
The “fitspiration” social media movement is one of the many reasons for such body discontent. In many cases, it has led to greater pressure on men to appear more muscular and lean which has led to heightened body image concerns, compulsive exercise and dysfunctional eating3. This year’s International Men’s Day provides us with an apt opportunity to apply some fresh pressure on different aspects of men’s eating disorders care.
“This year’s International Men’s Day provides us with an apt opportunity to apply some fresh pressure on different aspects of men’s eating disorders care.”
Firstly, we can apply pressure on the research community. Currently very little research, centred around eating disorders, studies men4. This is a problem because there are some key physiological and sociocultural differences in the way men present to services. The starting point is gathering information, and the likes of Dr Russell Delderfield at the University of Bradford5, amongst many others, are engaged in such. Continued efforts in this arena will be essential to the successful management of eating disorders in men, including male-specific phenomena.
Secondly, we can apply pressure on the delivery of care itself. For example, the few men that do arrive on the doorsteps of eating disorders inpatient services are often confronted by an ill-prepared, gender-biased service. To put it bluntly, the staff are used to looking after women. Psychoeducation needs to be delivered to staff on the various nuances involved in men’s care, including the ubiquitous stigma and perverse perceptions of masculinity that exist. Written inpatient material, such as posters and handouts, along with ward activities, need to be gender-neutral to create a more male-friendly environment, thus doing away with the notion that eating disorders are experienced by women alone6.
“… we can apply pressure on the delivery of care itself. For example, the few men that do arrive on the doorsteps of eating disorders inpatient services are often confronted by an ill-prepared, gender-biased service. To put it bluntly, the staff are used to looking after women.”
In my experience, and the experience of many clinicians that I talk to, ward staff tend to be predominantly female. The eating disorders consultant, dietitian, therapists, nurses, and healthcare assistants are all more likely to be women. Now, just for the record, I do not think that this is a bad thing. In fact, there are many positives of such arithmetic. However, there are some distinctly male commonalities; and a male perspective may influence ward operations in a way that may make it more accessible to men. In my experience, male patients have benefitted from having male staff present. However, this is not to say that rapport can be assumed purely based on gender.
Thirdly, we can apply pressure on the ethnic biases that exist within the system. We cannot talk about bettering the treatment of men in the eating disorders service without discussing the treatment of men from underrepresented ethnic groups. In the case of Black men, for example, there has been a protracted period of discontent over their treatment by the mental health services in general7. The social assignment of Black bodies to an underclass is longstanding, and some of its origins are rooted in slavery. To date, such societal structures persist, often at the behest of the mass media8. As a result, a feeling of learned helplessness has emerged, where many Black individuals fail to speak up through fears of not being taken as seriously as their White counterparts9. In the eating disorders service, we must not make the mistake of failing in our duty, by running with the many twisted stereotypes of what a Black male body should look like. We must not leave any man out in the cold and void of care.
“We cannot talk about bettering the treatment of men in the eating disorders service without discussing the treatment of men from underrepresented ethnic groups.”
The best way we can celebrate men is to take their mental health seriously. We must push back against the status quo. We ought to engage in eating disorders research more actively, more readily fight to improve the delivery of eating disorders care and more doggedly dismantle antiquated stereotypes of the male body.
Dr Chuks is a London-based specialty doctor in eating disorders. He is a regular social media commentator and podcast guest, and is frequently asked for his perspectives of eating disorders and race-related issues. His work has been featured in the NHS Race and Health Observatory, Patient UK and the BBC. He is a member of the Association of Black Psychiatrists. In his spare time, he loves to watch and play football, play drums, as well as travel with his wife.