“Hidden” eating disorder in older men going undiagnosed, says Priory expert

Binge eating disorder is rising in men over 50 but often goes unrecognised, according to a leading eating disorder specialist.

Dr Eileen Feeney, a Priory consultant psychiatrist specialising in eating disorders, said: “All forms of mental health problems have been on the rise during lockdown, and binge eating disorder is no exception.” In 2020, The Priory Group saw a 26.09% increase in the number of enquiries it received regarding treatment for the condition at its private clinics, compared to 2019.

Dr Feeney’s comments coincide with Eating Disorder Awareness Week, March 1 – 7. 

There is little public awareness around binge eating disorder (BED), which was only recognised as a separate condition in 2013. Experts believe many people may be suffering with the illness without realising. 

Beat, the UK’s leading eating disorder charity, have chosen BED as their theme for Eating Disorder Awareness Week. The campaign features the hashtag #YouMightKnowMe, based on their estimate that 1 in 50 people are currently struggling with the condition.

Dr Feeney, who practices at Priory’s Life Works facility in Surrey, believes the condition is often missed in men. “Most of the other eating disorders are predominantly female,” explained Dr Feeney, “which means the condition is sometimes hidden among men. It’s definitely under-recognised,” she added.

According to The Priory Group, BED is characterised by episodes of out of control eating rather than consistently overeating on a regular basis. It involves repeatedly eating a lot of food in a short space of time, until a person is uncomfortably full. Doing so can trigger feelings of guilt or shame, and the binges often happen alone.

A survey conducted by Beat as part of Eating Disorder Awareness Week, highlights the hidden nature of the illness, stating 61.4% of participants did not attend a special occasion due to their binge eating disorder.

Simon, 51, from St Albans, said he has always “eaten his feelings”, but only realised he had a serious problem 14 months ago whilst during an argument with his wife, he reached for the fridge and started filling his mouth with food unknowingly.

“That scared the hell out of me,” he said. “It’s the first time I recognised it. It was so unconscious.”

Simon, a member of Overeaters Anonymous, said his binge eating made him want to isolate. He said in the past his reaction to overwhelming feelings could be to go to the shop and eat five chocolate bars. “That would make me just want to be on my own even more, not talk to my family and just hide away.” He said he would always conceal his bingeing in the house – especially from his children. “I didn’t want to set an example that this was normal behaviour,” he said.

The origins of eating disorders in adults are complex and likely to be caused by deeper emotional issues. They can be triggered by job loss, divorce or bereavement or have their origins in childhood. Dr Feeney said older men sometimes suffer from BED if they drink a lot and have tried to cut down. 

Alan, a 59-year-old English language teacher from Yorkshire, said food became an issue for him in his early 20s, during a period he felt lonely and isolated working abroad. He said food has always been a coping mechanism during emotionally traumatic times and classes himself a food ‘addict’. 

Talking about his compulsive eating, Alan said: “On some level I do know that when I’m behaving like that I’m ashamed of myself – that I’m frightened – because I just can’t stop doing this thing.”

“People think that it’s about self-control and willpower, moral fibre, and it’s not. Once you’re addicted it’s about having absolutely no control over this thing,” he said.

The Priory Group believes that lockdown has increased the risks of BED. Dr Feeney said being indoors means more opportunity for binge eating, combined sometimes with the boredom of having little else to do. “Simply being nearer the kitchen is a risk factor, as is the opportunity to order massive numbers of takeaways,” she said.

Rebecca Willgress, Head of Communications at Beat, said calls to their helpline have increased during lockdown with a lot of people who struggle with binge eating finding it increasingly difficult. “People are shopping less. We’re being encouraged to do the big weekly shop – rather than going once or twice a week. So there’s more food in the house and that can be particularly triggering,” she said.

However, those with lived experience say the impact of lockdown is nuanced. Alan, who follows a 12-step recovery programme with OA, said lockdown has made it a lot easier for him to control his eating. “It was much more ordered. It was very simple,” he said. Alan has a sponsor who he sends his daily meal plans to. He said not being able to go to restaurants and coffee shops during lockdown has helped him maintain control.

So why do experts believe binge eating is going undiagnosed? One reason is the lack of public awareness. Many men will not know BED is a condition – let alone that treatment exists.

Richie Cartwright is a Co-founder of tech startup Fella, an organisation which supports men who struggle with binge eating. Richie, 26, from London, set up Fella as a result of his own experience with the condition which at times “totally dominated” his life. 

Richie first noticed he had an emotional attachment to food when he was 19, though he said the problem significantly worsened at 24. He said: “I was stressed at the time. Deeply so. I thought my first company had failed. I was a year out of uni, not sure what I was doing with my life and that’s when it spilled over.” He said that was the first time he googled his behaviour.

At first he thought his binge eating was an internal thing that he “just needed to tackle” – and not an external condition. “I’d probably been dieting since the age of 13 and I’d never once typed in ‘what is this thing I do where I eat loads of food and I feel out of control?’” He said the NHS page jumped out at him.

“I thought – that’s me, but it’s crazy. It says eating disorder? I, as a bloke, obviously couldn’t have an eating disorder. That’s out the window – it must be something else.” 

In 2020 singer Ed Sheeran admitted to struggling with binge eating during his 2014-15 ‘X’ tour – though the condition is rarely in the public eye. Richie said: “The interesting thing is there aren’t even Instagram influencers” – which he said there are for women who binge eat. “Why is there none of that for guys?” he asked. 

According to Richie, some men who come to Fella have previously found themselves the only man in group therapy which could be off-putting. He said instead, men who struggle with binge eating are turning to the internet for support in online communities rather than looking to more traditional healthcare services. 

Fella provides cognitive behavioural therapy through an online programme and a peer-to-peer community for men to support one another.

“I guess inherently in the condition, because it is so quiet, behind doors, stigmatised – whatever you want to call it – it has to be on the internet and anonymous. There’s no other place to go,” he said. 

The condition can often go unrecognised because men who binge eat are not always overweight. Simon said: “I’m a really good example of someone who has binge eaten all his life and looks healthy.” He said that when he told friends he was going to OA they responded: “What? But you’re not fat? He said: “That’s just people’s instant reaction. They think to be an overeater you’ve got to be overweight, and that’s just not the case at all.” Simon said there are different ways people with BED regulate their weight such as over-exercising and periods of either healthy or restrictive eating.

Specialists say that BED is not taken as seriously as anorexia or bulimia. In a recent survey conducted by Beat, almost half of respondents felt they were not taken seriously when they sought professional help.

Rebecca Willgress from Beat said people may think, “he’s just being greedy”, but she said the helplessness when people start to binge makes it clear that BED is a real disorder which hugely impacts people’s lives.

Those with lived experience also report a sense of shame attached both to the illness itself, and the stigmatisation of men with eating disorders.

Ms Willgress said a lot of people with BED call their helpline who are fearful they will be “fat-shamed”. “People say it’s very hard to talk about it with their friends and family because they’re afraid they’ll just make them feel more shameful about what’s going on,” she added.  

Beat estimates that, of the 1.25 million people with eating disorders in the UK, a quarter are male. 

Ms Willgress believes that men face additional challenges to women when it comes to finding treatment and support – starting with initially asking for help. She said often men over 50 will have a family themselves.

“They might feel they’re supposed to be the centre of the family – that they’re the strong one and shouldn’t be having this issue,” she said. 

According to Richie Cartwright, the hidden nature of binge eating partly derives from a gendered response. “It’s this classic masculine thing that guys don’t talk about stuff. 80% of the guys we help haven’t spoken to any single other human about this.” 

Dr Feeney from Priory Group believes part of the problem with men going undiagnosed is that GPs don’t recognise the symptoms. Dr Feeney said that in some cases “very overweight” men can seek help from their GP, but “the awareness isn’t there for GPs to ask the extra questions on top of the usual cardiovascular examination of the patient – and the condition can get missed.” 

Dr Dan Bunstone, the Chief Medical Officer at Push Doctor, said BED is a complex condition to diagnose.

Dr Bunstone, also an NHS GP, said: “As with all medical issues, particularly ‘hidden disorders’ like this, it relies on the patient recognising there is an issue in the first place, and subsequently seeking help.”

“The ability to diagnose is an important step,” said Dr Bunstone, “but equally as critical is raising patient awareness.” He said the number of patients – and particularly men – seeking help for BED is low. Though he thinks this can change if there are more pairs of eyes looking out for the signs and symptoms. He said if friends, relatives and healthcare professionals are able to flag when there could be an issue, they can make sure those suffering get the help and support they need.

According to Dr Bunstone, GPs are working hard to understand the condition more. He said all GPs are now required to complete at least fifty hours per year learning about advances within medicine.

Richie said he feels “driven” when he thinks of the number of men who may be struggling with this undiagnosed condition. “I think we’ve got a lot of work to do. I think it’s very exciting. We’re in this crucial zeitgeist moment where suddenly we’re becoming way more comfortable sharing these inner turmoils, and I think that’s powerful,” he said.

Rebecca Willgress believes people with BED can get better. “The sooner they can speak out and talk about it, the quicker that process is going to be,” she said.

There are different support options available for people struggling with BED: a GP or self-referral to a specialist like The Priory Group or Beat, CBT or a 12-step fellowship programme, amongst others. 

A year into his recovery, Alan says most of the time he has peace about food. Whereas before joining OA he said he felt helpless, depressed and desperate, now, he said: “I enjoy every day. I enjoy most parts of the day. Life is very different from what it was – I have hope.”

*Some interviewee names have been changed due to the anonymity of their recovery programmes.