Body Image in Gay Men: When and How to Intervene

The occurrence of eating disorders is 3 times higher in gay men than in straight men, and nearly 15% of all gay men report dealing with anorexia or bulimia during their lifetime.¹ However, most discussions about eating disorders, body dysmorphia, and poor body image center on the experiences of women and girls, leaving gaps in today’s mental health intervention strategies. 

Why Gay Men?

Gay men and straight women experience similar pressure through media portrayals of unattainable standards of beauty. Photographs of women are airbrushed to glamorize unhealthy thinness, while gay men are compared with muscular Adonises with 6-pack abs and no body fat. Michael Everett, MHS, an HIV educator and chief executive officer of Intimacy and Colour in Riverside, Georgia, explains: “Even within public health, the ads geared toward gay men present images of muscled men with small waistlines, which is impossible for every gay man to live up to and is not the only representation of good health.” 

These societal standards bleed over into a sexualized subculture that places a premium on muscularity and masculinity. It can be witnessed in the ads on popular gay men’s hookup apps like Grindr, where many profiles specify, “No Asians or Fems,” creating a tangible hierarchy of physical desirability. Whiteness, low-body fat, physical height, muscles, and masculine features are prized, while darker skin, slight stature, and feminine affectation are ridiculed.

This hierarchy echoes societal issues of homophobia, racism, and misogyny that gay men, especially gay femme men and gay men of color, must contend with on a daily basis. The oppression of gay men — including societal ridicule and family rejection — frequently leads to feelings of inadequacy and inferiority. In response, manipulation of weight, muscles, and physical appearance can become an object of fixation, as an element of oppression that the individual can control.

“For so long, I starved and drugged my body, offered it to the highest bidder because I was running from this pain — this idea that I was not correct as I was,” Jamal Jones, a queer person of color (QPOC) activist and case manager at Friendship Place in Washington DC, said. “There’s a lot of assimilation that happens in our communities. Folks want to be desired and accepted. Unfortunately queer male communities have adopted…a very white and very superficial way of viewing the body.”

Everett notes that the disproportionate prevalence of HIV in the gay male community reinforces this pressure to present as a powerful, healthy man, in direct contrast to the stereotype of an emaciated patient with HIV. Within the community, “a high value is placed on the perception of good health, which is aligned with a negative HIV status.”

Eating Disorders, Bigorexia, and More

Body image issues can manifest in a variety of behaviors in gay men. Some men restrict calories, abuse laxatives and diet pills, or binge-and-purge food, in cycles that mirror traditional anorexia nervosa and bulimia. On the opposite end of the spectrum, some gay men focus on increasing muscle mass by lifting weights and following an exercise schedule that exceeds their body’s ability to adapt.

Muscle dysmorphia, sometimes colloquially called “bigorexia,” can lead to serious health challenges, including stress fractures when the bones cannot support the pressure of muscular contractions. Even more troubling, some men develop rhabdomyolysis, which can lead to renal failure, resulting from the death of overworked or damaged muscle fibers. All of these issues can be compounded by anabolic steroid use, which is nearly 6 times higher in gay and bisexual adolescents as their straight counterparts.²