Research explores why so few men with eating, exercise and body image care problems seek treatment

This year's International Men's Day takes the theme of 'Positive male role models' but is a lack of representation in some healthcare resources putting men off seeking care when they need it? 

Role models can be powerful representatives in spaces that typically leave people feeling stigmatised, and their presence may have the potential to reduce this stigma. 

We often see this use of representative role models across men's mental health platforms, as campaigns commonly involve a stereotypically masculine man sharing that 'it's okay to talk about mental health', or something along those lines. Opinions as to whether we need to move forward from this are divided, but I believe there's at least one area where representation still needs consideration: Healthcare services for eating, exercise, and body image psychopathology (EEBIP e.g. eating disorders, body dysmorphic disorder, and sub-clinical variants).

The primary aim of my PhD research is to investigate why we see such a disparity between the numbers of men with EEBIP in the community compared to the number of men accessing EEBIP care.  According to a review of studies and mass media, men comprise around 25 per cent of community eating disorder populations yet only 10 per cent of clinical samples.

EEBIP seen as a 'woman's issue'

An initial systematic review of barriers and facilitators to men's EEBIP help-seeking found several studies where men said that the EEBIP healthcare 'system' was not set up for them, and the information and resources contained within it felt 'feminine', 'unwelcoming', and reinforced stigmatising societal ideas that EEBIP is a 'woman's issue' that men should not be associated with. 

These papers did not explore what it was within the 'system', and the documents it uses, that was contributing to these views. My supervisors and I felt that investigating the content of the policy and documentation of EEBIP healthcare organisations (services and charities) would highlight some reasons why men may feel that way, and spotlight areas to develop. 

We, therefore, undertook a content analysis of 86 separate documents from 15 UK-based eating disorder services and three UK-wide EEBIP charities. The documents collected were: 1) outreach documents (e.g. leaflets/posters); 2) home and symptom listing webpages; 3) referral policies (i.e. inclusion and exclusion criteria); 4) patient welcome packs (i.e. information given upon admission).

Analysis of documents 

When looking at referral policy and patient welcome pack documents, we found the information written was mostly inclusive of men, and of muscularity-oriented symptoms (commonly associated with men due to masculine body ideals). 

We found that these documents and resources were written in a manner that did not actively exclude men (i.e. no policy stated that men or males should be excluded) and was in accordance with evidence of the type of language that engages men. 

However, when analysing documents such as leaflets and posters, and webpages, some concerns were raised. For example, 'loss of menstrual cycle' was the most common physical symptom listed on webpages, potentially excluding men who do not menstruate (some websites instead said 'can affect sexual hormones [e.g. loss of menstrual cycle]' which is more inclusive). 

Additionally, no outreach resources mentioned muscularity-oriented concerns, which may limit recognition of behaviours that have shown many similar symptoms and health risks to the more 'typical' forms of EEBIP. As mentioned, muscularity-oriented concerns are often associated with men, but these concerns are seen across other genders. 

Analysis of images

The images contained across the documents were also analysed. Due to the interpretation of imagery, these were coded separately by two researchers and disagreements were discussed with the wider research team to reduce bias. When interpreting the images overall, 53.9 per cent of them were seen as gender neutral; however, of the images that were viewed as gendered, we reported that 82.5 per cent were feminine. 

When exploring further, looking at true life photographs of people, we found that 73.2 per cent of photographs were of feminine presenting individuals, compared to 22.3 per cent masculine presenting. Strangely, the only area of imagery that leaned more towards the masculine were illustrations of people, where 54 per cent were masculine presenting, compared to 34.9 per cent feminine presenting.

The image analysis brings me back to the theme for the 2024 International Men's Day. According to our analysis, there were nearly as many illustrations of masculine presenting people as there were true life images (34 vs 50, respectively). My concern about the reduced number of true-life photographs of masculine presenting people is that this may imply that men are less willing to show their face in association with EEBIP healthcare (i.e. men wishing to hide their experience with or involvement in a stigmatised 'woman's illness') and, as such, masculine representation must come in the form of illustration. 

This messaging may be emphasised further by the high number of feminine presenting true-life photos (164; over three times as many) and reduced number of feminine presenting illustrations (22).

Reinforcing societal views?

Overall, the lack of non-illustrated masculine 'presence', coupled with our concerns with outreach and website information, may represent the underpinning reasons why men report feeling 'unwelcome' and why they feel these healthcare organisations may be reinforcing societal views of EEBIP as a 'women's issue'. More research is needed to fully understand the influence of this imagery and information, but these results spotlight some key areas.

To conclude, if representative role models play an important part in helping groups feel welcome in spaces, then more true-life images of men and masculine presenting people in EEBIP healthcare resources are surely needed and may help men access the support they need. 

Author biography 

George Mycock is a PhD researcher at the University of Worcester exploring men's access to care for eating, exercise, and body image psychopathology (EEBIP). He is also the founder of MyoMinds, a mental health organisation that focuses on expanding research and awareness of exerciser mental health (e.g. EEBIP). George is also a lived experience consultant where he uses his experience of muscularity-oriented EEBIP to assist with various projects.