While the conversation about eating disorders typically focuses on women, new research suggests that men are affected far more often than we once realized.

Researchers at Boston Children’s Hospital studied the responses of 5,527 teenage boys from across the U.S. involved in the Growing Up Today Study. They found that 17.9 percent of them were extremely concerned about their weight and physique. Besides those troubles, those boys were more likely to engage in risky behavior like drug use and binge drinking.

Unlike girls, boys were more concerned with muscularity than being thin, with 9.2 percent of boys reporting high concerns with muscularity, compared with 2.5 percent concerned about thinness. About 2.9 percent of all boys questioned had full or partial criteria binge-eating disorder.

Nearly one-third of the boys admitted to infrequent binge eating, purging, or overeating.

Benjamin O’Keefe, a 19-year-old actor and public speaker, knows those feelings all too well. Growing up as a 6-foot, 3-inch tall “rich, poor, gay kid,” he developed anorexia during high school after struggling with his weight. When he began losing weight, people began complimenting his appearance.

“That reassurance tells you that what you’re doing is working. You really start feeling beautiful,” he said. “Often with an eating disorder, you don’t think in your head that anything is wrong, and when you get that reassurance from other people, it’s hard to see the problem with it.”

During a dress rehearsal for the musical Hair, O’Keefe passed out and his castmates noticed he never ate. The rehearsal was cut short until he agreed to eat something.

“It was the wake-up call I needed,” he said. “Having an eating disorder goes hand-in-hand with other problems, like depression and anxiety, which I already had.”

An Under- and Unreported Problem

Leigh Cohn, author of Current Findings on Males with Eating Disorders and Making Weight, said close to 40 percent of young men have an eating disorder and may be too scared to admit it if they’re even aware of it in the first place.

“Men are exercising because they think it’s healthy, but they don’t know enough about metabolism and nutritional value,” he said.

The disorders begin, Cohn said, simply by not having a firm grasp of how food and nutrition work. He said it’s not uncommon for boys concerned with their looks to overexert themselves through exercise and to not eat enough to compensate. Coupled with teasing and bullying because of potential weight problems, this habit can turn into exercise addiction.

“There’s a stigma on eating disorders, and there’s a greater stigma on men because they believe they have a woman’s disease. It’s emasculating,” Cohn said. “The biggest issue right now in the eating disorders field, in my opinion, is de-stigmatizing male eating disorders.”

While women are more prone to binging and purging to lose weight, men’s eating disorders often revolve around being muscular while still remaining lean.

“That’s like the same scenario as the woman who wants to be voluptuous and thin at the same time,” Cohn said. “For the average person, that’s unrealistic.”

An eating disorder is defined, regardless of gender, as excessive weight focus to the point that a person is thinking about food and weight to an unhealthy degree.

“If you’re a man who weighs himself five or six times a day or you go on binges and feel bad about them later and purge, these are all warning signs,” Cohn said.

Breaking the Stigma and Getting Help

Cohn regularly leads men’s groups related to eating disorders. In those seven-member groups, nearly all experienced some form of weight-based teasing that made them reevaluate their self-image. This, among other things, contributed to their disorders.

It’s normal for teenage boys to have extra body fat that is typically lost in the late teens and early 20s, but a new social focus on childhood obesity is leading to an increase in eating disorders among boys and young men, Cohn said.

Education, he said, is the key to curbing the problem.

“Males, in general, know less about nutrition in general than females. The lack of knowledge is a big problem,” he said. “Confounding the problem is this war on obesity, especially childhood obesity.”

Men, just like women, are often bombarded with images of low body fat men with rippling muscles that take years of disciplined training to achieve. This focus on looks needs to change for both genders in order for a person to be happy with his or her body, O’Keefe said.

“It’s not about the size of your weight, but it’s the size of your heart and the length of your ambition,” he said. “It’s one thing to say it, and it’s another thing to believe it. The bravest thing you can do in life is to allow yourself to be weak.