NEW YORK, N.Y. (WOWO) — Sylvester Stallone’s disclosure that he struggled with bulimia while preparing for his role in the 1982 movie “Rambo” is putting renewed attention on eating disorders among men, a problem specialists say can go undetected because symptoms often present differently than they do in women.
Stallone, 80, discussed his experience during an interview with The New York Times, explaining that his efforts to develop a more “animalistic” appearance for the film became an unhealthy fixation.
“It became an obsession. Really bad. It got to the point where I became bulimic,” Stallone said.
The actor’s disclosure comes as eating disorder specialists warn that some men are placing increasing pressure on themselves to achieve highly muscular or extremely lean physiques.
Brian Pollack, a licensed clinical social worker and certified eating disorders specialist at Hilltop Behavioral Health in Summit, New Jersey, told Fox News Digital that eating disorders among men are “highly underreported.”
The National Association of Anorexia Nervosa and Associated Disorders estimates that about 30 million Americans experience an eating disorder during their lifetime, with males making up roughly one-third of those cases.
Bulimia nervosa is characterized by repeated episodes of binge eating, in which someone consumes a large amount of food while feeling a loss of control, followed by behaviors intended to compensate for the calories consumed. The National Institute of Mental Health identifies vomiting, misuse of laxatives or diuretics, fasting and excessive exercise among possible compensatory behaviors.
Pollack said eating disorders can look different in men because body image concerns may center heavily on muscularity.
“Guys with eating disorders just present differently — for some men, it’s about musculature … they continue to build muscle because they are afraid that they are weak, they want their muscles to align,” Pollack told Fox News Digital.
Other men may pursue an extremely thin or defined physique and drastically restrict their food intake.
“We’re seeing this extreme need for perfection and musculature — and that is leading to bulimia right now,” Pollack said.
He said adolescent boys can be particularly vulnerable as they encounter messages online and elsewhere about what constitutes an ideal male body.
Social media trends can add another layer of pressure. Pollack pointed to the growing practice known as “looksmaxxing,” which involves efforts to improve one’s physical appearance, sometimes through extreme measures or cosmetic procedures.
He said some young men are becoming so focused on changing their appearance that the behavior can become harmful.
For families and friends, recognizing an eating disorder may be difficult because bingeing and purging frequently take place in secret.
“They’re hidden,” Pollack said. “People are ashamed of them at times.”
Pollack said warning signs can include compulsive exercise, increasingly rigid dietary rules and an intense preoccupation with body composition.
Some men may spend hours working out each day or meticulously track calories, protein and other aspects of their diets.
Others may become fixated on restrictive eating plans, including strict ketogenic diets, very high-protein diets or rules that allow only foods they consider “clean.”
In some cases, the restrictions can become so rigid that a person avoids food prepared by other people or refuses to eat outside a narrowly defined list of acceptable foods.
Pollack said severe restriction can also contribute to a cycle in which a person eventually binges and then attempts to compensate.
He described cases in which people eat large amounts of food after periods of restriction and then go to a bathroom shortly after the meal to purge.
Increasing use of laxatives or diuretics can be another warning sign, particularly if a person begins taking larger amounts in an effort to achieve the same perceived effect.
Pollack said eating disorders can affect males at virtually any age, from middle school and high school students to college students and adults.
“This is real, and men are afraid to talk about it,” he said. “There’s a real issue.”
The difficulty can be compounded by the way some men are socialized to handle emotional distress. Pollack said men may have trouble identifying or discussing the emotions underlying their behaviors, leaving families to notice physical or behavioral changes instead.
He recommends approaching the issue through conversations about body goals rather than immediately labeling someone’s behavior as an eating disorder.
Questions about whether someone is trying to “sculpt your body” or achieve a six-pack can provide an opening to discuss whether the pursuit has become excessive or is being used to avoid difficult emotions.
The medical consequences of bulimia can be severe.
“Just on a baseline level, with someone who purges, we see electrolyte imbalances, along with kidney and liver damage,” Pollack said.
He said he has also seen patients experience serious cardiac complications after prolonged malnutrition and repeated purging, including cardiac arrest.
Repeated vomiting can damage tooth enamel and result in significant dental problems. Purging can also contribute to esophageal problems, acid reflux and gastroesophageal reflux disease.
The potential consequences can range from chronic health problems to medical emergencies, making early recognition and treatment important.
“It’s a very serious scenario,” Pollack said.
Anyone experiencing recurrent binge eating, purging, severe food restriction, compulsive exercise or intense distress related to body shape or weight should consider talking with a qualified health care professional or eating disorder specialist.
