Celebrating psychology in the Midlands: Eating, exercise, and body image care: This is (not?) a man’s world

My name is George, I am a lived experience researcher and PhD candidate at the University of Worcester. For my PhD, I am doing what I have recently heard being called 'me-search' (a term I love) as a man who experienced severe distress on account of eating, exercise, and body image psychopathology (EEBIP). 

Despite my outward symptoms and multiple instances of telling my GP about my ruminating thoughts, I never received formal EEBIP-focused care. In fact, I frequently had my experiences minimised by clinicians who would often reassure me that I looked 'strong' and 'capable' of overcoming these struggles. I hope that introducing my positionality contextualises the focus of my PhD and my goal to initiate change in healthcare services.

I had the pleasure of attending the morning of the BPS 'Celebrating psychology in the Midlands' conference 2024. I say 'the morning of' as despite coming prepared with poster in hand and talk firmly drilled into my brain, what I couldn't prepare for was the illness that struck me and gradually grew during my train ride over. Luckily, I found myself in a welcoming space where I was able to present and take questions while feeling supported by the audience and our excellent chair, Dr Charlotte Scott. Below I describe the work that was encompassed within my poster and my talk, this time without the nasally 'sick voice'.

These studies are a part of my PhD, which aims to investigate potential reasons underlying repeated evidence that men living with EEBIP regularly do not access relevant healthcare. I hope my PhD findings will highlight key areas for strategic, targeted, development within EEBIP related healthcare organisations (services and charities), alongside some co-produced resources to address those areas. 

Barriers and facilitators to/of men's EEBIP help-seeking

To begin the PhD, I wanted to understand what researchers believe to be the barriers and facilitators to men's formal help-seeking for EEBIP. Alongside my supervisors (Dr Christian Edwards, Dr Una Foye, Professor Győző Molnár), I undertook a systematic review which reviewed men's EEBIP-related help-seeking research and summarised both barriers to and facilitators of EEBIP-related help-seeking. 

The review highlighted six barriers and two facilitators, alongside concerns with the amount of available research (e.g. no studies looked at help-seeking for muscle dysmorphia, despite many reports of men being an at-risk group). The barriers suggest that men, their social circles, and wider western society label EEBIP as a 'women's issue', that men see their EEBIP behaviours as beneficial to their lives, and that men do not feel included by EEBIP healthcare organisations which lack inclusive resources. 

The two facilitators highlight the influence of critical life events (e.g. being hospitalised by symptoms or experiencing a loss of control) in raising men's awareness of the negative impact of EEBIP and the role of family, peers, and/or romantic partners in encouraging help-seeking. 

Something's wrong, but what?

The review highlighted numerous accounts of men stating that the EEBIP healthcare 'system' was not set up to help them, and that the resources available for those experiencing EEBIP reflect this. However, no research outlined what it is within healthcare policy and resources that led to these views. 

This inspired my second study, which collected outreach documents (posters, leaflets, etc.), webpages (homepages and pages that listed EEBIP symptoms), referral policies (in/exclusion criteria), and patient welcome packs (information booklets given to those beginning care with a service) from EEBIP-related healthcare organisations (eating disorder services and EEBIP charities). Alongside my supervisors, I undertook a latent pattern content analysis of the text and images within these documents, looking to undercover masculine, feminine, or gender-neutral images and in/exclusive language and/or symptom information towards men and those experiencing muscularity-oriented EEBIP. Muscularity-oriented symptoms were specified as they are often linked to men due to muscular masculine body image ideals. It is noted that muscularity concerns are certainly not exclusive to men.

This is (not) a man's world – Content analysis findings

Imagery:

The content analysis study revealed that although most imagery was neutral of gender (54 per cent), the images reflecting a stereotypical gendered perception were mostly feminine (38 per cent of the total images vs 8 per cent masculine). Furthermore, analysis of the content within images (e.g. the number of instances of a masculine-presenting person located within an image) found that 73 per cent of true-life images were photos of feminine-presenting people, with 22 per cent being masculine-presenting. Interestingly, the only area of images that was predominantly masculine were illustrations of people, where 54 per cent were masculine-presenting compared to 35 per cent feminine-presenting.

Text:

We found generally inclusive text within internal documents (policy and patient welcome packs) which provided mostly gender and symptom inclusive policy and provided information predominantly in a task-oriented manner (providing structured information of goals and skills obtained) which has previously been suggested as more inviting to men (Seidler et al., 2018).

The text within outward facing documents (outreach document and webpages) was more concerning, although the documents were mostly neutral in the use of pronouns and identity markers. Outreach documents failed to mention any muscularity-oriented symptom markers (e.g. excessive weightlifting), despite 12 mentions, across five of 15 documents, of exclusively thinness oriented markers (e.g. drive for thinness). Within webpages, exclusively muscularity-oriented markers were mentioned 15 times across five of 46 pages, which is much less than the 42 mentions across 13 pages of exclusively thinness-oriented markers. 

Together these findings highlight imagery and some outreach information as potential contributors to the view that EEBIP healthcare services are not tailored to men. These may be targeted by relevant organisations seeking to improve inclusion.

Future thoughts

Moving forward, my next study is looking to uncover the knowledge and perceptions of men's EEBIP, and muscularity oriented EEBIP, within staff who work in EEBIP healthcare organisations. Understanding this can help paint a clearer picture of the barriers to men seeking help for EEBIP and guide development of staff training and/or protocol updates. Finally, I hope to work with men with lived experience of EEBIP to explore their desires for future resources, and to co-produce resources that can be used by organisations moving forward.

References/Further Reading:

Seidler, Z. E., Rice, S. M., Ogrodniczuk, J. S., Oliffe, J. L., & Dhillon, H. M. (2018). Engaging Men in Psychological Treatment: A Scoping Review. American Journal of Men's Health, 12(6), 1882–1900. https://doi.org/10.1177/1557988318792157