An actor known for his macho presence and muscular physique, Sylvester Stallone does not fit the stereotype of a person with an eating disorder. It makes his recent disclosure that he had experienced one all the more important.
In an interview with the New York Times tied to the release of his memoir “The Steps,” Stallone revealed that while filming “Rambo” and the “Rocky” sequels, he had “an obsession” with developing a “feral and aggressive” build. “It got to the point where I became bulimic. … I got down to 2.6 percent body fat when I was doing ‘Rocky III,’ and I couldn’t hold anything down,” he told the Times.
Bulimia nervosa is an eating disorder characterized by episodes of bingeing (consuming a large amount of food) followed by purging (through methods such as vomiting or taking laxatives). Stallone also shared that he turned to steroids to maintain his frame.
Stallone’s acknowledgment “challenges some of our society’s most persistent stereotypes that eating disorders primarily affect women or that someone with an eating disorder needs to look visibly unwell,” said Riley Nickols, a counseling and sport psychologist and clinical adviser for the National Eating Disorders Association.
It’s a powerful reminder that “men live in the same visual-obsessed world as the rest of us” and are subjected to similarly unattainable aesthetic ideals, said Erin Parks, a clinical psychologist and chief clinical officer and co-founder of online eating disorder treatment platform Equip.
Contrary to popular belief, eating disorders aren’t rare in men. It’s estimated that at least 1 in 3 people with an eating disorder — such as anorexia nervosa, bulimia nervosa or binge eating disorder — is male, which translates to millions of men affected in the United States. While global data in adolescents shows that the prevalence of eating disorders is higher in females, the rate is rising faster in males, and yet they still often go undiagnosed.
Stallone’s revelations also reflect the danger in an eating disorder that goes untreated: He pointed to both its monopolization of his thoughts and the “terrible toll” it took on his body.
Few aspects of physical and mental health are left unharmed by the persistent malnourishment of an eating disorder — but the biggest concerns are the potential risks of heart issues and suicide, Parks said. Some research suggests that when compared with women, men with eating disorders are more likely to be hospitalized and face a greater risk of premature death.
Below, experts explain how eating disorders in men commonly fly under the radar, why they pose a growing threat for this group and the unique considerations involved in treatment.
How eating disorders in men can evade diagnosis and care
Not all men with an eating disorder express certain hallmark symptoms, such as aiming to be slim or fearing weight gain, Parks said: “Instead, we hear them talking about body recomposition, about getting a low-percent body fat.”
Some might wish to get leaner by gaining muscle, Nickols said. This can be a manifestation of muscle dysmorphia, sometimes called “bigorexia.” “It’s a body image context of concern where an individual feels as though they are weaker than how they present,” said Brian Pollack, founder and clinical director of Hilltop Behavioral Health, a specialty eating disorder practice in Summit, New Jersey. In this mindset, a person might engage in disordered eating such as dialing up protein and restricting all other nutrients. Or they might excessively exercise or use supplements like creatine or steroids, Pollack said.
None of these behaviors may register as problematic — in fact, society often normalizes or even idealizes them in men as a version of dedication to their bodies, Nickols said. Compulsive exercise in particular “gets labeled as discipline,” Parks said. We see a man working hard at the gym for three hours rather than realizing it’s potentially problematic that he choose the gym over, for example, celebrating a friend’s birthday, she said.
Even the men who recognize that they’re unhappy may not tie those emotions to their restrictive eating or excessive exercise, Parks said, because of the pervasive misconception that eating disorders just affect women. And those who do suspect they have disordered eating often don’t seek care because of the stigma, Pollack said.
That can set off a vicious cycle: Clinicians don’t see many men with eating disorders, so they may not think to screen for them. Screening tools also rely on questions that may be skewed toward women’s experiences (like whether they’ve desired a “flat” or “empty” stomach) while failing to account for predominantly male-oriented symptoms such as obsessing over muscle or macros.
Men who get a diagnosis despite the odds are then often confronted with treatment centers filled with women, Parks said, at which they might feel out of place.
Why the risk for eating disorders in men may be higher than ever
Pollack said social media has created an unattainable male ideal of defined musculature and bone structure. “I’m getting calls about people trying to cut their faces to chisel their jaws or hitting themselves with hammers,” he said. “We’re seeing boys going to extremes with testosterone and human growth hormone.”
Despite the danger in such behaviors, they’ve been packaged as trends to follow: Bone smashing, looksmaxxing, cutting and bulking — these are all “euphemisms for things that if presented in a different context, everyone would think of as disordered,” Parks said.
Social media also exposes men to an extraordinary volume of appearance-based content, Nickols said. Decades ago, they might see the male aesthetic ideal in movies or ads, but now, it’s multiple times a day, every day. The same problem extends to lifestyle advice: Men can now be constantly bombarded by tips for ramping up protein intake or pushing their bodies at the gym.
The growing availability of GLP-1 drugs can play a role, too. Having access doesn’t necessarily raise a person’s risk for an eating disorder, much like access to alcohol doesn’t always lead to a substance use disorder, Parks said. But in people who are predisposed to developing an eating disorder whether because of genetics or environment, the quick weight loss and caloric deficit offered by a GLP-1 may trigger that underlying susceptibility, Parks said.
Treating eating disorders in men
The ideal treatment is tailored to the individual, since eating disorders can manifest in many ways across genders. Men and women can both benefit from working with a team — for instance, a physician, registered dietitian and mental health provider with a specialty in eating disorders, Nickols said. There are also virtual group therapy programs geared toward men or that include people of all genders to help fill the gap created by predominantly female inpatient programs.
The cornerstone of treatment is enhanced cognitive behavioral therapy, which is designed to be adapted for different eating disorders and populations. It involves identifying and then challenging the behaviors driving disordered thinking. Pollack recalled working with a man who was fighting a constant desire to bulk up and revealed that he often looked in the mirror, so Pollack had him note on his phone each time he did so. After surpassing 100 times on day one, the man was struck with the realization of how detrimental the habit had become.
Therapists often tackle many of a person’s disordered behaviors head-on — for instance, finding ways to encourage diet stability or limit hours of exercise, Pollack said. Parallel care with a physician can also be important for addressing the physical fallout of eating disorders in men, such as low testosterone or vitamin D levels.
Another portion of therapy involves breaking down how a person makes sense of their struggles, Nickols said, and to what extent shame, stigma, loneliness or other negative emotions might fuel them. Pollack said he often asks questions of men with their gendered experience of the world in mind: “What stopped you from feeling strong?” or “When did you go from acting physically in the world to acting on your body?” Understanding the foundation of a person’s disordered thinking can help a therapist better tailor interventions.
Ultimately, care can take a lot of different paths, but the most important thing for men is to seek it out. The National Eating Disorders Association maintains a directory of clinicians who offer treatment both virtually and in person. “Men can be quick to minimize symptoms of an eating disorder,” Parks said, even when they’re serious. “My advice to patients is, ‘Do not talk yourself into thinking you aren’t sick enough.’”
If you or someone you know is struggling with an eating disorder, help is available. You can contact the Alliance for Eating Disorders’s helpline at 1-866-662-1235.
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