Brian Pollack, a licensed clinical social worker at Hilltop Behavioral Health in Summit, New Jersey, says bulimia among men is "highly underreported" but increasing due to extreme demands for musculature and perfection. The trend is particularly evident among adolescent boys who consume significant information about societal ideals of masculinity.
The issue gained visibility after Sylvester Stallone revealed in an interview with The New York Times that he developed bulimia while preparing for his role in the 1982 film "Rambo." The 80-year-old actor described an "obsession" with appearing "animalistic," inspired by jaguars and cats. He stated, "It became an obsession. Really bad. It got to the point where I became bulimic." Pollack, who has not treated Stallone, noted that the actor's disclosure aligns with a broader pattern of men struggling with body image.
According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), approximately 30 million Americans experience an eating disorder during their lifetime, with roughly one-third being male. The National Institute of Mental Health defines bulimia nervosa by episodes of binge eating followed by purging behaviors, such as vomiting, excessive use of laxatives or diuretics, fasting, or excessive exercise.
Pollack explains that men often present eating disorders differently than women. Some focus on building muscle out of a fear of weakness, while others seek to become extremely lean. He compares the current pressure on boys to the beauty ideals faced by girls in earlier decades. "We’re seeing this extreme need for perfection and musculature and that is leading to bulimia right now," Pollack told Fox News Digital. He highlighted a trend he calls "looksmaxxing," where young men harm themselves in pursuit of an ideal appearance, including undergoing cosmetic procedures to alter jawlines.
Societal expectations of masculinity can hinder men's ability to express vulnerability. Pollack notes that bulimia is fundamentally about control; binging involves a loss of control over food, while purging is an attempt to regain it. Because these behaviors are often hidden out of shame, they can be difficult for others to detect. Warning signs include purchasing increasing amounts of supplements like creatine or performance-enhancing substances such as human growth hormone. Men may also exhibit compulsive behaviors around exercise and diet, such as working out for multiple hours daily or strictly calculating food intake.
Some men adhere to restrictive eating patterns, such as strict ketogenic diets or consuming only "clean" organic foods. Pollack says some individuals engage in "cheat days" at fast-food restaurants to satisfy intense urges caused by restriction. He reports seeing people hide in bathrooms within 45 minutes after meals to purge. Another red flag is the escalating use of laxatives or diuretics as smaller doses lose their effect.
The health consequences are severe. Pollack states that purging can lead to electrolyte imbalances, kidney and liver damage, and cardiac arrest resulting from prolonged malnutrition and heart damage. Other medical issues include severe dental erosion requiring expensive work and esophagus problems like acid reflux and GERD. Pollack emphasizes that these disorders affect men from middle school through adulthood and urges observers to ask about body goals to help identify underlying emotional distress.