It took Matt Wetsel, 26, more than a month to work up the courage to try group therapy for anorexia, the eating disorder he says consumed two years of his life. A college student at the time, Matt said he would plan to attend a meeting, become overwhelmed and would shy away.
When Wetsel finally steeled himself enough to attend, a woman stopped him and asked if he needed help. Unable to explain himself, he handed her a flier promoting the group. The woman disappeared, returning a few minutes later with the news that he could not take part. The group, it seemed, was for women only.
"I have never felt so defeated," Wetsel said in a speech on Capitol Hill last spring.
Eating disorders have long been believed to be a female issue. The National Institute of Health estimates that girls are two-and-a-half times more likely to have an eating disorder than boys, while groups like the nonprofit National Association of Anorexia Nervosa and Associated Disorders state that women are "much more likely than men to develop an eating disorder." Yet a growing body of evidence suggests that such numbers and statements may not truly reflect the large number of boys and men with eating disorders -- be it anorexia, bulimia, binge eating or the broader category of "eating disorders not otherwise specified."
Earlier this month, the BBC reported that hospital admissions for men with eating disorders increased by 66 percent in the last decade in the U.K. In the U.S., a recent study in the Archives of General Psychiatry found that binge eating and bulimia were indeed more prevalent among adolescent girls than boys, but that the prevalence of anorexia nervosa was exactly the same.
"The one million dollar question is what this means," said Daniel Le Grange, Ph.D, director of the eating disorders program at The University of Chicago and an author of that study.
"We don't know what happens to them, we don't know if [the prevalence] has changed or increased," he continued. "We don't know if the fact that we tend see more girls in a clinical realm means that boys tend to recover more readily on their own; we don't know why they don't come in for treatment more. We don't know."
Sam Thomas, founder of the U.K.-based charity Men Get Eating Disorders Too, echoed the sentiment, saying that the recent findings raise questions about whether eating disorders are up in earnest or if more practitioners are simply recognizing the symptoms.
"We suspect that these new findings are only the tip of the iceberg, as we know that there is still a large majority of male sufferers who struggle to get the help they need, due to the stigma and stereotypical gender assumptions still made about eating disorders," Thomas told The Huffington Post.
For his part, Wetsel -- who has been in recovery for more than five years and has become an eating disorder activist, running the blog ...Until Eating Disorders Are No More -- has written that his recovery mandated he fit himself into a "culture mostly designed, tailored and intended for females." Many of the books he read referenced women only, using the pronoun "she."
Wetsel said he developed a thick skin about such gender issues, but imagines that other men struggle as well, particularly in light of the consternation he faced when telling people about his disorder.
"I want to say, 'Well, what should a recovered anorexic look like? Should I be female? Should I be emaciated?'" he said. "If you saw me around town I'd probably be wearing a band shirt and some shorts cut off at the knee. You'd probably see a few tattoos. I guess no one's expecting someone by that description to have a story about being anorexic."
Which could be a reason why men are less likely to seek treatment: The people around them, including their practitioners, may not recognize the symptoms and encourage them to get help.
"It often doesn't cross parents' or doctors' minds, because the public is so schooled to think that eating disorders are a female thing only," said Le Grange of the University of Chicago. He estimates that generally, for every 10 cases they see in his program, one or two is a boy. Last week, however, he saw four cases alone.
What is needed next, according to Le Grange, are further studies looking at the prevalence and impact of eating disorders in boys and men to better understand any differences in treatment strategies, as well as to assess what happens to boys with eating disorders in the long term.
In the meantime, people like Wetsel -- who was eventually welcomed into the group meetings at his university and said they were integral to his recovery -- are speaking up.
"This is serious stuff. There isn't any room for people to treat eating disorders as anything less than a life-threatening illness," he said. "It's bad enough and hard enough for women to get help and be taken seriously, and men have to deal with an additional layer of stigma that supposedly challenges the way people see their masculinity and sexuality."