Disordered Eating in Men: When Healthy Eating Stops Being Healthy
By Dr Bradley Powell, Clinical Psychologist and co-founder of Regal Private Therapy Practice
Disordered eating describes patterns of eating, exercise and thinking about food that do not meet the threshold for a diagnosed eating disorder but still narrow someone's life. In men it often looks like discipline: strict rules, tracked macros, training through injury. The clearest warning sign is usually not what you eat, but how much freedom you have lost around it.
I have spent much of my career working with men who care a great deal about training hard, eating well and looking a certain way. I care about those things myself. What I want to set out here is where that starts to tip, how you would notice, and what you can do about it.
What is disordered eating?
Disordered eating is a broad term for eating, exercise and body-image patterns that cause distress or restriction without necessarily meeting diagnostic criteria for a specific eating disorder. It sits on a continuum. At one end is ordinary variation in how we all eat. At the other are the diagnoses NICE covers in its guideline on eating disorders (NG69): anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorder.
The line between the two is genuinely blurry, and that is part of the problem. NICE is explicit that professionals should not use single measures such as BMI or how long someone has been unwell to decide whether to offer treatment for an eating disorder. If a clinical guideline says a number is not the test, it is worth applying the same logic to yourself. You do not have to look unwell, or have been struggling for years, for this to be worth taking seriously.
The NHS is clear that anyone can develop an eating disorder, and that with treatment most people recover.
What does a healthy relationship with food actually look like?
A healthy relationship with food is one where you eat consistently, eat a broad range of foods, and food does not take up an excessive amount of your thinking or interfere with your life.
The first thing I would look at is the timeline of someone's day. Generally, our bodies and brains need regular fuel. For many people that means breakfast, lunch and dinner, with snacks when needed, rather than going for long stretches without eating. This is not a fringe idea. Establishing a pattern of regular eating is a core component of the cognitive behavioural treatments used for eating disorders.
Some people skip meals or delay eating, and that alone does not mean someone has a difficult relationship with food. The problem is that difficulties creep in slowly. It might start with skipping breakfast, and gradually develop into more rigid rules about when, what and how much you are allowed to eat.
A healthy relationship with food also involves flexibility. If entire food groups are off limits, or certain foods are forbidden despite you wanting them, it is worth asking why. There is a real difference between choosing not to eat something and feeling you are not allowed to.
Another thing to consider is whether you compensate. You might have rules like, "I can only eat this if I train today", or feel you have to burn off something you have eaten. If eating certain foods leads to guilt followed by restriction the next day, that is a signal.
It is also worth thinking about the relationship between your emotions and your eating. Some people eat significantly more when they feel low, stressed or anxious. Others lose their appetite or deliberately eat less. Our eating naturally fluctuates. But if food or restriction has become one of your main ways of managing difficult emotions, that is worth paying attention to.
A healthy relationship with food is not about having the perfect diet. It is about consistency, balance and flexibility. You should generally be able to eat a broad range of foods, enjoy meals with other people, respond to hunger, and sometimes eat something simply because you want to, without significant guilt.
The question I would ask is not, "Am I eating healthily?" It is, "How much freedom do I have around food?" If your diet looks excellent on paper but maintaining it requires rigid rules, constant planning, anxiety and avoidance, that may not be a healthy relationship with food.
How do you know if your relationship with food is slipping?
You usually notice it in how much room food is taking up, not in what you weigh. These changes happen slowly. Almost nobody wakes up one morning and suddenly has a very difficult relationship with food.
It often begins with something entirely reasonable. "I just want to eat a bit healthier." "I want to lose a little weight." "I want to look leaner." Then it becomes, "I'll cut this out too." Before long there is more weight loss, more thinking about food, and more restrictive behaviour. The rules that were supposed to make you healthier start running more of your life.
This happens across restriction, overeating, and more orthorexic patterns where someone becomes intensely focused on eating in a way they consider clean or optimal. The common denominator is a loss of freedom.
Signs worth paying attention to
You are spending increasing amounts of time thinking about food, calories, macros or your next meal.
More foods or food groups are becoming off limits.
You feel guilty or anxious after eating certain foods.
You restrict, then experience intense urges to eat that feel hard to control.
You compensate for eating through exercise or restriction afterwards.
You are increasingly eating in response to emotions, or eating less when distressed.
You are avoiding restaurants, holidays or social plans because you cannot control the food.
Your mood drops significantly when you cannot follow your normal eating or training routine.
Your concentration or energy is suffering.
Your life is gradually organising itself around food, training or how your body looks.
Not everyone experiences all of these, and recognising two or three does not mean you have an eating disorder. It does mean it is worth talking to someone.
What is food noise, and what does it tell you?
Food noise is the term people use for persistent, intrusive thinking about food that runs in the background of the day. It has entered common use largely through conversations about weight-loss medication, but in my clinical work it more often shows up as a consequence of restriction rather than something separate from it.
This matters, because the instinctive response to constant thoughts about food is usually to tighten the rules further. That tends to make it louder. If you decide you can never have chocolate again, you will very likely start thinking about chocolate more. Eventually you eat some, feel guilty, and compensate by restricting the following day. The cycle reinforces itself.
That pattern is well described in the clinical literature. Rigid dietary restraint is understood as one of the mechanisms that maintains eating difficulties over time, which is why reducing restriction, rather than increasing it, is a core target of evidence-based treatment.
So if food occupies a great deal of mental space, the useful question is not "how do I silence this?" but "what am I currently not allowing myself?"
How do body image and food problems reinforce each other?
They feed each other directly. When someone follows strict food rules, weighs frequently, checks their appearance and trains to a rigid schedule, their self-worth gradually becomes dependent on whether they are meeting those rules.
It becomes: if I stick to my plan, I feel good about myself. If I break a rule, I feel bad about myself. If I train, I feel good. If I miss a session, I feel guilty. You are putting all your eggs in one basket.
This is not just an observation from the clinic room. The leading cognitive behavioural model of eating disorders places exactly this at the centre: a system of self-evaluation in which self-worth is judged predominantly in terms of shape, weight and the ability to control them, maintained by factors including perfectionism, low self-esteem and difficulty tolerating strong emotions.
It is incredibly difficult to sustain, because there will always be someone leaner. You get leaner, and then decide you need to be leaner still. You train five times, then feel guilty about the sixth session you missed. You never quite feel like you are doing enough.
There is far more to your identity than your body. Your relationships, your work, your interests, your values and how you treat people are all part of who you are. The more we broaden someone's sense of self into those areas, the less power food and appearance have over how they feel on any given day.
Ironically, focusing harder on your appearance can maintain a negative body image. If you already feel badly about your body, you are more likely to look in the mirror critically and search for evidence that something is wrong. You then restrict or train harder to fix it, which makes you monitor your appearance more closely. Negative body image leads to more checking, which gives you more opportunities to criticise what you see.
Comparison is a large part of this for men. If you train regularly, you are probably not comparing yourself with the average man. You are comparing yourself with the leanest men in your gym, or with selected images online. When you look at someone else, you notice what you see as their strengths. You do not stand there itemising their flaws. Yet in the mirror, you may do exactly that.
Body image is exactly that: an image, a perception, not an objective measurement of how you look. If your mind is trained to search for flaws, changing your body does not necessarily change the mindset. You may get leaner and still find something else that needs fixing.
Why the scales and the mirror are unreliable guides
Both become problems when someone uses them to decide how to feel about themselves and what they are allowed to eat that day.
With weighing, someone steps on the scales each morning. If the number is down, they feel good. If it is up, they think, "I need to eat less today." The difficulty is that a single reading tells you very little about whether body fat has changed. Water makes up roughly 60% of adult body weight, varying with sex, age, activity and body composition, and that total is in constant flux through normal physiological processes. Weight moves for reasons that have nothing to do with fat.
If someone is monitoring weight for a legitimate health or fitness goal, the pattern over several weeks tells you far more than any individual number. But if weighing is causing distress, or driving how you eat that day, stepping away from the scales entirely is often the more useful option, and that is a conversation worth having with a professional rather than resolving alone.
The mirror has the same problem. Your body genuinely looks different at different points in the day. You may look leaner in the morning. By the evening you have eaten and drunk and your abdomen may be fuller. That is what a normally fed and hydrated body does. It is not fat gain.
There is also a psychological cost to checking. The more you check, the more chances you give yourself to find something you dislike. Checking is meant to reassure. It usually maintains the anxiety instead.
Social media compounds it. Fitness models and influencers are photographed under optimal conditions: after manipulating food and fluid, after training, with good lighting, posing and tanning. The image you see may have been chosen from dozens and edited afterwards. You are comparing yourself standing in your bathroom at the end of a working day with somebody else's carefully prepared moment. They do not look like that all day either.
Look in the mirror when you get ready. That is normal. Repeatedly checking your stomach, examining yourself from different angles or flexing throughout the day cannot tell you whether anything has meaningfully changed.
The scales and the mirror are just sources of information. The problem is when we let them determine our mood, our self-worth, or what we are allowed to eat.
Is eating the same meals every day actually healthy?
Eating the same few meals every day is not inherently harmful, but a narrow and repetitive diet carries both nutritional and psychological costs. There is a huge amount of content online suggesting that if you want to get lean you should simply eat the same thing daily. The classic version is chicken, rice and broccoli.
The problem is that social media rarely comes with caveats. What suits one person may not suit another.
Chicken, rice and broccoli is not unhealthy. The issue arises when someone's overall diet becomes extremely narrow. A varied diet provides a wider range of nutrients and fibre. Depending on what you are excluding, continually cutting out foods and food groups can increase the risk of nutritional inadequacy.
Then there is the psychological side. Eat the same restrictive meals every day and eventually you will become bored and start thinking more about everything you are not allowing yourself.
This is close to what people mean when they talk about orthorexia: an intense preoccupation with eating in a way that is clean, pure or optimal. It is worth being precise here. Orthorexia is widely used in public conversation, but it is not currently a recognised diagnosis in DSM-5-TR or ICD-11, there is no agreed set of diagnostic criteria, and the evidence base is still developing. That does not mean the distress is not real. It means the label is a description rather than a diagnosis, and the useful clinical question is the same one as everywhere else in this article: how much of your life is this taking up?
A regimen might work for a limited season. The honest question is whether you could realistically and happily eat that way across the year. This is where yo-yo patterns come from. Someone becomes very strict before summer, gets lean, cannot sustain it, abandons the plan, and eventually returns to another period of restriction.
For most people the more sustainable goal is a way of eating that supports training while leaving room for a restaurant, a dessert, a holiday, and then returning to normal without guilt or compensation.
Can under-eating actually damage your training?
Yes, and this is the part men tend to find most persuasive. If you are chronically under-fuelling, your performance and recovery can decline even while your appearance is improving.
This is well established in sports medicine. The International Olympic Committee's 2023 consensus statement on Relative Energy Deficiency in Sport describes a syndrome of health and performance problems in both male and female athletes exposed to low energy availability, meaning inadequate energy intake relative to the demands of training. The 2023 update specifically highlights emerging evidence on the role of inadequate carbohydrate availability, and on the interplay between low energy availability and mental health.
I learned a version of this myself. I was training hard before my stag do, eating in a deficit, and had cut my carbohydrate intake right down because I assumed that would get me leaner. I then started working with a PT who gave me a plan containing far more food than I expected. I remember being genuinely shocked at how much I was being told to eat. I ended up in some of the best shape of my life, in a much healthier way, with more energy and a varied diet. Eating less is not automatically better.
Food is also central to our lives, and it is deeply social. If maintaining your physique means you cannot eat with friends, cannot go for dinner spontaneously, cannot enjoy a holiday or cannot concentrate at work, it is worth asking what that version of health is costing you.
When someone develops a difficult relationship with food, their world tends to get small. Part of recovery is usually making it bigger again. The more meaning you draw from relationships, work and interests, the less psychological space food and appearance need to occupy.
Someone can genuinely believe they are getting healthier because they are getting leaner, while their energy, training, social life and wellbeing all deteriorate at the same time. Appearance and the number on the scales should not be your only measures of whether something is working.
What is bigorexia?
Bigorexia is the common term for muscle dysmorphia, a preoccupation with the belief that your body is insufficiently muscular or lean, even when others see you as very muscular. It is recognised in DSM-5-TR and ICD-11 as a specifier of body dysmorphic disorder rather than as a stand-alone diagnosis.
It is particularly hard to spot in men, because many of the behaviours involved are socially rewarded. Going to the gym, eating enough protein and wanting to build muscle are not problems in themselves. The issue is when they become rigid and compulsive and start controlling someone's life.
Someone might train through injury, feel significant anxiety if they miss a session, organise their day around eating and training, constantly compare their physique with other men, check themselves repeatedly in mirrors, or avoid situations where their body will be visible. They may look objectively muscular and still see themselves as too small. The internal critic is loud.
That is why the behaviour alone is not the best indicator. The better questions are: how much mental space is this taking up, how distressed are you by your body, how much freedom have you lost, and what is it costing you elsewhere in your life?
NICE guidance on body dysmorphic disorder (CG31) recommends cognitive behavioural therapy including exposure and response prevention, addressing the key features of BDD, for adults with mild functional impairment, with more intensive treatment or an SSRI considered at higher levels of impairment.
Why do eating disorders in men go unnoticed?
Because the behaviours are often praised rather than questioned. I previously led one of the few dedicated male eating disorder support groups in London, and how hard it can be for men to recognise the problem and reach support was one of the clearest things to come out of it.
First, a man may genuinely not see a problem. Someone loses weight, becomes very lean, trains every day and is rigidly disciplined with food, and people congratulate him. That makes it much harder to notice when discipline has crossed into something harmful.
Second, there is still real shame and stigma. Eating difficulties have historically been stereotyped as a female problem, despite the fact that men experience them too. Saying "I'm struggling with food", "I'm scared of gaining weight" or "I don't like my body" can feel exposing.
Third, the presentation itself can differ. Research on eating disorders in men notes that men are less likely to use some of the compensatory behaviours the classic clinical picture is built around, and more likely to compensate through exercise, which is one reason symptoms get missed by the people around them and sometimes by professionals.
Men also tend to be less likely to talk openly about how they are feeling in general. Even as a Clinical Psychologist, I recognise that opening up about something you are struggling with is difficult. It is hard for anyone. There are particular cultural barriers for men.
One analogy I use with male clients is the gym. If you wanted the best physical results, you might get a PT, a coach or join a class. You would not see that as weakness. Psychological support works the same way. If you want to improve your mental fitness, you work with someone who understands it and who becomes another member of your team.
How do you get help?
The first step is usually the hardest one: saying it out loud to somebody.
That might be a friend, a partner or a family member. For men in particular, I think it is worth choosing that person carefully. Within some friendship groups and fitness communities, behaviours that represent a genuinely difficult relationship with food have become normalised. If everybody around you is tracking obsessively, cutting for months and talking negatively about their bodies, you may say what is happening and simply hear, "That's normal, mate." Sometimes it helps to speak to someone slightly outside that environment.
If training is part of the picture, you could also speak openly to a good coach. Tell them, "I'm thinking about food all the time", or "This plan is taking over my life." A good coach should recognise that your overall health matters more than a particular body-fat percentage.
Professionally, your GP is a sensible first point of contact, and the NHS route is the one most people should start with. NICE recommends that when an eating disorder is suspected after initial assessment, the person is referred promptly to a community-based, age-appropriate eating disorder service.
If you are seeking psychological therapy privately, work with an appropriately qualified and regulated clinician: an HCPC-registered Clinical Psychologist, or a BABCP-accredited therapist with relevant experience in eating difficulties. You want somebody who understands not simply what you are eating, but what is keeping the problem going. That might include perfectionism, body checking, avoidance, rigid rules, compensatory exercise, self-esteem, or how you respond to difficult emotions.
Support with disordered eating and body image at Regal Private Therapy Practice
At Regal Private Therapy Practice we work with adults experiencing difficulties with food, body image and exercise, using approaches recommended in national guidance, including cognitive behavioural therapy and acceptance and commitment therapy. I have a particular clinical interest in men's mental health, body image and the relationship between psychological wellbeing and physical fitness.
Assessment starts with understanding what is maintaining the problem for you specifically, rather than only what you are eating. We see clients in person in Marylebone and online across the UK.
Read more about our adult therapy service today.
If you are currently very unwell, or your physical health is affected, specialist NHS eating disorder services are the right route and we will say so.
If you need support now
If you are struggling to cope or worried about your safety, help is available today. Contact your GP, or call 111 and select the mental health option. Samaritans are available 24 hours a day on 116 123. In an emergency, call 999 or go to your nearest A&E.
Beat, the UK's eating disorder charity, runs a free helpline on 0808 801 0677 (0808 801 0432 in Scotland), with web chat and email support. Check current opening hours at beateatingdisorders.org.uk.
Frequently asked questions
What is disordered eating?
Disordered eating describes patterns of eating, exercise and thinking about food that cause distress or restriction without necessarily meeting the criteria for a diagnosed eating disorder. It includes rigid food rules, compensating for eating through exercise, and preoccupation with food or body shape. It exists on a continuum with diagnosed eating disorders.
How do I know if I have a problem with food?
The most useful question is how much freedom you have lost. If food, training or your appearance take up significant mental space, if more foods are becoming off limits, or if you avoid social situations because you cannot control the food, it is worth speaking to a professional. You do not need to look unwell for it to matter.
Can men get eating disorders?
Yes. The NHS is clear that anyone can develop an eating disorder. Men are widely recognised as under-diagnosed, partly because eating difficulties have been stereotyped as a female problem and partly because men more often compensate through exercise, which tends to be praised rather than questioned by those around them.
Is bigorexia a real condition?
Bigorexia is the common name for muscle dysmorphia, a preoccupation with not being sufficiently muscular or lean. It is recognised in DSM-5-TR and ICD-11 as a specifier of body dysmorphic disorder rather than a stand-alone diagnosis. NICE guideline CG31 covers the treatment of body dysmorphic disorder in the UK.
Is orthorexia an official diagnosis?
No. Orthorexia describes an intense preoccupation with eating food considered clean, pure or optimal, but it is not recognised in DSM-5-TR or ICD-11, and there is no agreed set of diagnostic criteria. The distress people describe is real, and it is often assessed and treated alongside other eating difficulties.
Written by Dr Bradley Powell, Clinical Psychologist and co-founder of Regal Private Therapy Practice. Dr Powell has a particular interest in men's mental health, body image, eating difficulties and the relationship between psychological wellbeing and physical fitness. He was formerly Vice Chair of a specialist male eating disorder charity and previously led one of the few dedicated male eating disorder support groups in London. BSc MSc PGDip (CBT) DClinPsy AFBPsS. Chartered Clinical Psychologist. BABCP-accredited CBT therapist. HCPC registration PYL044863.
Editing and web adaptation by Greg Anderson.
Clinically reviewed by Dr Bradley Powell, Clinical Psychologist
References
National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. NICE guideline NG69. Published 23 May 2017, last updated 16 December 2020. https://www.nice.org.uk/guidance/ng69
NHS. Eating disorders: overview. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/
Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behaviour Research and Therapy. 2003;41(5):509–528.
McNeil-Masuka J, Boyer TJ. Insensible Fluid Loss. StatPearls. NCBI Bookshelf. Last updated 25 July 2023. https://www.ncbi.nlm.nih.gov/books/NBK544219/
A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders. doi:10.1007/s40519-022-01512-5
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine. 2023;57(17):1073–1097. doi:10.1136/bjsports-2023-106994
Cooper M, et al. Muscle dysmorphia: a systematic and meta-analytic review of the literature to assess diagnostic validity. International Journal of Eating Disorders. 2020. doi:10.1002/eat.23349
National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. NICE guideline CG31. Published 29 November 2005. https://www.nice.org.uk/guidance/cg31
Foye U, Mycock G, Bartel H. "It's a Touchy Subject": Service Providers' Perspectives of Eating Disorders in Men and Boys. Journal of Contemporary Psychotherapy / SAGE. 2024. doi:10.1177/10608265231153087
