The growing popularity of weight-loss medications like GLP-1s has triggered abroad reevaluation of the driving forces behind our relationship with food. As a result, researchers are also taking a fresh look at the neurological and psychological drivers of eating disorders — including binge-spectrum eating disorders, which affect approximately 2.8 million adults in the United States.
Ross Sonnenblick , a doctoral candidate in the Department of Psychological and Brain Sciences, recently published a paper in Psychology of Men & Masculinities detailing some of the reasons why men are less likely to seek treatment for eating disorders. He sat down with the Drexel News Blog to share some of his findings and discuss the effects of GLP-1s on society and eating disorder research.
What made you decide to do research on the difference in binge-spectrum eating disorders between men and women?
Men account for one quarter of all adults with eating disorders but are substantially less likely than women to seek treatment for them (or for most other health conditions). I wanted to draw attention to the experiences of men with eating disorders, with the eventual goal of encouraging more men to seek psychological treatment for them.
In this study, I found that men with binge-spectrum eating disorders who enrolled in a clinical trial tended to have higher body mass indices (BMIs) and levels of impulsivity. The higher BMIs point to a societal factor influencing who seeks therapy: Because society stigmatizes overweight/obesity more strongly in women than in men, men might not feel as compelled to “do something about their weight” — in this case, seek therapy for an eating disorder — until they weigh comparatively more.
The higher level of impulsivity suggests that therapy for binge-spectrum eating disorders in men might need to strengthen its focus on providing alternative methods of dealing with action impulses. That way, when men are at high risk of making impulsive decisions, they will be equipped to do something other than turn to food.
What was the greatest factor you found that prevented men from seeking psychological treatment for their binge-spectrum eating disorders?
Simply put, men did not recognize that they had eating disorders. I conducted in-depth interviews with 15 men who met full diagnostic criteria for either bulimia nervosa or binge-eating disorder, and only one of those men had even heard of binge-eating disorder. These men knew that they struggled with their eating, but they did not know that they had eating disorders, and they certainly did not know that therapy could help them to recover.
Knowledge is power, and once these men found out that they had diagnosable conditions for which evidence-based treatments exist, most of them expressed interest in trying those treatments out for themselves.
How is one able to tell the difference between overeating and binge-eating and what are some of the symptoms?
Most people overeat sometimes. They eat a bit more than they intended, or they go for extra helpings of mashed potatoes and pumpkin pie on Thanksgiving. After that, they shrug and move on. Most people do not experience binge eating.
People who binge-eat describe losing control over their eating, feeling unable to stop eating once they start, or even giving up on trying to control their eating at all. They often eat until they feel uncomfortably full, or they eat even when they are not physically hungry. Afterward, people who experience binge eating often feel guilty, depressed, or angry at themselves.
The definition of binge-eating disorder requires that a person experience an average of one binge episode per week for three months, and the best estimates suggest that binge-eating disorder affects about 1-2% of all adults in the United States at any given point in time. Another 7% of adults in the United States sometimes have binge-eating episodes.
What was the biggest surprise that you had in your findings?
For me, the biggest surprise was also the biggest cause for hope. I had suspected that men might not recognize their eating disorders and that they might downplay the seriousness of their conditions. I had not, however, anticipated how enthusiastically men would support other men seeking therapy. In fact, the men whom I interviewed explicitly and emphatically celebrated men for seeking therapy for their eating disorders. They said that it takes real courage for men to go to therapy, and they encouraged other men to take that brave step toward improving their mental health.
How have GLP-1 medications brought greater awareness to eating disorders?
At present, around one in eight U.S. adults has used a GLP-1 medication, and health professionals expect that figure to increase. The rise of GLP-1 medications has accentuated two key points with opposite implications for society’s collective eating-disorder risk:
- Many of the factors influencing people’s body sizes and relationships with food have a biological basis. This fact could bring newfound compassion and understanding to people who have long struggled with their weight and eating. Emerging research also suggests that these medications might meaningfully reduce binge eating among adults with binge-spectrum eating disorders. These medications could have a profoundly positive impact on the population’s cardiometabolic health — if they are made cheaply available to everyone who could benefit from them.
- Society is still obsessed with people’s physical appearance. As people lose weight, they might find that they cannot lose enough weight to alleviate their body dissatisfaction. Already, people with eating disorders have misused these medications. Moreover, with unequal access to these medications, people who do not take them might experience intensified body dissatisfaction as they compare themselves to people who have lost weight with the help of these medications. In some cases, that heightened body dissatisfaction could lead to eating disorders.
In short, GLP-1 medications might do a lot of good, or they might not. They will cause lots of people to lose lots of weight, and their meteoric rise to societal prominence has unquestionably brought greater awareness to eating. The catch is that bringing greater awareness to eating sometimes results in eating disorders.
What factors contribute to binge-spectrum eating disorder?
People with bulimia nervosa and binge-eating disorder, the two main binge-spectrum eating disorders, often try to lose weight by restricting their eating. Once they reach a certain level of hunger, their physiological drive to survive kicks in and overwhelms their effort to eat less. After binge-eating episodes, they often double down on their attempts to restrict their eating, thus perpetuating a vicious cycle in which dietary restriction leads to binge-eating episodes.
People also use binge eating to regulate their emotions. Some people say that binge eating numbs them, distracts them (for example, from anxiety, depression, or traumatic memories), or gives them a sense of pleasure that they lack in their daily lives. Everyone needs to regulate their emotions and find pleasure somehow; unless they identify and believe in alternatives, they will keep resorting to binge eating.
What do you see as the most important next steps for research on eating disorders in men?
Existing assessments to detect eating disorders were developed for women and overlook or neglect symptoms of disordered eating that are more common in men. My research team is currently developing a brief screening tool that focuses on men’s symptoms and uses language geared toward men. We hope to deploy this screening tool in primary-care clinics, at Veteran’s Affairs facilities, and wherever else men receive their health care. We believe that if men screen positive for disordered eating in the presence of medical providers whom they already trust, those providers will have the opportunity to engage the men in conversations about effective paths toward recovery. Many of those paths include psychological treatment.
Reporters interested in speaking with Sonnenblick should contact Mike Tuberosa at mt85@drexel.edu.
